Care Home: Westbourne Nursing Home

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What the care home does well People are assessed before they move into the home to ensure their needs can be met, and are encouraged to visit anytime and have a meal with the people in the home and meet the staff. A person spoken to about their admission said it went smoothly as they already knew the staff well during recent day care visits. There are good care plans, which include the support of healthcare professionals when required. People are risk assessed to help prevent pressure sores and the correct equipment is provided. People are treated with dignity and respect by the staff and the following comments were made; `Staff are kind and helpful`, `I am looked after well`, `staff are kind, I like living here`. Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 6Medication administration was well managed which helps to protect vulnerable people who need assistance. Many complimentary letters were seen where staff had provided end of life care. Various activities are well organised by the activities co-ordinator who also takes people out and helps at mealtimes. The activities include; Dominos. Bingo, hand care, music and movement, board games, baking, crafts, reminiscence groups, and Whist drives. Regular residents meetings help to find out what people want to do. Spiritual needs are met with regular visits by the local vicar. The people living in the home said they enjoyed the activities. The staff helped people with their meals in an unhurried manner in order that they can enjoy what is seen as one of the highlights of the day. The staff take complaints and concerns seriously, and a relative said staff respond well when concerns are raised. Most of the people living in the home were spoken to and all said they felt safe in the home. The knowledge of the staff and the policies and procedures of the home help to protect people from abuse, and give staff the information they need to identify and report issues of abuse. The home is well maintained and was very clean throughout, and people said the laundry service was good. The home has an experienced and well qualified team of dedicated staff, which helps to ensure that people are treated with respect and their needs are well met. The care staff were pleased to have regular meetings and an open and supportive management team. There were clear lines of responsibility in the management team, which helps people feel they can be relied on. A relative told the inspector that `real improvements can be seen and suggestions I have made have been completed`. Other relatives said that `the relatives and residents meetings were a positive improvement`, which means people can have their say. `The manager is very good`. The home produces a newsletter for people to see what has been happening in the home and what plans the management have for improvements. Health and safety records were well maintained and any risks were identified and reduced where needed. Many policies and procedures had been reviewed recently and the new manager was trying to complete them all to help ensure that the home is well run. The AQAA and dataset information, which was well recorded, indicated that the servicing and maintenance of equipment in the home was complete, which helps to ensure a safe environment for everyone. What has improved since the last inspection? Individual care plans have been introduced using a new model, which includes all care needs. The care plans seen were well recorded, had clear actions for staff to follow, and were reviewed monthly. The home had new weighing scales for use with a wheelchair so that nutritional assessments can be more accurately assessed for everyone. Mainly fresh produce is used in the home now, this includes meats, fruit and vegetables. An additional variety of foods had been added to the menu. People living in the home and relatives said that the quality of the food has improved and that the food is good. The increase in chef hours means that a more varied diet is provided, and hot alternatives can be given for supper. Since the last inspection the lounge, dining area and hallway have been redecorated. Paintings had been purchased to enhance the home and some old style divan beds have been replaced by profiling beds that can be adjusted to the different heights. Several rooms have been decorated and some carpets and curtains replaced. Care staff have been released from catering duties at tea and supper time due to the increase in chef hours at these times, which can be a busy time of day. Quality assurance is improving and the manager had distributed surveys to relatives, residents and staff, and recently tea and coffee tasting sessions were organised to help people choose which brands that they like. CARE HOMES FOR OLDER PEOPLE Westbourne Nursing Home 190 Reservoir Road Gloucester Glos GL4 6SB Lead Inspector Kate Silvey Key Unannounced Inspection 14th & 19th November 2007 9:20 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 Westbourne Nursing Home DS0000069818.V348652.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. Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westbourne Nursing Home Address 190 Reservoir Road Gloucester Glos GL4 6SB 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) 01452 506106 01452 422 939 Westbourne:90@aol.co.uk Westbourne Care Limited Mrs Caroline Margaret Finch Stinton Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who may be accommodated is 19. 