Care Home: West House

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What the care home does well The home is well managed and maintained. Staff understand their roles and receive training to help them support and care for residents. The views of residents are obtained and some action is taken so as to address the issues raised. There is detailed and up to date information about the home made available to people who are looking for a care home. Each person who moves into the home receive information about the day to day running and routines of the home and how to make a complaint if they are unhappy. The manager carries out a detailed assessment of each person`s needs before they are offered a place in the care home. From these assessed needs care plans are drawn up with information to help staff assess individuals properly. Risks to the health and safety of people living in the home are identified and plans are put in place to help minimise risks to residents. Complaints and concerns are taken seriously and investigated promptly and responded to. Most staff have received training around safeguarding vulnerable from harm or abuse and all staff are given information about their roles and responsibilities for safeguarding when they commence work at the home. One member of staff has been designated as a `safeguarding champion` who acts as point of reference if staff or residents have any issues or questions. What has improved since the last inspection? A new care manager has been employed and improvements have been made in the day to day running of the home. Care plans and other information about the assessed health and personal care needs of residents is recorded in a clearer way so that staff have accurate and up to date information about the people they support. Residents are asked about their preferences, likes and dislikes around food and activities so that these can be planned to suit individuals needs and wishes. Staff take more care when handling and supporting residents and this has lead to a reduction in injuries to residents. More activities and opportunities for recreation and socialising are available for residents in the home and residents tell us that the home is more relaxed. Residents now have the choice of where they take their meals and can use the dining tables in the conservatory if they choose. What the care home could do better: All people living in the home must have a care plan developed for them, which describe their assessed health and personal care needs so that staff have accurate and current information to help them support residents appropriately. Staff must ensure that residents receive the medicines prescribed for them as part of their treatment. More opportunities for people to participate in activities outside of the home for those residents who request these. Staff must only be employed once all of the checks including references from previous employers and checks on employment history have been carried out thoroughly. Key inspection report Care homes for older people Name: Address: West House 11 St Vincents Road Westcliff On Sea Essex SS0 7PP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Carolyn Delaney     Date: 2 0 0 5 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: West House 11 St Vincents Road Westcliff On Sea Essex SS0 7PP 01702339883 01702346518 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Barry Gelfand Name of registered manager (if applicable) Barry Gelfand Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accomodated is 25 The registered person may provide the following categories of service only: Care Home with Nursing - Code N To service users of the following gender: Either whose primary needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home West house is an established care home providing nursing care for up to a maximum of twenty-five older people. Although the home predominantly accommodates residents of the Jewish faith, this is not exclusively the case and residents of other faiths or no faith are also accommodated. The home consists of a traditional residential property, which has been modified and extended to meet the needs of older people. The shaft lift Care Homes for Older People Page 4 of 29 Over 65 25 25 0 0 Brief description of the care home and stair lift gives access to all three floors where accommodation and communal areas are situated. The home is situated close to local shops and amenities and is within easy reach of the main shopping area; the seafront and local theatre are also nearby. There is a limited amount of parking to the front of the home.At the time of this report the fees for a place at the home range between £350.00 and £750.00 per week. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a second key inspection of the service in line with our methodology for monitoring and improving services, which have a 0 star poor quality rating. We last inspected the service on 8th December 2009. As part of the inspection we asked the manager to complete an Annual Quality Assurance Assessment. This is a document that providers of social care services are required under the Care Standards Act to send to us and tell us how they feel they meet the needs of the people who use their services and how they evidence this. They also tell us how they plan to improve the services they provide. We review the information they give us and use this to plan our inspection. We sent surveys to ten people who live in the home. We asked people to tell us about the service and to highlight any areas where the home did well and any areas where they felt improvements could be made. We had not received any completed surveys at Care Homes for Older People Page 6 of 29 the time of writing the draft report. Comments made will be reflected in the final report. We reviewed other information available to us such as notifications of any illness, incidents or issues at the home which impact on the health, safety and wellbeing of people living in the home. We reviewed any information, complaints, concerns or allegations of poor practice or abuse we may have received about the service. We carried out a site visit to the home on 20th May 2010. We spoke with three residents, three members of staff, the homes manager, care manager and a visiting district nurse. We looked at care plans and other written information that staff record about the needs of people living in the home and how they support them. We looked at the arrangements for ensuring that residents receive the care and medical attention they need, including medicines. We looked at how residents were supported in living their lives as independently as possible and the arrangements in place for providing opportunities for activities, socialising and occupation. We looked at how complaints and concerns were dealt with and how the views of residents were obtained and acted upon. We looked at the arrangements for recruiting and training staff and for safeguarding people who live in the home from harm and abuse. We looked at how the home was managed and maintained. Information obtained was triangulated and reviewed against the Commissions Key Lines for Regulatory Activity. This helps us to use the information to make judgements about outcomes for people who use social care services in a consistent and fair way. