Care Home: Westbank Nursing Home

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What the care home does well The home provides detailed information for new and prospective residents. This is set out in an indexed format, so that it is easy to access specific details. Nursing and care staff ensure that personal care is carried out respectfully, and with attention to detail. Assessments and care plans confirm that residents are given the choice of a bath or shower, and with attention to promoting good skin integrity. The home has a relaxed and friendly atmosphere. Visitors are made welcome, and offered drinks. Residents said that the food is well cooked, there is a good choice, and they are not rushed at meal times. What has improved since the last inspection? CARE HOMES FOR OLDER PEOPLE Westbank Nursing Home 64 Sevenoaks Road Borough Green Kent TN15 8AP Lead Inspector Mrs Susan Hall Unannounced Inspection 9th September 2008 07:20 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 Westbank Nursing Home DS0000026213.V371777.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. Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westbank Nursing Home Address 64 Sevenoaks Road Borough Green Kent TN15 8AP 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) 01732 780066 01732 780054 westbank@new-meronden.co.uk New Century Care (Borough Green) Ltd Mrs Barbara Hammond Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP) The maximum number of service users to be accommodated is 40. Date of last inspection 17th October 2006 Brief Description of the Service: Westbank Nursing Home is a purpose built care service, which was opened eighteen years ago. It is owned by the company New Century Care, who purchased it in 2003. The company currently have a total of twenty-seven care homes situated across England and Scotland. The home is located in the village of Borough Green, and can easily be accessed from the M20, M26 and M25 motorways. It is close to local shops, pubs, a post office, and other amenities. The premises are a large detached building, set in three acres of attractive gardens. There are beautiful views across the surrounding countryside. Accommodation is arranged on one level. All bedrooms are for single use, and three bedrooms have en-suite toilet facilities. There is a large dining room/lounge, a newly added conservatory, and a small private visitors room. There is ample parking space available. Current fees range from £445.19 to £960.00 per week, depending on the assessed needs of the individual resident, and the room being used. There are additional costs for items such as hairdressing, newspapers, and chiropodist. Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home is assessed as having a rating of good, 2 stars. This was a key inspection, which includes taking into account all information obtained about the home since the previous inspection. This includes formal notifications made to CSCI; the completed Annual Quality Assurance Assessment form (which all homes are required to complete annually); any complaints or concerns made directly to CSCI; and a visit to the home. The inspection visit was carried out by one inspector, and lasted for eight and a half hours. It commenced at 07.20, so that we (i.e. CSCI) were able to meet some of the night staff available, as well as day staff. During the visit we talked with seven residents and eleven staff, as well as the general manager, and the clinical services manager, who were available throughout the day. It was also helpful to meet the homes area manager, and the companys operations director, who were attending a meeting in the home on that day. CSCI received nine completed survey forms, which included comments from residents, visiting health professionals and staff. These mostly had positive feedback, with staff stating that they have good training, and that the home provides a friendly atmosphere to work in. A health professional stated that they had received positive feedback from relatives; and that the home takes action on any concerns raised by residents or relatives. Residents said on the day that they are looked after very well. The visit included viewing all areas of the home; talking with staff and residents; and examining documentation such as care plans, medication charts, and staff files. The home has recently been struggling with a shortage of nurses and care staff. Most shifts are covered by the homes own staff and their own bank staff, and recruitment is ongoing. What the service does well: The home provides detailed information for new and prospective residents. This is set out in an indexed format, so that it is easy to access specific details. Nursing and care staff ensure that personal care is carried out respectfully, and with attention to detail. Assessments and care plans confirm that residents are given the choice of a bath or shower, and with attention to promoting good skin integrity. Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 6 The home has a relaxed and friendly atmosphere. Visitors are made welcome, and offered drinks. Residents said that the food is well cooked, there is a good choice, and they are not rushed at meal times. What has improved since the last inspection? What they could do better: Care plans could show more evidence as to how the Mental Capacity Act is applied for residents who are no longer able to make their own decisions about important issues. There is a requirement to ensure that moving and handling procedures are being properly carried out at all times. Medication management is generally satisfactory but there are some areas which could be further improved. Some residents would appreciate additional opportunities to go out of the home for shopping or relaxation. The décor and furnishings are generally clean, and satisfactorily maintained. However, the general impression of the home is that the décor is tired; and the home could be much better presented if a refurbishment was carried out. The carpeting throughout is generally in poor condition, and there are stale odours in the home, which seem to come from carpets which no longer respond properly to cleaning processes. Carpets in some rooms have been replaced, but still appear to be of poor quality. Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 7 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. Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 8 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 Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 9 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): 1-5 (standard 6 does not apply in this home). Quality in this outcome area is good. The home provides detailed information to enable prospective residents to make a decision about moving into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose and service users guide are well presented, and are set out with different subjects so that they are easy to read and find the relevant information. These are kept up to date, so that they show the range of staff available in the home. Each resident is provided with their own copy of the service users guide on admission. This includes details of information about items such as visiting, meal times, rooms available, use of phones, ordering newspapers, activities, and a précis of the pattern of the day as to how the home runs on a day to day basis. Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 10 The clinical nurse manager carries out a pre-admission assessment for all prospective residents. Three pre-admission assessments were viewed, and were seen to contain comprehensive information about all aspects of the persons medical, social and personal care needs. The manager ensures that any necessary equipment is in place prior to admission. Each resident is provided with a contract for the terms and conditions of the home. A sample contract is included in the service users guide. All admissions are for a trial period of four weeks, after which a review is held to ensure that the placement is suitable. The service users guide contained a brief summary of the homes complaints process, but should include the complaints procedure. The manager said that this would be added in. Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 11 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): 7-11 Quality in this outcome area is good. Personal and health care needs are met by a team of competent and caring staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans are set out for each resident in two folders – one folder with care plans, and the other with assessments and charts for day to day care. The second of these folders in kept in residents own bedrooms with their agreement. The managers must ensure that there is no information contained in these folders that contravenes residents privacy and dignity. Each resident has care plans in place for every aspect of daily living – e.g. maintaining a safe environment, personal hygiene, nutrition, mobility, activities and social needs, and communication. These are backed up by associated risk assessments kept in the second folders, easily available for staff to access. The care plans and assessments are re-evaluated monthly. Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 12 They contain clear details and directions about how care is to be given. For example, moving and handling assessments state if a hoist is to be used, and which one, and if two carers are needed. Risk assessments are carried out for use of bed rails, and the documentation showed that use of bed rails is discussed with the resident and/or their relatives/representative, so that they are aware of the risks associated with using them, as well as the risks of not using them. There are also risk assessments in place for residents who prefer to have a lap belt in their wheelchairs, as they feel more secure with this form of restraint. Wound care is well managed, with separate records for each pressure ulcer or wound, and a detailed record for each dressing change, and photographs, showing the progress of healing. Consent is obtained for taking these photos. Each new resident is asked to complete a questionnaire about their previous lifestyle, and to identify the way in which they like to spend the day. These forms confirm their preferences about items such as socialising, taking part in activities, going to the hairdresser, hobbies, interests, and preferred time for getting up, going to bed and likes and dislikes. A chat with one of the night staff confirmed that in so far as reasonably possible, residents are able to get up at their preferred times. They may be assisted to get up earlier than usual if they have to attend a morning hospital appointment, or similar reason; or if they request to do so. Residents usually have a bath or shower (according to choice) every third day, unless they ask for these to be more frequent, or less frequent. The home ensures that appropriate referrals are made to other health professionals, and care plans showed input from these, such as GPs, speech and language therapist, dietician, physiotherapist, optician and specialist nurses from the West Kent PCT. Daily records are completed by nurses and care staff. These contain adequate details. Additional charts are maintained to monitor specific care needs, such as fluid charts and turn charts, and diabetic blood sugar records. We (i.e. CSCI) were informed that there have been some recent occasions when residents may possibly have not been moved according to the moving and handling procedures in their care plans e.g. a hoist not being used when the care plan specifies that a hoist must be used. There is no evidence to show that any residents or staff have been put at risk, and so this has not been dealt with as a Safeguarding issue. However, CSCI have requested that the managers investigate this concern, and ensure that moving and handling procedures are always carried out correctly. The registered manager stated that this matter would be addressed. Medication is stored in a clinical room, and is mostly administered via a monitored dosage system. Storage cupboards have sufficient space and are Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 13 kept in good order, with evidence of stock rotation. The controlled drugs cupboard is of