12/02/07 Date of last inspection Brief Description of the Service: Westbourne Nursing Home is a converted Victorian property, which has been extended and refurbished to provide accommodation for up to nineteen older people that require nursing care. Westbourne is situated in a pleasant residential area on the outskirts of Gloucester. Accommodation is provided on two floors, accessed by a shaft lift and stair lifts. The home is equipped with assisted bathing facilities and suitable adaptations. Eight of the bedrooms have en suite facilities. Two large communal areas are provided on the ground floors. The home also has the benefit of a large accessible well kept garden. The Statement of Purpose and Service Users Guide is on display in the main entrance of the home. All people can have their own copy if they wish. The homes fees are £590 - £605 per week. Prospective service users are sent a separate tariff with the Service Users Guide, which explains how the fees are calculated according to the level of dependency. The information also includes the amount of nursing care contribution paid for people that are self funded. Additional charges are made for toiletries, newspapers, hairdressing and chiropody. Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Westbourne Care Limited was registered with the Commission as the registered providers on 14 June 2007. The new registered manager Mrs Caroline Stinton, Registered General Nurse, has worked at the home for many years and was the nurse manager. The unannounced inspection took place over two days with one inspector. All the people accommodated were seen and many were spoken to during the inspection. Visitors were spoken to and staff were interviewed, which included the activities coordinator and one of the cooks. The inspector observed staff during mealtimes, whilst giving care and when activities were provided. The accommodation and grounds were seen, including the kitchen and laundry facilities. Records were looked at, which included care plans, medication, recruitment, and fire safety. The Commission received four surveys completed by relatives and the inspector spoke to two relatives on the telephone. Six staff surveys, and one survey completed by a doctor were also returned to the Commission. An Annual Quality Assurance Assessment (AQAA) of the home completed by the registered manger was sent to the Commission. What the service does well: People are assessed before they move into the home to ensure their needs can be met, and are encouraged to visit anytime and have a meal with the people in the home and meet the staff. A person spoken to about their admission said it went smoothly as they already knew the staff well during recent day care visits. There are good care plans, which include the support of healthcare professionals when required. People are risk assessed to help prevent pressure sores and the correct equipment is provided. People are treated with dignity and respect by the staff and the following comments were made; ‘Staff are kind and helpful’, ‘I am looked after well’, ‘staff are kind, I like living here’. Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 6 Medication administration was well managed which helps to protect vulnerable people who need assistance. Many complimentary letters were seen where staff had provided end of life care. Various activities are well organised by the activities co-ordinator who also takes people out and helps at mealtimes. The activities include; Dominos. Bingo, hand care, music and movement, board games, baking, crafts, reminiscence groups, and Whist drives. Regular residents meetings help to find out what people want to do. Spiritual needs are met with regular visits by the local vicar. The people living in the home said they enjoyed the activities. The staff helped people with their meals in an unhurried manner in order that they can enjoy what is seen as one of the highlights of the day. The staff take complaints and concerns seriously, and a relative said staff respond well when concerns are raised. Most of the people living in the home were spoken to and all said they felt safe in the home. The knowledge of the staff and the policies and procedures of the home help to protect people from abuse, and give staff the information they need to identify and report issues of abuse. The home is well maintained and was very clean throughout, and people said the laundry service was good. The home has an experienced and well qualified team of dedicated staff, which helps to ensure that people are treated with respect and their needs are well met. The care staff were pleased to have regular meetings and an open and supportive management team. There were clear lines of responsibility in the management team, which helps people feel they can be relied on. A relative told the inspector that ‘real improvements can be seen and suggestions I have made have been completed’. Other relatives said that ‘the relatives and residents meetings were a positive improvement’, which means people can have their say. ‘The manager is very good’. The home produces a newsletter for people to see what has been happening in the home and what plans the management have for improvements. Health and safety records were well maintained and any risks were identified and reduced where needed. Many policies and procedures had been reviewed recently and the new manager was trying to complete them all to help ensure that the home is well run. The AQAA and dataset information, which was well recorded, indicated that the servicing and maintenance of equipment in the home was complete, which helps to ensure a safe environment for everyone. Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Good quality food is provided but some people would like more choice at lunchtime. People said; ‘some meals are good, but there is no choice’ and ‘there is not much choice of food here’. The staff could ask people the day before what they would like for lunch so that they feel there is a real choice for their main meal and not a set menu. Recruitment records need to be checked to ensure that there are two relevant references, that certificates of qualifications are seen and that all Criminal Records Bureau information is correct, to help ensure people are protected. The record of two peoples personal monies could be more clearly written and signed by two staff to protect everyone concerned. Supervision for all staff is planned this should be completed and recorded every two months to help identify the training need and all aspects of practice. Please contact the provider for advice of actions taken in response to this Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 8 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. Westbourne Nursing Home DS0000069818.V348652.