Care Home: WCS - Westlands

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What the care home does well Good information in the pre-admission assessments was present in all of the three case files that were looked at. These would enable the home to decide if they were able to meet the person`s needs or not. Care plans were reviewed and revised as necessary and dependency scores were evaluated every month to make sure that care plans were up to date and relevant in order that the person`s needs were met. All evidence showed that the residents` health and well being were safeguarded by the medication policies and practices of the home. Residents were cared for in a respectful manner and this ensured that their dignity and self-esteem were maintained. WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 6Residents were occupied and stimulated being offered a variety of activities on a regular basis. Included in the four-week cycle of the activity programme were cake making, manicures, Bingo and `horse racing`, ball games, Life History, making music and sing a longs. Special occasions were celebrated and the following comment was in the comments book made available to residents and visitors. "Many thanks to staff for the lovely party they put on for xxx`s 93rd birthday. We were made most welcome." Also seen in this book was a comment from a visitor, "Always enjoy coming here. Warm, welcoming atmosphere". Residents and visitors spoken with during the visit also confirmed this. Observations made and discussion with residents showed that people living at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, whether to join in activities or not and where to spend their time. Meals are taken in attractive and comfortable dining rooms. The menus showed a variety of nutritious and interesting meals and offered ample choice. Residents spoken with said that they always enjoyed the meals. There were plenty of snacks and fresh fruit in communal areas that residents were able to help themselves to. The home had recently had an inspection from the Environmental Health Department and had received a good report. The home had also achieved the department`s Gold Award in January 2008 and a `Healthy Heartbeat Award`. Residents and visitors can be confident that their concerns will be listened to. The home has appropriate policies and procedures and undertaken appropriate training to safeguard residents. There had been no complaints or adult protection referrals since the previous inspection. The home offers the people living there comfortable and attractive surroundings, which are clean, free of offensive odour, safe and generally well maintained. All areas of the home are accessible to all residents by ramps to the outside and a passenger lift to all floors.. The normal staffing allocation was for there to be three care staff on each of the three units on each shift. In addition ancillary staff comprised of two cooks, a designated laundry assistant and three domestic staff. There was every indication that there were sufficient staff to meet the needs of the residents.The importance of training was recognised with staff having undertaken induction, mandatory training and other specialised needs training to give them the knowledge and skills to ensure that the needs of the people living at the home are met and in safe surroundings. More than two thirds of the care staff had achieved National Vocational Qualification Level 2 exceeding the required 50% of staff to have this qualification and showing that these staff were competent in their role. Residents spoken with were complimentary about the way in which they were cared for. One said, "I only have to press my buzzer and they are there." The manager had an enthusiastic and progressive approach to managing the home and this was evident in the AQAA and at the time of the visit. The home has a Quality Assurance system that monitors the services and practices in the home to ensure that the home operates in the interest of the people living there. Staff supervision is carried out at two monthly intervals. Staff supervision is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues. It is also an opportunity for staff to contribute to the way that the service is delivered. Records of maintenance and services indicated that the home was a safe place to live and to work. What has improved since the last inspection? The Statement of Purpose and Service User Guide had been reviewed and revised and was up to date at the time of the inspection visit. Very good progress had been made in improving the care plans and the reflected the current needs of the people living at the home. There was an increased choice of activities available for the residents which included, cake making, manicures, Bingo and `horse racing`, ball games, Life History, Making music and sing-a-longs. There were sufficient care staff to meet the needs of the people living at the home, supported by ancillary staff of laundry, domestic and catering staff. New people referred to the home were offered copies of the Statement of Purpose and Service User Guide at the point of looking around the home in order to give them the information they needed to help them to make a decision about living at the home or not. There have been a large number of environmental improvements including, the redecoration of bedrooms and replacing of bed linen, towels, new commodes, and the complete refurbishment of a dining room. New armchairs have been ordered and the home is awaiting their delivery. The manager had applied for registration with us before this report was completed. What the care home could do better: CARE HOMES FOR OLDER PEOPLE WCS - Westlands Oliver Street Rugby Warwickshire CV21 2EX Lead Inspector Lesley Beadsworth Unannounced Inspection 6th March 2008 12:40p X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service WCS - Westlands Address Oliver Street Rugby Warwickshire CV21 2EX 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) 