Care Home: The Westbury Nursing Home

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What the care home does well There is detailed information about what the home has to offer, and the admission of new people in to this home is well managed. This means that people will know what to expect from The Westbury Nursing Home. People who live here will be well looked after and will have their specific care needs met in the way that they wish. Their needs for privacy and dignity will be respected. Medication procedures are well managed and are safe The Westbury will make sure that people`s social care needs are met by providing a range of meaningful activities and events. Visits from family, friends and outside organisations are encouraged. People will be provided with a well balanced and nutritious diet, and the meals are well cooked and nicely presented. The people who live here can be assured that any complaints or concerns they may have will be listened to and acted upon. They will be cared for by staff who will safeguard and protect them from coming to any harm.The Westbury Nursing HomeDS0000020344.V376280.R01.S.docVersion 5.2The Westbury Nursing Home is a very comfortable and well furnished home. It is fully equipped to meet the needs of the people who live there, is clean tidy and fresh smelling. The people who live in The Westbury will be cared for by staff who are skilled and competent to do their jobs. They are well trained and this means that people can be assured that their needs will be met. The Westbury Nursing Home is well managed and is run for the benefit of the people who live there. It is safe and the welfare of both people who live there, and the staff team is promoted. What has improved since the last inspection? Only one requirement was made after the last inspection and this has been complied with. The home were required to improve the ventilation in the communal area`s to make them a more comfortable temperature in the warmer weather. Large ceiling fans and walls one and one air conditioning unit has been installed. On the day of the inspection the home was warm but the weather outside was exceptionally hot. What the care home could do better: It has not been necessary to issue any requirements as a result of this inspection. One recommendation has been made about the way that end of life decisions are recorded. They must be much clearer and indicate the person`s wishes and evidence consultation with the GP and family members Key inspection report CARE HOMES FOR OLDER PEOPLE The Westbury Nursing Home Falcondale Road Westbury On Trym Bristol BS9 3JH Lead Inspector Vanessa Carter Unannounced Inspection 30th June and 1st July 2009 09:30 DS0000020344.V376280.R01.S.do c Version 5.2 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. The Westbury Nursing Home DS0000020344.V376280.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 The Westbury Nursing Home DS0000020344.V376280.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Westbury Nursing Home Address Falcondale Road Westbury On Trym Bristol BS9 3JH 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) 0117 907 9971 0117 9146665 moirapayne@btconnect.com Westbury Care Limited Mrs Penelope Anne Brown Care Home 73 Category(ies) of Old age, not falling within any other category registration, with number (73) of places The Westbury Nursing Home DS0000020344.V376280.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 73. 20th June 2007 Date of last inspection Brief Description of the Service: Westbury Nursing Home is operated by Westbury Care Limited. The home is privately run and provides accommodation for 73 people who require nursing care. Accommodation is provided on three floors. The home has 67 single rooms with en suite facilities and four shared rooms with en suite facilities. The home is set within its own grounds and is within a short walking distance from the village of Westbury on Trym. There are local shops and amenities nearby plus a bus route into the City centre. At the time of this inspection, the cost per week to reside at Westbury Nursing Home ranges from £550 - £710 and will be based upon individuals assessed needs. Fees are reviewed annually and if care needs increase. This weekly fee does not include provision for items such as hairdressing, chiropody, dental, ophthalmic, or audiology services. People who wish to know what Westbury Nursing Home has to offer can be provided with information about the home by accessing the Service Users Guide, which will detail the services and facilities available at the home. The Westbury Nursing Home DS0000020344.V376280.