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 Westbourne Nursing Home DS0000069818.V348652.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People move into the home only after an assessment of need has been completed, which helps to ensure that their needs can be met and their admission is well planned. EVIDENCE: The inspector saw two examples of pre-admission assessments. The format used by the home included the areas identified in the National Minimum Standards for assessment. The assessments were well recorded which helps to ensure that peoples needs can be met and their admission is well planned. A person was spoken to about their admission and they said it went smoothly, as they were already coming to the home for day care and knew the staff well. People are encouraged to visit the home unannounced to see for themselves what the home has to offer. Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 11 Healthcare professionals from a hospital outside the county had completed another pre-admission assessment. The requirement to review and amend the Statement of Purpose and the Service User Guide has been completed and the inspector saw both documents in the hall. People spoken to were pleased to have the information in the Service User Guide. Westbourne Nursing Home DS0000069818.V348652.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. This judgement has been made using available evidence including a visit to this service. All people had a regularly reviewed care plan, which was well recorded, identifying needs and providing clear actions for staff to follow. People are well supported by healthcare professionals when required to ensure appropriate care is given. Medication is well managed and people are protected by the policies and procedures used. People in the home say they are treated with dignity and respect and have their privacy upheld. EVIDENCE: Three care plans were looked at in detail and the requirements from the last inspection had been met, which was to ensure care plans were kept under review and that service users and or their relatives are involved. The three people were spoken to and all agreed that they were treated with dignity and respect by the care staff. One person said “there is nothing I can Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 13 think of I want to change, the food is good, the staff are kind, I have a nice room and I am comfortable”. Individual care plans have been introduced using a modified Roper’s Nursing model. Problems are identified, and each problem has a goal and an action plan. The care plans seen had good detailed actions for staff to follow, which included a good action plan for a person with sight impairment and another for communication. All care plans are reviewed at least monthly and more often when required. The reviews seen were meaningful and the daily records identified what had been happening, which supported the care plan actions. People living in the home sign their care plans where possible. Risk assessments are completed and reviewed, it was recommended that at least an annual assessment of all aspects of care is completed to help ensure that new problems and risks are identified. People are weighed regularly and the new scales, for use with a wheelchair, ensure a more accurate record for some. The manager plans to improve nutritional screening and all weights will be recorded individually in the care plans to easily identify the need for intervention. People have appropriate pressure relieving equipment and a risk assessment is recorded so that measures can be taken to prevent pressure sores. There is evidence that healthcare professionals support people in the home when required to ensure that they receive appropriate care. The requirements from the last inspection regarding medication are complete, which included, a second signature when transcribing, secure storage of all medication, the correct temperature of storage, and the safe disposal of medication. The medication is well managed, the home uses the original containers for administration and a trolley to transport medication between floors. The trolley and cupboards inspected were well organised and medication was safely stored. The staff transcribe all medication administration records. The manager is considering using a monitored dosage system where the supplying pharmacist will print the records. Currently there are no people that self-medicate, however, the bedrooms have lockable storage should people wish to. The medication is audited monthly to help ensure safe handling, it was recommended that tablet counts are completed as part of the audit. The manager stated that doctors’ complete regular reviews of peoples medication, and the supplying pharmacist will be commencing a six monthly inspection. There is a comprehensive medication administration policy and procedure. It is recommended that the home obtain a British National Formulary medication reference. The nursing staff receive medication administration training from the supplying pharmacist to ensure their training is updated. The home provides a cordless telephone so people without their own line can take and make calls in the privacy of their own room. Staff were seen treating people in a dignified unhurried manner and privacy curtains were provided in shared rooms. People say they are treated with dignity and respect by the Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 14 staff and comments made were; ‘Staff are kind and helpful’, ‘I am looked after well’, ‘staff are kind, I like living here’. Many complimentary letters were seen where staff had provided end of life care. The wishes of people are recorded regarding terminal care and some staff have completed training for end of life care. The manager plans to send more staff on a specific dignity focussed course (The Dignity Challenge). Westbourne Nursing Home DS0000069818.V348652.