sufficient size, and these drugs are well recorded and audited every week. The controlled drugs cupboard is rusty in places, and should be reviewed to check if it needs to be replaced. There are two medication trolleys, and these are just sufficient to store daily medication for each side of the home. Eye drops are dated on opening, but not bottles of medicines, and one was found which may have been out of date, but there was no way of knowing as it had not been dated on opening. This was discussed with the clinical services manager, who agreed that it would be good practice to date all bottles on opening. Medication Administration Records (MAR charts) are generally well maintained, and include a photograph of each resident, and any specific directions about their medication. Some handwritten entries had not been signed, and these must be signed by two nurses for accountability. The home has a system in place for assessing a residents ability if they wish to self – administer medication, and each room has a lockable facility. The clinical room window was partly boarded up. This matter was already being dealt with, to replace reinforced glass, and fit window bars. Staff were seen to interact well with residents and to treat them with respect and kindness. Residents said that they are very well looked after and it is very good here. Discussions are carried out as soon after admission as possible in regards to residents wishes about death and dying, and resuscitation in the event of an emergency. Some of the care plans showed that the senior staff are very good at ensuring these discussions take place, but do not clearly show that the Mental Capacity Act is being applied in recording the ability of the resident to make their own decisions. This documentation could be improved, particularly in circumstances where residents no longer have the mental capacity to take detailed decisions, and these are made by someone else on their behalf. These decisions need to be backed up by showing how the decision has been reached, and signed and dated by the people involved in making the decision. Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 Quality in this outcome area is good. The home provides a suitable range of activities for residents enjoyment. Food is well cooked; and there is a good variety for meeting nutritional needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an activities co-ordinator who has worked at the home since it opened, and is very well acquainted with residents preferences in regards to social activities. There is a monthly programme of activities and entertainment, which is provided for each resident, and displayed on small notice boards in their own rooms. Activities are managed on a day to day basis according to what the residents feel like doing that day. This may include items such as exercises to a DVD (which several residents were watching/taking part in during the morning of the inspection); reminiscing, quizzes, bingo and crafts. Many residents prefer one to one time, which may include hand/leg massage, nail care, and being taken for walks in the grounds. The home has three acres of beautifully maintained grounds; and there is a path all the way round the home so that residents can walk around, or go round it in wheelchairs. Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 15 The home has entertainment afternoons with singers and musicians, and special afternoons such as a strawberry tea, birthday celebrations, and parties for special occasions. Residents are sometimes taken out to the nearby village (for example, for a recent flower festival); and some go out with their relatives. The home does not have a minibus, but can borrow one from another company home, or can access wheelchair taxis. They try to arrange outings to places such as garden centres one - two times per year, and some residents would appreciate increased opportunities for going out. However, the results from the most recent residents survey indicated that most are satisfied with the amount and range of activities available. Church services are held in the home each month, and other ministers are able to visit the home according to residents wishes. Residents are able to bring in their own items, and some residents have taken full advantage of this, and have personalised their own rooms with photos, ornaments etc. A property list is completed on admission. The home provides information about obtaining advocacy, for residents who can no longer manage their own affairs, and do not have a family member to assist them. Residents said that the food is very good, that there is plenty of choice, and sufficient quantity. One resident said: the trouble is, they are feeding me too well! Menus are discussed between the manager, clinical manger and cooks, and are altered to include new ideas or choices from residents. The home employs a cook and a kitchen assistant throughout the day, to ensure that residents wishes can be accommodated. The menus run on a four weekly cycle, and the cycle is altered to accommodate seasonal changes. Meal times are flexible for residents who are going out, and for breakfast times. There is always a choice of main meal and dessert, and choices of hot or cold dishes/sandwiches, soup etc. at tea times. Tea is served between 5-6pm. Hot drinks are served with biscuits in the mornings, and with home made cakes in the afternoons. Evening drinks are offered with biscuits or snacks if residents ask for them. The night staff said that they have full access to the kitchens, and will always make a snack such as sandwiches or toast for anyone in the night. The kitchen was seen to be clean, tidy and well equipped. Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. Complaints are taken seriously and are dealt with appropriately. Residents are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is on display in the front entrance hall, and contains all the required information. It states that concerns and complaints should first be addressed to the manager, and then includes the details of the companys operations director for anyone who wishes to use that pathway. Details are also included for the local Social Services department and for CSCI. The complaints procedure was not included in the service users guide, and the manager agreed that it should be included. This means that each resident will have a copy in the folder in their own room. The complaints log showed that there were three complaints in the last year, and the records show that these were properly investigated, and appropriate action was taken to deal with the issues raised. The manager ensures that complainants are kept informed about the progress of any investigation. The manager and clinical services manager have an open door policy, and also speak to most residents on most days. Residents are confident that any concerns are taken seriously, and are dealt with properly. Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 17 The manager is familiar with the procedures for safeguarding vulnerable adults, and has a copy of the Kent & Medway policies and procedures available for reference. Prevention of abuse is discussed during the initial induction process. All staff is required to attend training in the protection of vulnerable adults, and to have yearly updates. All nursing and care staff were up to date with this. The manager was already aware that some of the housekeeping staff had not had this training during 2008, and was arranging this. Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 Quality in this outcome area is adequate. The home is suitable for its purpose and is kept generally clean. However, many areas would benefit from redecoration, and most carpeting needs replacing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The building is a very pleasantly situated, purpose built home, set in attractive gardens. It has been designed with four wings, all on one floor, and with ten beds in each wing. The outside of the home is well maintained. The entrance hall is a disappointment after the view of the outside, as although the décor is generally clean and adequate, the carpet is old, and there are old-fashioned armchairs. There is a generally stale smell throughout the whole home, which seems to be a result of constantly cleaning old and stained carpets, which no Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 19 longer respond to the cleaning process. The manager said that she has been informed that the home is due for refurbishment soon. The home is decorated in all areas in the same colour (cream/magnolia), which is very bland, and does not give any added interest to bedrooms or communal areas. Some residents bring in their own soft furnishings to personalise their own rooms. The home has a very large dining/lounge area; and a new conservatory – with some new furniture - has been added in the last year. There is a small quiet room adjacent to the front entrance hall. The corridors and lounge/dining room are light and spacious. The bedrooms are all above the recommended size of 10 sq.m. The home has sufficient numbers of bathing and toilet facilities. The toilets have suitable hand and grab rails, toilet surrounds, and raised toilet seats or over toilet commode chairs. There is sufficient space for hoists and wheelchairs. The bathrooms are fitted with assisted baths, and the shower rooms are easily accessible for residents and care staff. These facilities are very bland, and do not appear homely. The home is equipped with a nurse call system for all rooms, and staff ensure that residents have access to their call bells. There are three hoists and two stand-aids. Staff generally feel that another hoist would be helpful. There is sometimes a problem with needing a particular hoist that is over the other side of the home, and so takes time to access the correct hoist. This may also have some bearing on the information to CSCI that some staff have not been carrying out moving and handling procedures correctly for all residents (see section on Health and Personal Care).A survey form included a comment that additional shower chairs would be helpful, and a new one had already been ordered and arrived on the day of the inspection visit. Residents are provided with nursing beds, and there is sufficient pressure relieving equipment available. All radiators have been fitted with covers for safety, and hot water temperatures are recorded monthly. Thermostats have been fitted to hot water outlets where residents have access to these. All of the bed linen, towels and personal clothing is laundered in the home, and there is a laundry assistant on duty seven days per week. The laundry is equipped with two washing machines and two tumble dryers. The washing machines are fitted with a sluice facility, and a red alginate bag system is used for dealing with soiled items. There are systems in place for managing items of lost clothing. Residents clothes are ironed as appropriate. Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 20 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): 27-30 Quality in this outcome area is good. Staffing levels are satisfactorily maintained, and staff training is reliably carried out. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels in the day time comprises two trained nurses and six carers in the mornings; two nurses and four carers in the afternoons and evenings; and one nurse and three care staff at night. Discussions with different staff confirmed that this usually works well in practice. There have been some recent shortages of nurses and care staff due to sickness. Other staff or bank staff can usually cover these shifts. The clinical services manager will also work as a nurse or carer if others cannot cover the shortage. The home is continuing to recruit more staff. The company has a policy of not using agency staff if at all possible. However, they must ensure that there are sufficient means in place to cover shortfalls. The home has domestic, kitchen and laundry staff on duty each day, and a maintenance man for three days per week. He looks after the gardens as well as carrying out day to day maintenance for the home. The home also has work done by other maintenance staff from the company, especially for large maintenance jobs or redecoration. Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 21 All care staff are informed at interview that they are expected to study for NVQ level 2. The home has over 50 trained to this level (or NVQ 3), which is very good; and several others are currently studying for NVQ 2. Three care staff are currently working for NVQ level 3. Three staff recruitment files were examined, and these showed that there are good recruitment procedures in place. Applicants are obliged to complete an application form with a full history of employment; provide details for two written references; proof of ID; and any training certificates. A POVA first check is carried out prior to commencement of employment; and staff work under supervision until a Criminal Record Bureau (CRB) check is received. All staff have a basic induction, followed by mandatory training. The staff training matrix shows that mandatory training is up to date in most areas, or is already booked. The only area not up to date is POVA training for housekeeping staff, and this has already been mentioned in the section on Complaints and Protection. The company have their own training staff, and external courses are also used. Nursing staff are able to update their own skills and competencies, by attending courses such as male and supra-pubic catheterisation; end of life care, and PEG feeding. Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 22 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; and 35-38 Quality in this outcome area is good. The residents benefit from living in a home which is run by an effective manager and a competent staff team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager was appointed in November 2007, and is registered with CSCI. She has a management qualification, and oversees all of the general running of the home. The nursing care is delegated to the clinical nurse manager, who is a level one nurse, and works closely with the general manager. They are supported by an area manager, who visits the home two to three times per month; and via monthly managers meetings with managers from other company homes. Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 23 The staff were seen to interact well with each other, and said that they help each other out if there are staff shortages. There is a formal staff one to one supervision process, and this is delegated to the heads of departments, and with carers allocated to nursing staff. One to one supervision is approximately every six to eight weeks, and staff also have a yearly appraisal. The manager and clinical nurse manager have an open door policy, enabling staff and residents or relatives to talk with them at any time. Staff meetings are held two to three times per year, with the last one held in June. The company have a quality assurance system in place which includes yearly residents surveys. The most recent survey had 42 of questionnaires returned. The results show that most residents are satisfied or more than satisfied with the standards of care, food, activities, atmosphere and friendliness of staff. The biggest cause for dissatisfaction in the home is the odour – which seems to emanate from the carpets. Others feel there is room for improvement with the décor and furnishings. The results are in a folder which is available to all. The home does not manage personal monies for any residents. If they cannot manage these themselves, they have a delegated appointee, who may be a relative or solicitor, to assist them. Most day to day items such as toiletries or new clothes are brought in by relatives, but the manager will arrange for the purchase of these for anyone who does not have relatives available. Records and documentation are kept in good order and are well maintained. Servicing records are retained for all items such as electricity, hoist servicing, PAT testing and fire equipment. The home has an up to date fire risk assessment. Accident and incident records are well documented. Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 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 2 3 3 2 3 3 3 2 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 25 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. 1 Standard OP8 Regulation 13 (4) (c) and (5) Requirement Timescale for action 17/10/08 2 OP9 13 (2) 3 OP19 23 (2) (b,d) To ensure that all moving and handling procedures are carried out in accordance with the risk assessments in care plans. Investigation response to be received by the given date. In regards to medication: 17/10/08 • To ensure that all handwritten entries on Medication Administration Records are signed by two nurses. • Medication must not be administered to any staff within the home. • The controlled drugs cupboard should be reviewed to ensure that where it is rusty it does not compromise the safety of the cupboard. • The boarding on the window must be replaced with appropriate glass and safety features. To review the state of the 09/03/09 carpets throughout the home, and replace these as needed. Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 26 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 Refer to Standard OP1 OP8 Good Practice Recommendations To ensure that the complaints procedure is included in the service users guide. To provide clear information as to how the Mental Capacity Act is applied for residents who no longer have the mental capacity to make their own decisions. This should particularly be applied to documentation about making end of life decisions. To increase the opportunities for residents to go out of the home. To ensure that all staff keep up to date with POVA training. For the estates management to provide a plan for redecoration and refurbishment of the premises, with dates; and ensure that residents and relatives are informed about this. To review hoisting facilities, and ensure that there are a sufficient number of hoists for use at all times throughout the home. 3 4 5 OP12 OP18 OP19 6 OP22 Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Westbank Nursing Home DS0000026213.V371777.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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