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 3 star. This means the people who use this service experience excellent quality outcomes. This key inspection was unannounced and took place over two days. A total of 10 hours were spent in the home. Evidence to form the report has been gathered from a number of sources:• Information provided by the Home Manager in the Annual Quality Assurance Assessment (AQAA) • Information supplied in Care Quality Commission survey forms, completed by people who live in the home (7) and staff (3) • Talking with the Home Manager and the Group Manager • Talking with registered nurses, care staff and ancillary staff • Observations of staff practices and their interaction with the people who live in the home • A tour of the home • Case Tracking the care of a number of people • Talking with a number of the people who live in the home • Talking with a number of visitors to the home • Looking at some of the homes records What the service does well: There is detailed information about what the home has to offer, and the admission of new people in to this home is well managed. This means that people will know what to expect from The Westbury Nursing Home. People who live here will be well looked after and will have their specific care needs met in the way that they wish. Their needs for privacy and dignity will be respected. Medication procedures are well managed and are safe The Westbury will make sure that people’s social care needs are met by providing a range of meaningful activities and events. Visits from family, friends and outside organisations are encouraged. People will be provided with a well balanced and nutritious diet, and the meals are well cooked and nicely presented. The people who live here can be assured that any complaints or concerns they may have will be listened to and acted upon. They will be cared for by staff who will safeguard and protect them from coming to any harm. The Westbury Nursing Home DS0000020344.V376280.R01.S.doc Version 5.2 Page 6 The Westbury Nursing Home is a very comfortable and well furnished home. It is fully equipped to meet the needs of the people who live there, is clean tidy and fresh smelling. The people who live in The Westbury will be cared for by staff who are skilled and competent to do their jobs. They are well trained and this means that people can be assured that their needs will be met. The Westbury Nursing Home is well managed and is run for the benefit of the people who live there. It is safe and the welfare of both people who live there, and the staff team is promoted. What has improved since the last inspection? What they could do better: 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. The Westbury Nursing Home DS0000020344.V376280.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 The Westbury Nursing Home DS0000020344.V376280.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4. 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. There is detailed information about what the home has to offer, and the admission of new people in to this home is well managed. This means that people will know what to expect from The Westbury Nursing Home. EVIDENCE: The statement of purpose and service user guide is up to date and is reflective of the service and facilities available at The Westbury Nursing Home. A copy of the document is kept in the main reception area along with a copy of the previous inspection report. The service user guide is given out to people who enquire about the home and who live in the home. The seven people who completed our survey forms said that they had received enough information The Westbury Nursing Home DS0000020344.V376280.R01.S.doc Version 5.2 Page 9 about the home to enable them to make a decision that the home was the right place for them. Every person who stays in this home will be provided with a statement of terms and conditions, referred to as the Nursing Care Agreement. A schedule of payments will also be produced which will detail who is paying what towards the costs of the weekly fee’s. Of the seven people who completed our survey forms, six said that they had received a ‘contract’. One person spoken with during the inspection said that their relative had dealt with all financial matters when they had moved in. No person will be admitted to the home without having first had their care needs assessed, to ensure that the home can meet their specific care needs. An assessment visit will be made by the home manager or a competent member of staff, to either the person’s own home or the hospital ward. Where appropriate additional information will be gathered from health and social care personnel, so that as much information as possible is gained about the person’s needs. A ‘Client Needs Assessment’ will be completed and includes information about the person’s past medical history, current medications, and a profile of their current needs and their family set up. We saw two such assessments that had recently been completed – the document is comprehensive and covers the full range of physical, mental, emotional and social needs. This assessment is used as the basis for the care planning documentation that is then prepared for each person. The home provides placement for up to 73 people who have nursing care needs. We were told that many of the people who come to live at The Westbury are recommended by word of mouth or by introductions from social and healthcare professionals. The home looks after many people who have attracted continuing healthcare funding and have palliative care needs. The home maintains high occupancy levels and any vacancies will be filled quickly. This is because the home has good reputation. The Westbury Nursing Home DS0000020344.V376280.