01788 576604 01788 535553 admin@westlands.f9.co.uk Warwickshire Care Services Limited vacant post Care Home 38 Category(ies) of Dementia - over 65 years of age (11), Old age, registration, with number not falling within any other category (27) of places WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th October 2006 Brief Description of the Service: Westlands is a three-storey purpose built care home. The home is currently owned and managed by a voluntary organisation, Warwickshire Care Services. Westlands underwent a major refurbishment in 1998. The home is located close to Rugby town centre, bus and railway stations and is located within a community, which provides local services such as shops, public houses, restaurants, coffee bars and clubs. Accommodation is located on three floors. Each floor has one lounge and a dining area with integral kitchenette. All bedrooms are single some have ensuite facilities. Service users can furnish and redecorate to their own taste if they wish. The gardens are attractive, well maintained and accessible. There is a variety of garden furniture including sun umbrellas and tables. A ramp allows easy access to the patio area. The home provides both long-term residential care for 38 frail older people, and a day care facility, which accommodates up to eight older people. The fees for the home were not included in the Service User Guide. WCS - Westlands DS0000004270.V360662.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 2 star. This means the people who use this service experience good quality outcomes. The inspection included a visit to the Westlands. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment (AQAA), which is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Information contained within this, from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place between 12.40pm and 10.05pm. What the service does well: Good information in the pre-admission assessments was present in all of the three case files that were looked at. These would enable the home to decide if they were able to meet the person’s needs or not. Care plans were reviewed and revised as necessary and dependency scores were evaluated every month to make sure that care plans were up to date and relevant in order that the person’s needs were met. All evidence showed that the residents’ health and well being were safeguarded by the medication policies and practices of the home. Residents were cared for in a respectful manner and this ensured that their dignity and self-esteem were maintained. WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 6 Residents were occupied and stimulated being offered a variety of activities on a regular basis. Included in the four-week cycle of the activity programme were cake making, manicures, Bingo and ‘horse racing’, ball games, Life History, making music and sing a longs. Special occasions were celebrated and the following comment was in the comments book made available to residents and visitors. “Many thanks to staff for the lovely party they put on for xxx’s 93rd birthday. We were made most welcome.” Also seen in this book was a comment from a visitor, “Always enjoy coming here. Warm, welcoming atmosphere”. Residents and visitors spoken with during the visit also confirmed this. Observations made and discussion with residents showed that people living at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, whether to join in activities or not and where to spend their time. Meals are taken in attractive and comfortable dining rooms. The menus showed a variety of nutritious and interesting meals and offered ample choice. Residents spoken with said that they always enjoyed the meals. There were plenty of snacks and fresh fruit in communal areas that residents were able to help themselves to. The home had recently had an inspection from the Environmental Health Department and had received a good report. The home had also achieved the department’s Gold Award in January 2008 and a ‘Healthy Heartbeat Award’. Residents and visitors can be confident that their concerns will be listened to. The home has appropriate policies and procedures and undertaken appropriate training to safeguard residents. There had been no complaints or adult protection referrals since the previous inspection. The home offers the people living there comfortable and attractive surroundings, which are clean, free of offensive odour, safe and generally well maintained. All areas of the home are accessible to all residents by ramps to the outside and a passenger lift to all floors.. The normal staffing allocation was for there to be three care staff on each of the three units on each shift. In addition ancillary staff comprised of two cooks, a designated laundry assistant and three domestic staff. There was every indication that there were sufficient staff to meet the needs of the residents. WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 7 The importance of training was recognised with staff having undertaken induction, mandatory training and other specialised needs training to give them the knowledge and skills to ensure that the needs of the people living at the home are met and in safe surroundings. More than two thirds of the care staff had achieved National Vocational Qualification Level 2 exceeding the required 50 of staff to have this qualification and showing that these staff were competent in their role. Residents spoken with were complimentary about the way in which they were cared for. One said, “I only have to press my buzzer and they are there.” The manager had an enthusiastic and progressive approach to managing the home and this was evident in the AQAA and at the time of the visit. The home has a Quality Assurance system that monitors the services and practices in the home to ensure that the home operates in the interest of the people living there. Staff supervision is carried out at two monthly intervals. Staff supervision