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: All people living in the home must have a care plan developed for them, which describe their assessed health and personal care needs so that staff have accurate and current information to help them support residents appropriately. Staff must ensure that residents receive the medicines prescribed for them as part of their treatment. More opportunities for people to participate in activities outside of the home for those residents who request these. Care Homes for Older People Page 8 of 29 Staff must only be employed once all of the checks including references from previous employers and checks on employment history have been carried out thoroughly. 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. Care Homes for Older People Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who move into West House are assured that the home will be suitable for them because their needs are assessed and they are given accurate information about the services provided. Evidence: The manager told us in the Annual Quality Assurance Assessment that there was detailed information made available in brochures and on the homes website around the services and accommodation provided at West House. They told us that there had been no breakdowns in placement (where a person would have to move out of the home because their needs were not being met) since the last inspection. They did not provide any information around the process for assessing the needs of people before they were offered a place in the home, and we discussed this with them when we carried out our site visit. When we visited we looked at the arrangements for assessing the needs of people Care Homes for Older People Page 11 of 29 Evidence: before they were offered a place in the home. We looked at the assessments carried out for three people who had recently moved into the home. We saw that the manager had visited each person and assessed their health, personal care and social needs. The assessment covered activities of daily living including communication, sight and hearing, mobility, personal care and maintaining safety. There was also information recorded about each persons health and general fitness, their level of activity and the medicines they were taking. The manager reviewed the information obtained during the assessment so as to make the decision as to whether the home would be able to meet the individuals needs. We spoke with two residents who had recently moved into the home. They told us that they had not visited the home before moving in but that they had met the manager. Both people told us that they were satisfied with the home. One person told us It is alright but its not like your own home. The other person told us that they had moved in with their husband and they were pleased that this had been possible. We saw that each person had a contract of terms and conditions, which included information about the charges for their place in the home. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in West House are supported for their health and personal care needs, however people may not always receive medicines as prescribed for them as staff do not always follow the homes policies and procedures so as to ensure that medicines are available. Evidence: The manager told us in the Annual Quality Assurance Assessment that the home has a very good care manager and a team of senior care staff who provide a high standard of care to residents. They told us that the home and staff promotes person centred care planning and respect residents privacy and dignity. The Annual Quality Assurance Assessment did not refer areas where the home could improve on, such as the issues we identified at the last key inspection and we discussed this with the manager during the site visit. When we visited the home we looked at the care plans for three people to see how information about their assessed health and personal care needs was recorded. We saw that there was no care plan in place for one person who had been living in the Care Homes for Older People Page 13 of 29 Evidence: home for almost one month. We spoke with staff and the care manager and they confirmed that no care plan had been developed for this person. Some assessments around risks to this persons health and safety and some information around their preferences for getting up, going to bed etc was recorded, however there was no care plan to identify how staff were to support this person for their assessed health and personal care needs. There were care plans in place for the other two people and these described the level of encouragement or support that both individuals needed to carry out activities of daily living including eating and drinking, mobility, washing and dressing. There was also information around specific risks to both individuals health and safety such as risks of falls and injuries and risks of developing pressure sores due to reduced mobility. There were detailed assessments of risks to individuals in place with information as to how staff were to act to minimise the risks to residents. We looked at records made around accidents and incidents in the home and we saw that there was a significant reduction in the number of injures to residents, in particular injuries sustained as a result of staff moving and handling people in the home. We spoke with three residents and they told us that they were for the most part happy living in the home. One person told us Its ok here and the new staff are very nice. Another person said The home is good, its never like your own home but staff do their best to make it as good as they can. We spoke with a visiting district nurse