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live here will be well looked after and will have their specific care needs met in the way that they wish. Their needs for privacy and dignity will be respected. Medication procedures are well managed and are safe. EVIDENCE: A plan of care is prepared for each individual person upon admission to the home and this is based upon the ‘client needs assessment’. The specific needs of the person are set out with instructions for the staff on how these needs are to be met. It is evident that people are consulted in this process and their views and expectations are incorporated in to the plan of care. We looked at the care plans that had been prepared for five randomly selected people. The plans were detailed and informative and included information about people’s personal preferences. It was evident that the plans had been prepared in The Westbury Nursing Home DS0000020344.V376280.R01.S.doc Version 5.2 Page 11 conjunction with the person and others relevant to their care. Two separate visitors who were spoken with during the inspection, said that they had been consulted with about their relatives care and “there was a real sense that the staff want to care for the person as an individual”. Care delivery arrangements are reviewed on a monthly basis and a record of the meeting is made, including who attended and what decisions were made. All in all the plans were up to date, and minor changes were promptly made to some of the plans, at our suggestion. In addition to the care plans a number of screening and risk assessments are undertaken – manual handling, nutrition, falls and the likelihood of developing pressure sores. As a result of the manual handling risk assessment, the level of risk involved with any moving and handling procedure is determined, and a safe system of work is devised. We suggest that this includes details about what size slings are to be used with hoisting equipment. This will ensure people’s safety is maintained – this was acted upon during the inspection and again evidences that this service wants to get everything right. A copy of this safe system of work is kept in each person’s bedroom – one member of staff spoken with said they would check the document after any time off, to ensure that no changes have been made in how a person is moved. A daily record is kept for each person. The notes were detailed and respectful and it was possible to see what care each person had received. Good accounts of any significant events are made and it was easy to track what actions the nursing staff had taken as a result of any medical needs. “I am very well looked after”, “I congratulate Westbury on the care of my relative, he has greatly improved, because of the superb nursing care, good food and impressive caring ethos” and “ I have been here one year, I am all settled in and very pleased with how well I am looked after”, were just some of the very positive comments received about this home, during the course of the inspection. Contained within each person’s care plan there is a record of contact with GP’s or other health care professionals. We saw that people are visited by chiropodists, physiotherapists, nurse assessors from the PCT regarding health funding, dentists, opticians and hospice nurses. People will be registered with a new local GP if necessary and this will be acted upon on admission to the home. We were told that most people are registered with one GP practice and a visit to the home is made by this GP on a weekly basis plus as needed. Other GP’s are called in as and when required, and people spoken with confirmed that they see their doctor when they need to. We asked about the prevalence of pressure sores and were told that at the current time there are two people with pressure sores but both were admitted to the home with them. There are seven other people who have other wounds that need dressing. A Wound Assessment and Treatment Plan will be prepared for each wound, and wounds are photographed, measured and mapped. The The Westbury Nursing Home DS0000020344.V376280.R01.S.doc Version 5.2 Page 12 plan will include details about the dressing products to be used and the frequency for the wound to be redressed. An evaluation record is made so that the nursing staff can monitor progress or deterioration. We could see that the home have sought the advice of the GP and a specialist Tissue Viability Nurse where needed. We saw that appropriate pressure prevention equipment is being used where this is needed, and that nutritional intake is monitored and positional changes are undertaken and recorded as a means of supporting the healing process. We discussed medications with a registered nurse on the first floor and were told that the same procedures are in place on the ground floor. There are well managed systems in place for the ordering, receipt, storage and disposal of medications. The bulk of tablets are dispensed by the pharmacist in blister packs, but where tablets are dispensed in bottles or packets, the date that the supply is opened is recorded – this means that people will not receive medications that have gone past their best-by-date. Oxygen cylinders are stored in a locked cabinet outside and where oxygen is in use in the home, appropriate warning signage is in place. People spoken with during the inspection confirmed that they were well looked after and that they received all the care and support that they needed. We observed the interaction between the staff, the management team, people who live in the home and visitors – there was a great deal of camaraderie and friendship shown and it was evident that the staff are genuine in their care for the people they are looking after. One visitor said “the staff are considerate, when we leave here we know Mum is being well looked after”, and another relative said “this is the best possible place for my