is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues. It is also an opportunity for staff to contribute to the way that the service is delivered. Records of maintenance and services indicated that the home was a safe place to live and to work. What has improved since the last inspection? The Statement of Purpose and Service User Guide had been reviewed and revised and was up to date at the time of the inspection visit. Very good progress had been made in improving the care plans and the reflected the current needs of the people living at the home. There was an increased choice of activities available for the residents which included, cake making, manicures, Bingo and ‘horse racing’, ball games, Life History, Making music and sing-a-longs. There were sufficient care staff to meet the needs of the people living at the home, supported by ancillary staff of laundry, domestic and catering staff. New people referred to the home were offered copies of the Statement of Purpose and Service User Guide at the point of looking around the home in WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 8 order to give them the information they needed to help them to make a decision about living at the home or not. There have been a large number of environmental improvements including, the redecoration of bedrooms and replacing of bed linen, towels, new commodes, and the complete refurbishment of a dining room. New armchairs have been ordered and the home is awaiting their delivery. The manager had applied for registration with us before this report was completed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 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 WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 Quality in this outcome area is good. Information required to make a decision about choice of home is available when needed. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s Statement of Purpose and Service User Guide had been updated in May 2007 and contained comprehensive information about the home and the services offered. The Service User Guide should also contain the costs of accommodation at the home so that the prospective residents have the information of how much it would cost them to live there. However residents spoken with said that they had received sufficient information about the home before moving in. Good information in the pre-admission assessments was present in all of the three case files that were looked at as part of the case tracking process. These would enable the home to decide if they were able to meet the person’s needs or not. A format provided by the organisation was used which consisted of a WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 11 front sheet with personal details and brief notes of the person’s daily living activities and brief notes of assistance required for specific mobility, transfers, personal care and eating and drinking needs. A section of this form includes the dependency score that is completed separately and asks, - can the person’s needs can be met at the home; if not what needs cannot be met; if a choice of homes has been given to the person; whether the move would be a positive choice and if there are any concerns that the home can address; why did the person choose Westlands? A checklist was available to be completed regarding if the person had visited the home, had been provided with copies of the Statement of Purpose, Service User Guide, had been shown a copy of the inspection report and asking for the dates that these things had happened. WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. Care plans include the information required to meet the needs of the people living at the home. Residents have access to health care professionals and are cared for in a respectful manner. They are safeguarded by the medication system. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Good progress had been made in improving the care plans for all residents, and senior staff had obviously worked hard to reach the stage they were at. Detailed care plans were present in each of the three care files looked at. They set out the care required in sufficient up to date detail to ensure that all aspects of the health and personal health needs of residents were met. There was not a specific section for mental health needs but the information was integrated within all other needs. In order to ensure that all mental health needs are met consideration should be given to having a designated section in the care plan. They also included such detail as whether the person was able to use the call bell; if they liked the door open, ajar or closed when they occupied the room; whether they had accepted the offer of a key to their bedroom or not. WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 13 Care plans were reviewed and revised as necessary and dependency scores were evaluated every month to make sure that care plans were up to date and relevant in order that the person’s needs were met. Residents, and relatives if the resident wished, were invited to join in reviews of care plans at six monthly intervals, giving them the opportunity to be involved and agree to the care provided. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician, chiropodist and Community Psychiatric Nurse being identified in the care files looked at. A comment in the home’s comment book made by a social worker said, “Thank you Westlands for making a difference to my client’s well being.” Records for the use of bedrails where appropriate, falls, pressure areas, weight, bathing and preference of time of day for bathing were in place within the files looked at. Completed risk assessments for nutritional risk screening and a manual handling risk assessment were also in place. These would help to minimise any risk. Body maps for showing any problems with skin integrity and where any necessary creams or ointments were to be applied were included in the care file. Individual risk assessments were also in place, for example for the use of oxygen; aspiration/choking; social isolation. Preventative measures such as pressure relieving mattresses and cushions were in use. The home had a satisfactory medication policy. The home used a multi dose system of dispensing medication in blister packs transported to residents in a lockable trolley. Medication was stored correctly; those to be taken internally were appropriately stored separately from those for external use. All Medication Administration Record Sheets looked at were clearly named, had no unexplained gaps or incorrectly used codes and recorded the receipt and disposal of medication for that person. Medication audits are carried out at the end of each administration round to ensure that the correct numbers of tablets remain. We carried out a random audit of tablets and there was one error, other tablets tallying with the Medication Administration Record Sheets. A sample of the signatures of all staff trained to administer medication was kept with the medication records. To confirm that the correction medication had been received the home retained copies of all prescriptions. Controlled drugs were stored, recorded and administered appropriately. There was a satisfactory protocol for ‘prn’ (as required) medication so that staff were clear about when this medication should be offered. WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 14 All evidence indicated that the residents’ health and well being were safeguarded by the medication policies and practices of the home. Time was spent with residents and staff in the lounges and dining room. Terms of preferred address were on the residents care plan and heard to be used by staff. Residents were cared for in a respectful manner and this ensured that their dignity and self-esteem were maintained. WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. Residents are occupied and stimulated. Visitors are made welcome and their needs considered. Residents have choices and control over their daily lives and enjoy the nutritious and varied meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An activity organiser based in the day centre coordinated activities with day care service users and with residents. Residents’ interests and their social, religious and cultural need are recorded in their care plans, which enables staff to be aware of what they would prefer to be included in the activity programme. There was an increased choice of activities available for the residents at this visit. These included, cake making, manicures, Bingo and ‘horse racing’, ball games, Life History, Making Music and sing-a-longs. There was a four-week cycle of suggested activities but the eventual activity was dependent on the residents’ wishes. Most activities took place in the dining room/lounge adjacent to the kitchen where the day care service users tended to spend their time. Special occasions were celebrated and for the recent Valentines Day staff and residents spoke of making cards, photographs being taken and receiving cards and roses from the home. A Diamond Wedding had WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 16 also been celebrated. The comments book made available for staff and visitors included comments such as, “Many thanks to staff for the lovely party they put on for xxx’s 93rd birthday. We were made most welcome.” A residents’ meeting was held every month where activities and other areas of the services offered are discussed. Minutes were available although the most recent were waiting to be typed. There were no restrictions to family and friends visiting and visitors could be entertained in the communal areas or in the privacy of the resident’s own room. The visitors policy was included in the Service User Guide. Visitors had recorded such comments as, “Always enjoy coming here. Warm, welcoming atmosphere.” Visitors and residents spoken with supported this and a visitor spoken with said, “They make me very welcome.” Observations made and discussion with residents showed that people living have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, whether to join in activities or not and where to spend their time. Staff were heard to ask residents where they wanted to sit after their meal and whether they wanted to join in activities. The ground floor had two dining rooms. The one adjacent to the kitchen, with an adjoining lounge area, and was used by residents for breakfast and by day care service users during the day. The manager said that residents had asked to continue to use this area for breakfast but preferred lunch and tea in the second dining room, also on the ground floor, which had been recently redesigned and refurnished to a high standard creating a restaurant-style area. Tables had been decorated with fresh flowers, there was good quality an coordinating table linen and the current menu was on display for residents. The dementia unit had a separate dining area. Menus were nutritious, varied and interesting and offered two choices of main meal. An example of a lunch on the menu was, homemade asparagus soup; roast lamb with roast and/or creamed potatoes, carrots and sprouts OR Jacket potato with a choice of filling; mixed berry rice pudding. Other alternatives were also available each day if choices were not wanted, such as cheese, egg or cooked meat salad, cheese and biscuits, fresh fruit, milk pudding, fruit and/or ice cream. The teatime meal on the day of the visit was Cheese pasties or sandwiches. There were large bowls of fresh fruit and baskets of snacks WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 17 such as packets of crisps and wrapped chocolate and biscuits available in lounges throughout the day for residents to help themselves. Residents spoken with said that they always enjoyed the meals. Environmental Health had recently visited the home and the report was available for inspection. Only one recommendation had been made, which was for the thermometer probe to be