and they told us that they felt the home was excellent. They told us We are contacted if there are ever any problems and staff act on advice we give them. We looked at the arrangements for ensuring that people living in the home received the medicines, which were prescribed for them as part of their treatment for health conditions. We saw that all staff who had responsibilities for administering medicines had received training to help ensure that they handled and administered medication correctly and safely. We looked at the storage arrangements for medicines and saw that these were appropriate. However on checking records of incidents, which had happened in the home since the last inspection we found that a member of staff had left medicines in the office and that a resident had picked these up. This could potentially put residents at risk and we discussed this issue with the homes manager and care manager who assured us that measures had been put in place so as to reduce this happening again. We looked at the medication administration records for each of the eighteen residents living in the home on the day of the inspection. We saw that records were generally well maintained. However staff had not signed records to indicate that one resident Care Homes for Older People Page 14 of 29 Evidence: had received their Serotide inhaler at 10pm for five days within the previous month. We also saw that one resident had not received one of their medicines for four days. We discussed the implications of this and the importance of ensuring that residents received medicines as prescribed for them with the manager, care manager and one member of senior staff. We also advised the manager that such incidents should be reported to us in line with Regulation 37 of the Care Homes Regulations 2001 as we had not been informed of this. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in West House have opportunities to participate in social and recreational activities, however more opportunities could be provided for more able residents to participate in activities outside of the home. Evidence: The manager told us in the Annual Quality Assurance Assessment that the home provides freshly cooked food for residents with a daily choice of meals. They told us that when a new person moves into the home, the chef will speak with them to find out information around their dietary needs, likes and dislikes. They told us that the home provides an array of entertainment such as external music entertainer each week and that staff provide opportunities for daily activities in the home, some of which are made up of groups and some one to one activities. When we last visited the home there were very limited opportunities for activities and occupation for residents. The manager had undertaken to make improvements in this area. When we visited the home we looked at the arrangements in place for providing opportunities for residents to participate in activities of their choice. We saw that when a person moved into the home staff spoke with each person or their families to obtain information about the individuals hobbies and interests and the things they liked to do Care Homes for Older People Page 16 of 29 Evidence: in their free time. We saw that residents had the opportunity to discuss their preferences for activities at meetings, which were held each month. We looked at the minutes from the recent meetings held and saw that residents had requested more activities including movies, more exercise and more day trips. We discussed this with the manager and they told us that more activities had been provided, however day trips out of the home had not yet been arranged. We spoke with two residents about the activities provided and asked them whether they met their needs. One person told us that they would like to go out more. They told us I would like to go out a couple of times a week but there are not enough staff. I dont get to go out much. They told us that the home was a happier place and that it was more relaxed. One person told us I like the singing, bingo and watching films, especially the old ones. They told us that staff dont have much time to sit and chat with us as they are so busy all the time. On the day of the inspection a music entertainer visited the home and spent two hours singing. Residents appeared to enjoy this and sang along with the entertainer. Following this residents watched a film of their choice. We looked at the planned activities for this month. We saw that there were a range of activities planned for morning and afternoon each day. These included ball games, exercises, music, dancing, pampering sessions, karaoke and arts and crafts. There were no activities planned outside of the home such as shopping, going out for coffee or to local amenities for some of the more active residents who told us that they would enjoy these. We looked at the arrangements for providing meals for residents. We saw that when a person moved into the home the chef spoke with them about their food likes and dislikes, and any special diet requirements they had. This information was recorded and meals and menus were planned so that they reflected residents wishes. We saw that the daily menu was displayed on a notice board in the lounge so that residents could easily see what meal options were planned for the day. On the day of the inspection residents were offered parsnip soup, a choice of turkey pie with roast potatoes and vegetables or fish fingers. For the supper time meal there was a choice of bread rolls with egg, tuna or tomato. During the day we observed that staff supported residents who needed assistance in an unrushed way and that residents were given plenty of time to finish their meals. Staff offered hot and cold drinks to residents throughout the day. Three of the residents we spoke with told us that they enjoyed the meals at the home. One person said The food is ok, my favourite is curry and we had one last week. Another person said I like the food, I would like to see more fish on the menu but overall I enjoy the meals. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in West House are assured that their complaints and concerns will be taken seriously and they are safeguarded from abuse and harm because staff are know how to recognise and deal with these issues. Evidence: The manager told us in the Annual Quality Assurance Assessment that they receive very few complaints from residents or their families. They told us that they have a policy and procedure for receiving and dealing with any complaints or concerns. They told us that they had received one complaint within the past twelve months and that this had been investigated and not upheld. The manager told us of the improvements made since the last inspection. They said that all new staff were given information around safeguarding people who may be vulnerable from abuse or harm. They said that they had identified one member of staff to act as a safeguarding champion to be a point of reference for staff if they had any queries around safeguarding issues and protecting vulnerable people. They told us that there was now a suggestion box where residents and visitors could make suggestion and comments anonymously should they wish to. When we visited the home we looked at the arrangements for receiving and dealing with complaints. The manager told us that there had been no complaints received within the past six months since the last inspection visit and records of complaints received confirmed this. We saw that the manager met each month with residents to Care Homes for Older People Page 18 of 29 Evidence: obtain their views and comments about the home and their experiences of living there. The manager told us that the suggestion box was situated in the hallway so as to allow people to use it anonymously should they chose. They said that no suggestions or comments had been received. We discussed how people who may have communication difficulties or memory impairment were supported to raise concerns, make complaints and / or suggestions. We advised them that residents could be reminded of the suggestion box and how to make complaints during the monthly meetings held. During the site visit we spoke with four residents. Each of them told us that they did not have any complaints about the home. One person said Most of the staff here are good and the manager is very good. If I am unhappy I will speak to him. Another person said I have no complaints but I would like to go out more. We spoke with two members of staff. One told us that they had not been given safeguarding training yet but that this was planned. They confirmed that they had been given a leaflet about safeguarding people and that they had received training at the last home they worked at. We looked at the arrangements for safeguarding people living in the home. We saw that all new staff were given information around safeguarding vulnerable people, which included details of their roles and responsibilities for recognising and reporting poor practices. We looked at evidence provided by the manager for staff training. We saw that of the nineteen people who worked in the home, ten people had received safeguarding training within the past year, two had received training in 2008 and one person had not received training since 2004. The manager told us that other staff who had not received training were to do so within the next month. Following the inspection visit the manager contacted us regarding staff training around safeguarding people who may be vulnerable. They told us that they had contacted the local safeguarding team to query the frequency of staff training and been informed that staff only need updated traing where there have been changes to policies or practices, however it is good practice for staff to undertake regular refresher training especially if they have not received training for a number of years. When we last visited the home we had identified issues around how staff handled residents when supporting them physically such as assisting them with mobilising and the use of hoists. We saw that staff did not always take due care when supporting residents and that this had resulted in unnecessary injuries such as skin tears. When we carried out this inspection visit we looked at accident and incident records. We saw that there were no incidents where staff practices had caused injuries to residents. We observed how staff supported residents when assisting them to move and transfer Care Homes for Older People Page 19 of 29 Evidence: from chairs etc and we saw that they treated residents with care and handled them appropriately. We looked at how staff were recruited to work in the home. We saw evidence that checks including Criminal Records Bureau disclosures and Independent Safeguarding Authority checks (formally PoVA First checks) were carried out for all staff before they commenced work in the home. These checks help to ensure that only individuals who are suitable are employed in the home and that residents are protected. Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in West House enjoy a clean, safe and comfortable environment, which suits their needs. Evidence: The manager told us in the Annual Quality Assurance Assessment that West House provides a homely environment that is safe, comfortable, clean and free from odours. They told us that they had endeavoured to change the layout of the communal area so as to encourage more interaction between residents and staff however this had not been possible due to the position of fire exits in this area. When we visited the home we carried out a brief tour of the premises. All communal areas we looked at including bathrooms and lounge areas were clean and free from unpleasant odours. Residents bedrooms were clean and personalised with items of their own furniture, photographs and ornaments etc. The home has a maintenence plan and employs someone to deal with any maintenence issues promptly. There is aplan in place for continually assessing and improving the homes environment including purchasing flat sceen televisions for residents bedrooms. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in West House are cared for and supported by a staff team who work well and are trained to individuals assessed needs. Evidence: The manager told us in the Annual Quality Assurance Assessment that they had a robust recruitment procedure. They told us that they had a stable team of staff who were kind and caring. They told us that a new care manager had been employed to work in the home since the last inspection. When we visited the home we looked at the arrangements in place for recruiting, training and deploying staff to met the needs of residents. The manager told us that the staffing levels for the home were five care staff in the morning, four in the afternoon and three during the night. In addition the manager and care manager were available during the day and a dedicated cook, housekeeper and maintenance man were employed in the home. We looked at the duty rotas for four weeks including the current week. We saw that these staffing levels had been maintained and that staff had a minimum and usually two days off per week. We saw that extra staff were employed to cover when the cook had days off. We spoke with four residents and asked them if they felt that there were sufficient staff available to care for them. Each of the four told us that staff were available to Care Homes for Older People Page 22 of 29 Evidence: help them when they needed. One person commented that staff were often too busy to sit and chat and one person told us I would like to go out more often but there are not always enough staff to do this. We spoke with three members of staff and they told us that they were supported by the manger and had enough time to look after residents properly. One person told us We have a good team and we work very well together to care for residents. We observed how staff engaged with and supported residents and saw that this had improved since the last inspection, with staff spending time talking to people and supporting them at mealtimes etc. We looked at how staff were recruited to work in the home. We looked at the staff files for four people who had been employed to work in the home since the last inspection. We saw that checks including Criminal Records Bureau disclosures and Independent Safeguarding checks (formally PoVA First) had been obtained before each person started work. References had been obtained however these were not always from the persons previous employer and checks had not been carried out around each persons previous employment history. These checks are important in determining the suitability of people to work in the home. We discussed our findings with the manager and they assured us that improvements to the recruitment procedure would be made. We looked at the training provided for staff working in the home. The manager provided us with a copy of the training spreadsheet, which showed what training each member had undertaken. We saw that eleven of the fifteen care staff had been given training around care planning, all staff had received training for the safe moving and handling of people, two staff had been trained in the Mental Capacity Act 2005. Most staff working in the home had received safeguarding training and medication. Some staff had undertaken training in the safe use of bed rails, nutrition, stoma care, pressure area care, diabetes, catheter care and palliative care. Each of the three members of staff we spoke with told us that they received training to help them understand and meet the needs of people living in the home. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. West House is well managed and run in the interests of the people who live there, however more could be done to act on the comments and suggestions made by residents. Evidence: The manager told us in the Annual Quality Assurance Assessment that the home is very well run with the interests of people who live there at the forefront. They told us that there was a comprehensive set of policies and procedures to safeguard both residents and staff. The manager said that the operate an open door policy where residents, their families and staff can freely discuss any issues they may have. They told us that they carry out a number of audits so as to ensure that the home is well managed. When we visited the home we saw that a new care manager had been recently appointed to manage the day to day care provision in the home. The manager told us that they no longer provided nursing care and that no nursing staff were employed in Care Homes for Older People Page 24 of 29 Evidence: the home. The manager had not applied to the Care Quality Commission to apply to vary the conditions of registration so as to reflect the changes in the services provided and we advised him that he should do this as soon as possible. We discussed the Annual Quality Assurance Assessment with the manager. We told him that the assessment had not been completed accurately to reflect each of the outcome areas and what the home did well, areas for improvement and how improvements were to be made. This information is required under the current regulations and is used to plan inspections. We looked at how the views of people who live in the home were obtained and used to improve their experiences. We saw that regular meetings were held where residents were asked about the things they would like changed or improved. We looked at the minutes for the most recent meetings. We saw that residents asked for more activities, especially day trips and outings in meetings held in January, March and May 2010. There was little evidence that outdoor activities had been arranged or planned. Other areas such as preferences for meals and activities within the home had been improved as a result of listening to the views of residents. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 (2) Staff must ensure that so far 28/02/2010 as it is practical that residents receive medicines which are prescribed for them. Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Each person living in the home must have a plan of care, which describes their individual assessed health, personal care and social needs. This must be done so that staff have up to date and accurate information about the needs of the people they support. 30/06/2010 2 9 13 Staff must ensure that so far 30/06/2010 as it is possible that medicines as prescribed for their health needs are available and administered. This must be done so that people living in the home receive the treatment they needs. 3 29 19 All of the appropriate checks 25/06/2010 including references from each persons previous employer and checks on employment history must be Page 27 of 29 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action carried out before staff commence work in the home. This must be done so as to ensure that only suitable people are employed at the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 12 18 38 More opportunities for activities outside of the home could be provided for those people who request this. All staff working in the home should undertake training around the safeguarding vulnerable people. More could be done to act on the wishes and comments made by residents so as to improve their experiences of living in the home. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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