mother, and I do enjoy visiting”. One person who visits on a daily basis, said that the staff “care about me too and that makes my relative content”. The home will continue to look after people who are dying and those who have palliative care needs. They work closely with St Peter’s Hospice nurses and often admit people to the home who are eligible for full nursing care funding. All registered nurses are competent in setting up and monitoring syringe drivers so that medication to assist with pain relief can be administered by this route when prescribed by the GP. We were told that the home receives many compliments from bereaved relatives after their loved ones have died. The home manager and a number of other staff are currently involved in the St Peter’s Hospice “End of Live project with other care services – this means that the home can follow best practice and ensure that people will have a ‘good and comfortable death’. This is commendable. We saw that people are asked what their individual end of life issues. For some people this included a ‘do not resuscitate’ decision. In one example seen, it appeared that this was a decision made by relatives. These records must evidence what the person’s wishes are where appropriate, and must evidence as being agreed by the GP, in conjunction with the person, family and the home. The Westbury Nursing Home DS0000020344.V376280.R01.S.doc Version 5.2 Page 13 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Westbury will make sure that people’s social care needs are met by providing a range of meaningful activities and events. Visits from family, friends and outside organisations are encouraged. People will be provided with a well balanced and nutritious diet, and the meals are well cooked and nicely presented. EVIDENCE: The Westbury employs three activity therapists and two of them have recently completed a Creative Activity Therapy training programme with the national open college network. One of the therapists told us that this included dementia awareness, reminiscence and planning activities. Activities are arranged at the weekends as well as during the week. The homes philosophy is for people to continue to lead a meaningful live and in order to achieve this, they find out as much as possible about each person’s previous life. A social assessment is recorded so that the staff team know what people like to do and The Westbury Nursing Home DS0000020344.V376280.R01.S.doc Version 5.2 Page 14 what activities they would like to see arranged. The care staff are included in any of the activities that are arranged so that they can understand the importance of social and emotional fulfilment, in meetings people’s ‘holistic’ needs. We were told that theme weeks are often arranged. This may be in connections with religious celebrations or national sports events. The theme during the week of the inspection was “The Seaside” and the main lounge and dining room was decked out with bunting, kites, and other items connected to the beach. A punch and judy show had been arranged for mid morning and ice creams were served after this. On day two, a cream tea was served in the afternoon. We were told that some people will be going out on a trip to the seaside soon, but for those who were unable to go, the beach had been brought to them. A harpist visits the home on a fortnightly basis and a musician who plays the keyboard visits monthly. Examples of other things that are arranged include reminiscence therapy, armchair travel sessions, visits from the church and communion, and an art tutor visits each Thursday. We were told that they have recently introduced a “Make a Wish” programme and that one person wanted an art exhibition and three people wanted to visit the zoo. In the dining room there was a display of framed art work, done by people who live in the home. The trip to Bristol Zoo was in the process of being arranged. Family visitors told us that the staff were always very helpful is getting their relative ready to receive communion, an activity that was very important to them. People who completed our survey forms or were spoken with during the inspection made the following comments – “there is always something going on, I love the bingo”, “I enjoy some of the activities especially if music is involved” and “our relative has been out on trips when well enough and thoroughly enjoys time spent with the carers”. Birthdays will always be celebrated with a cake and a sing along. A number of people spoken with during the inspection told us that they preferred to spend their time in their rooms reading or watching television but would always be told what is going on. It is evident that people are able to choose how to spend their time. There is an open arrangement for visitors and relatives and friends are able to call at any reasonable time. One relative said “I visit everyday and I am always welcomed and offered refreshments. I have lunch with my relative each day and I pay for this. It is a very satisfactory arrangement”. We were told that the local primary school will visit the home and put on plays and concerts and that people “love seeing all the children perform”. We met with the catering manager who told us “today’s meal is in line with a trip to the seaside. We are serving fish and chips”. Meals are served from the two kitchenettes, with food having been delivered there in hot trolleys. The meals are served out by catering