calibrated. This had been done by the time of our visit. The report said that, “the kitchen and staff very clean. Kitchen well run.” The kitchen had achieved the Gold Award of the Food Hygiene Inspection Rating Scheme, from Environmental Health in January 2008 and had also achieved a ‘Healthy Heartbeat Award’ related to healthy eating. WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. Residents and visitors can be confident that their concerns will be listened to. The home has appropriate policies and procedures and undertaken appropriate training to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure, a copy of which was in the Statement of Purpose. A copy was also in the manager’s office but even though visitors residents are told that they are welcome there at any time there should be one displayed in a place where it is readily available to residents and visitors, such as the reception area. The home has a complaints log where records of complaints, any investigations and action taken are recorded. However there had not been any complaints made since the last inspection. The home has an adult protection policy and also had a copy of the local authority policy. These enabled the management and staff to know what to do in the event of an allegation or suspicion of abuse. Many staff had undertaken recent training related to the protection of vulnerable adults. All staff need to have taken this training so that they all have the knowledge and skills to be able to identify abuse and to safeguard residents from it. All recruitment practices safeguard residents from the employment of unsuitable people. WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,24,26 Quality in this outcome area is good. The home offers the people living there comfortable and attractive surroundings, which are clean, free of offensive odour, safe and well maintained. All areas of the home are accessible to all residents. infection control systems are in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The front of the home was accessed via ramp that enabled wheelchair passage. All other areas of the home were also accessible to wheelchair users. The reception area of the home was attractive and furnished to a high standard. It was bright and welcoming with such items as the Statement of Purpose and Service User Guide and certificates being displayed in a noninstitutional way. The rest of the home was decorated and furnished to a good standard, with good quality pictures and photographs of residents decorating the walls in WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 20 communal areas. Some armchairs were looking worn but the manager said that these were to be replaced as new ones had been ordered and were due to be delivered in the very near future. The dementia unit was on the lower ground floor and at the time of the visit catered for nine residents. Some of the paintwork on this floor was badly scraped and the worktop in the kitchenette was worn. Doors to bedrooms had been painted a light colour in order to brighten up the corridor, although it is considered useful to people with dementia to have different coloured doors for identification purposes. It was noted that the temperatures of the fridge on this unit had not been recorded each day so that it could be monitored that the fridge maintained appropriate temperatures for the storage of food. Some recordings were higher than the recommended 5°C or less. This creates the risk of food not being kept safely. The bedrooms of the people case tracked were looked at. These were comfortable and well decorated, as in the rest of the home, and were personalised to the occupants’ preference with photos, pictures, ornaments and soft toys. All areas of the home visited were clean and free from offensive odour. Laundry facilities were inspected and found to be well organised, clean and hygienic with appropriate laundry equipment and washing programmes. The home was using new laundry bags that were colour coded according to the washing temperature needed for the items. They also had dispersible bags for soiled laundry so that it does not need to be handled unnecessarily and thereby maintaining infection control. Hand washing facilities in communal areas included soap dispensers and disposable towels in order to maintain infection control. WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. There are sufficient care staff available to meet the needs of the residents supported by ancillary staff. Good recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. EVIDENCE: The normal staffing allocation was for there to be three care staff on each of the three units on each shift. At the time of the visit there were only two allocated to the dementia unit as there were two vacancies on that unit. In addition ancillary staff comprised of two cooks, a designated laundry assistant, working 9am to 2pm for five days a week and three domestic staff each working 25 hours a week. There was every indication that there were sufficient staff to meet the needs of the residents. There had been a need to use agency staff to cover absences but the manager planned to increase the home’s bank staff which would reduce this need and help to maintain continuity of care. Residents spoken with were complimentary about the way in which they were cared for. One said, “I only have to press my buzzer and they are there.” The manager said that the care staff were “doing wonderfully well” in achieving National Vocational Qualifications with more than two thirds of them having WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 22 completed the training and other staff currently undertaking the training. This qualification shows that staff have been assessed as being competent in their role. Three staff files were looked at and there was evidence that all recruitment procedures and practices were robust and safeguarded residents from the appointment of unsuitable people, including the appropriate Protection