staff and there is a choice of two main meals each lunch-time. Some people will choose to have their meals served in their own rooms. We joined a group of people for the midday meal on the first day of the inspection. Battered fish or steamed fish was served with chips, The Westbury Nursing Home DS0000020344.V376280.R01.S.doc Version 5.2 Page 15 creamed potatoes and garden pea’s, followed by ice cream or fresh fruit salad. For supper time there is generally a selection of sandwiches or a hot snack meal provided. The menus offer a wide variety of choices and can cater for specific dietary and cultural needs – alternatives to the two daily options can be provided upon request. Of the seven people who completed our survey forms, six stated that they “always” liked the meals, and one said they “usually” did – “my mother’s likes are catered for and she enjoys her meals” and “the food is always lovely; my relative’s only comment is that there is too much”. People spoken with during the inspection said “normally the food is good but I didn’t enjoy my fish today” (we did observe the staff offering other food to this person but it was declined) and “meal times are always a pleasure. It is like a posh hotel”. We saw that second helpings were offered and that cold drinks were served with meals followed by tea or coffee. The Westbury Nursing Home DS0000020344.V376280.R01.S.doc Version 5.2 Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live here can be assured that any complaints or concerns they may have will be listened to and acted upon. They will be cared for by staff who will safeguard and protect them from coming to any harm. EVIDENCE: The home’s complaints procedure is included in the statement of purpose and is displayed in the main reception area of the home. Those people spoken with during the course of the inspection said that they knew how to raise concerns or complaints and would ask to speak to the manager or the deputy if necessary. “There is absolutely nothing to moan about here, although some people never seem satisfied” and “if you mention anything it always gets sorted out, but there is nothing wrong at all. Far from it”. Those people who completed our survey forms made the following comments “I am able to speak to any of the nursing staff”, “I have always been happy with everything” and “I know that any problems I may have would be sorted out”. In the last 12 months the manager has dealt with two complaints and we were told that these were resolved within the 28 days stipulated in the complaints procedure – one of the complaints was upheld (loss of laundered items) and measures were put in place to prevent the same happening again (a new system for The Westbury Nursing Home DS0000020344.V376280.R01.S.doc Version 5.2 Page 17 tagging people’s laundry has been introduced). The Care Quality Commission have not received any complaints or safeguarding concerns regarding this home. All staff will receive Safeguarding of Vulnerable Adults (SOVA) training as part of their mandatory training programme. The group manager organises regular training for the staff team and several staff spoken with said “it raised our awareness about all the different aspects and told us what to look out for”. Those staff spoken to, both care and ancillary staff, demonstrated good awareness of abuse issues and knew what they should do to safeguard those people in their care. Staff also made reference to the need to ‘whistle blow about bad practice. The staff team have all been provided with information about the mental capacity act, and deprivation of liberty safeguards, and it is discussed in staff meetings. Training sessions will be arranged so that staff will have better information about when to make best interest decisions for the people they look after. The Westbury Nursing Home DS0000020344.V376280.R01.S.doc Version 5.2 Page 18 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, 20, 21, 22, 23, 24, 25 and 26. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Westbury Nursing Home is a very comfortable and well furnished home. It is fully equipped to meet the needs of the people who live there, is clean tidy and fresh smelling. EVIDENCE: The Westbury Nursing Home holds a prominent position, over looking the Falcondale Road, one of the main roads leading in to the centre of Bristol. It is a short walking distance from the leafy suburbs of Westbury-on-Trym, where there are local shops and other facilities. The home was tastefully converted from the buildings previous use, and is now a very comfortable and well The Westbury Nursing Home DS0000020344.V376280.R01.S.doc Version 5.2 Page 19 equipped nursing home. Accommodation is spread over four floors but the very top floor is only used by administrative staff. There are two shaft lifts in between the ground and first floors plus a smaller platform lift between the ground and garden floor levels (lower ground). The home is set in its own grounds with landscaped gardens, established shrubbery and views out over Westbury-on-Trym and Bristol. There is a roof top patio with new patio furniture, providing a very pleasant area for people to sit outside in. We were told that a new entrance automatic door is to be installed, the hall and stairway is to be re-floored and redecorated. There is an ongoing programme of decoration and refurbishment to maintain this home to its high standard. The light and spacious communal areas of the home are open plan, and consist of a large lounge and dining room on the ground floor, a new conservatory and sun room. This large area is broken up into lounge areas and dining areas, and each are well decorated and furnished. The upstairs mezzanine floor is also open plan and overlooks the ground floor lounge and dining room. The glass atrium ceiling offers plenty of light into both floors, but has been ‘whitewashed’ to limit heat build up and keep the home cooler. In addition large ceiling fans and one air cooling unit has been installed as a means of keeping the temperatures in the home at an acceptable level. The standard of decoration and the quality of the furniture and soft furnishing is excellent and provides a very comfortable home for the people who live here. Kitchenettes form part of the communal areas on both ground and first floor and from these areas drinks and meals are served. There are three assisted bathrooms and a wet shower room on both the ground and first floor. The two wet rooms have been installed since the last inspection. The five bedrooms located in the garden level, each have their own en-suite wet room. All the other bedrooms have en-suite facilities of toilet and wash hand-basin. In addition there are a number of toilets located throughout the home, accessible from communal areas. The corridors around the home are all fitted with grab rails and are wide enough to allow people to move about easily with walking frames or wheelchairs. There is a plentiful supply of hoisting equipment, different sizes of slings, stand-aids and other pieces of moving and handling devices to meet the needs of the people who live in the home. We were told that additional equipment has been purchased since the last inspection to meet the increasing needs of highly dependent people. There is a nurse call bell system installed throughout the home As already stated all bedrooms have en suite facilities. Five of the bedrooms are for shared occupancy and screening is in place so that privacy can be provided when personal care is being delivered. People are supported to personalise their bedrooms with pictures and ornaments and they are able to bring items of furniture should they wish. We saw the majority of the The Westbury Nursing Home DS0000020344.V376280.R01.S.doc Version 5.2 Page 20 bedrooms during a walk around the home and each looked clean and tidy and well furnished. Some of the bedroom carpets have been replaced with hard flooring as part of infection control measures. There are specialist nursing beds (electric profiling beds) and pressure relieving mattresses in most bedrooms The home was spotlessly clean and tidy and free from unpleasant odours through out the course of the inspection. Fresh fragrant flowers are always sited in the main reception area and replaced regularly. The home employs a large team of housekeeping staff, on a daily basis, who were seen to be working diligently throughout the two days. Designated housekeeping staff will work in the kitchen areas and are just used for kitchen and food work rather than the other domestic duties. Visitors and people who live in the home, spoken with during the course of the inspection said that the home was always clean and fresh – “the standard of cleaning is very good” and “when we were looking for a place for mum, we were very impressed with the atmosphere and cleanliness of this home”. The seven people who completed our survey forms said that the home was always clean and tidy, and made the following comments -“the cleaners are often about but not intrusive. They seem very well organised, very polite and accommodating” and “everywhere is always clean and tidy”. The Westbury Nursing Home DS0000020344.V376280.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. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in The Westbury will be cared for by staff who are skilled and competent to do their jobs. They are well trained and this means that people can be assured that their needs will be met. EVIDENCE: On the day of inspection there were 14 carers and three registered nurses on duty, plus the home manager, maintenance, catering and housekeeping staff. We were told that this is the normal staffing levels and that there was sufficient staff on duty to meet people’s needs. One person commented on our survey form “we sometimes have to wait too long for personal assistance” and another, “staff are always very busy but always helpful and react to requests for help”. The manager told us that staffing levels are kept on review and will be based upon the collective dependency levels of the people in residence. There are key times of the day when requests for assistance are higher and staffing levels do take this in to account. We were told that there is very little turnover of staff, with some carers and nurses having worked at the home for many years. Agency nurses are not The Westbury Nursing Home DS0000020344.V376280.R01.S.doc Version 5.2 Page 22 used. This means that people will be looked after by staff who are familiar with their needs and they will receive consistent care and support. The home currently employs 44 care staff of which 40 have achieved, or are working towards, a National Vocational Qualification (NVQ) at least at Level 2, in Care (91 ). There is an expectation that all new staff will complete an NVQ when they have settled in to the job and one new member of staff