of Vulnerable Adults and Criminal Records Bureau checks having been made. The home had given training high importance. All staff files looked at included a staff development plan referred to as the ‘skill scan’ and identified the training staff had undertaken and that which they needed to take. New staff had undertaken induction training. The training records showed that the majority of staff had undertaken training related to health and safety issues, including moving and handling, use of hoists, Health and Safety, Infection Control and First Aid. Other training included ‘Person Centred Care’, Pressure Area care, Introduction to Dementia and a further 4-day course on Dementia. staff said that they had ample opportunity to attend training. There was no record of staff having undertaken fire safety training. WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is good. A person undertaking the appropriate qualification and who has previous management experience manages the home. The monitoring and auditing of the service and practices ensure that all services operate in the best interests of residents. Policies and practices safeguard the health, safety and welfare of the people living at the home. In general the finances of the residents are secure but there are shortfalls in access to money held for safekeeping. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager had been in post for two years, had managed a previous similar service and was about to complete the Registered Managers Award. She had not applied for registration as had preferred to have had a further key inspection before this. However she had made this application before this report was completed. The manager showed an enthusiastic and progressive WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 24 approach to her management role both in the AQAA that she provided and at the time of the visit. A care manager and four lead carers as well as an administrative assistant support her in the management and administration of the home. The home had a Quality Assurance Programme that included surveys being used for residents and other interested persons. These were also provided in a pictorial easy to read format. The organisation provided a “Monthly QA Record” which included a statement with instructions that it is read to each person living at the home each month and the person is asked to score and comments on the how they see the services they receive. A set list of twelve statements/questions about the services is listed in the record and one a month is asked of each person and their response recorded in the same way. These systems indicate that the home is monitoring the service in order to enable growth and improvement, in order to ensure that the home operates in the interest of the people living there. Staff supervision is carried out at two monthly intervals. Staff supervision is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues. It is also an opportunity for staff to contribute to the way that the service is delivered. The registered provider should make an unannounced visit to the home each month and forward a report to the manager and to us on the findings at this visit. Whilst the manager was able to show that monthly quality assurance visits are made to the home a report is not received by us. The home looks after money for some of the residents. Transactions and cash balances were checked at random and tallied correctly. The records for this and the security for the safe key is the responsibility of the administrative assistant. In response to concerns that this member of staff is not in the home at weekends and evenings are therefore money cannot be accessed by the residents the manager said that residents are aware of this and plan ahead, requesting their money whilst the administrative assistant is on the premises. Whilst this might be satisfactory most of the time, residents should have access to their money at all times, especially for any unplanned spending. The manager said that consideration would be given to the key to the safe and the record keeping becoming the responsibility of other senior staff as well. This would also be of benefit when money is received into these accounts as currently this was put ‘under the door’ of the locked room of the administrative assistant until that member of staff came back in. This is not entirely safe or reliable. A random check of maintenance and servicing records was made. There had been recent servicing on the boiler; an up to date gas safety certificate was available; fire alarm testing was up to date; hot water temperatures had been WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 25 checked to prevent residents suffering any accidental scalding; the passenger lift servicing was up to date and the ‘Five year’ electrical wiring test was within date showing that the home was maintaining health and safety. They provided sufficient evidence to indicate that the home was a safe place to live and work. WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 3 WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 27 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. 2. 3. 4. 5. Refer to Standard OP1 OP15 OP19 OP33 OP35 Good Practice Recommendations The current fees should be published in the Service User Guide. Temperatures of fridges storing food should be maintained at below 5°C. This should be monitored by checking the temperature daily. The minor maintenance tasks identified on the lower ground floor should be addressed. A representative of the registered provider should make an unannounced visit each month and forward a report of the visit to the manager and to us. Money held on behalf of residents should be accessible to them at all times. There should be a safe and reliable system for receiving money into the home. WCS - Westlands DS0000004270.V360662.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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