confirmed they had just started the course. We saw that those who were without an NVQ had received more than sufficient training. This means that people will be looked after by competent well trained staff and can therefore be assured that their needs will be met. We looked at the recruitment procedures that are followed before any new staff are employed, to ensure that unsuitable staff are not able to work in the home. The measures that are in place safeguard the people who live in the home. Potential new recruits will have had to complete an application form and attend for interview with the home manager or group manager. Two satisfactory written references, POVA and CRB clearance will all be in place before employment starts. We checked five staff files and spoke with new members of staff and confirmed these arrangements. New staff will complete an induction training programme when they start working at the home and will be allocated to an experienced worker. They will receive instruction in fire safety and manual handling as part of this training. All staff will receive mandatory training in these subjects plus food hygiene, first aid, safeguarding of vulnerable adults, health & safety and dementia care. Other training that has already been organised this year includes eating well for older people, infection control, drug administration, ‘slips trips and falls’ and staff supervision. Staff spoken with during the course of the inspection said that the training opportunities were excellent. The Westbury Nursing Home DS0000020344.V376280.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Westbury Nursing Home is well managed and is run for the benefit of the people who live there. It is safe and the welfare of both people who live there, and the staff team is promoted. EVIDENCE: The registered home manager Penny Brown has been at The Westbury Nursing Home for seven years. She is registered general and orthopaedic nurse and has many years experience in managing care and nursing homes. There is also a deputy manager who has worked in the home for 10 years, and both The Westbury Nursing Home DS0000020344.V376280.R01.S.doc Version 5.2 Page 24 provide strong leadership and direction for the staff team, meaning that people are living in a nursing home that is well managed. It was evident from speaking to people who live in the home, relatives and some of the staff that the manager is very approachable, is very visible and involved in what is going on, and knows about each of the people who live there. We were told that staff meetings are held on a regular basis and the views and opinions of staff are listened to. Resident’s meetings are held every month and their thoughts are incorporated into activity plans and menu planning. A cheese and wine family evening is held quarterly. Questionnaires are given out to find out what people’s experiences are of living in the home. They are asked to make comments about the catering and food, the personal care and support they receive, the daily living arrangements, the premises and the management. Information gained is incorporated in the annual development plan, and the manager knows those areas where they are planning to make further improvements. In addition to this overall review of quality, regular audits are completed in areas such as food, environment, social activity, medication and care planning. It is evident that people who live in the home remain at the centre of all decision making. The home has a system in place to look after people’s cash and have robust procedures in place to safeguard money held. Only three people have access to the safe and two staff signatures are required to record any transactions in and out of the accounts. We sample checked three accounts and the amounts of money held tallied with the records held. The home is well maintained throughout and no health & safety concerns were identified as a result of this inspection. The fire log was up to date and all the necessary weekly monthly or quarterly checks had been completed as recommended by the fire officer. We were told that they have made arrangements for an additional fire door to be installed near the platform lift following completing a recent fire risk assessment. All the necessary servicing and maintenance contracts are in place and were up to date. Safe systems of work in respect of moving and handling tasks are devised and reviewed as required. All these measures confirm that the home takes their responsibility for the health & safety of the people who live and work there, seriously. The Westbury Nursing Home DS0000020344.V376280.R01.S.doc Version 5.2 Page 25 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 4 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 3 3 3 3 3 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 4 3 X 3 X X 3 The Westbury Nursing Home DS0000020344.V376280.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 OP11 Good Practice Recommendations Where end of life decisions are recorded these must include the person’s wishes or indicate how the decision has been reached. Appropriate records should be kept showing who is involved The Westbury Nursing Home DS0000020344.V376280.R01.S.doc Version 5.2 Page 27 Care Quality Commission South West Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@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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