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 excellent. This judgement has been made using available evidence including a visit to this service. Suitable activities and ones chosen by people are organised by a dedicated activities co-ordinator, and are enjoyed within the home and in the community. Religious/spiritual needs are met in the home where relatives and friends are made welcome. Good quality food is provided that people like, but some want more choice at lunchtime. EVIDENCE: The home employs an activities co-ordinator from 9:30 – 15:00 hours four day each week, she is experienced and committed to providing a range of activities for people to enjoy. The varied programme seen included; Dominos. Bingo, hand care, music and movement, board games, baking, crafts, reminiscence groups, Whist drives. People were also occasionally taken out locally with the activities co-ordinator. Cream teas are organised and celebrations of national and international days take place where food and activities from different parts of the world are experienced. The funds for outing outside the home, visiting entertainers and equipment have to be raised by ways of a raffle etc. as there is no budget for this. One relative said the activities organiser ‘does a tremendous job’. Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 16 A relative sometimes helps with the activities and care staff help occasionally. Several people were seen taking part in activities during the inspection, and many needed constant support. It is recommended that care staff join in as much as possible otherwise the co-ordinator has to try and support everyone. Residents Meeting are held every six weeks to find out what people want to do and for them to comment on anything they wish to, minutes are kept and information is included in the homes newsletter. People also complete quality assurance surveys for the manager. There was well written information in the daily records about what people do. Risk assessments are completed for activities as part of the care plan. The activities co-ordinator is qualified in aromatherapy massage and some people enjoy this relaxing therapy. The activities co-ordinator will soon be completing an activities course, one day a week for six months and the home is taking on the guidelines of the National Association for Providers of Activities for Older People to help improve the activities further. Spiritual needs are met in the home with regular visits by the local vicar and one person has an individual religious service in her own room. Diversity issues are looked at and the manager had information for staff to enable them to understand the needs of all people accommodated. The people living in the home spoken to said they enjoyed the activities. The manager has designed a new record for personal histories to help staff to become aware of what people have enjoyed doing in their life, so that more individual activities are provided. The new four week menus seen had some different dishes on, but not all of them were popular. A choice of salads and soup was available as an alternative to the lunch menu, but it was in small print and was not transferred to the daily large print menu board. There were two people who commented that a choice of food was not available, and after discussion with the manager it was agreed that people should be asked the day before what they would like for lunch. The increase in chef hour’s means there is a hot alternative at suppertime, which enables the home to provide a more varied diet. The home has fresh fruit available and uses mainly fresh vegetables, which are added to the daily homemade soup. The soup is popular with the people living in the home and most were satisfied with the meals provided People told the inspector that; • ‘The food is good’ • ‘we are well fed, I like the food, I am not sure if there is a choice’ • ‘some meals are good, but there is no choice’ • ‘there is not much choice of food here’ • ‘the food is homely’. Relatives surveyed and spoken to said; • The quality of the food has improved. • The new menu does not appear to appeal to the residents, they like old fashioned food not quiche and lasagne. Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 17 • • Someone offers a choice of food in the evening but lunchtime there is a menu displayed that does not offer choice. I am offered meals when I visit the home. The manager stated that the quality of food provided has improved as the home buys all fresh meat now and tinned meats are no longer used. The homes quality survey of people living in the home resulted in 90 said the food was good, and staff also taste the food to aid quality control. People had access to jugs of water or juice throughout the day and snacks of fruit, biscuits, cakes and crisps were always available. Special diets can be catered for, currently four meals are pureed to help people with swallowing difficulties. It was discussed with the manager that some people may need to be referred to the Speech and Language Therapist (SALT) to ensure they have the correct consistency of food to aid digestion. Lunchtime meals were observed and staff were carefully helping people who required some assistance and people were unhurried which helps to ensure that meals are a highlight of the day for everyone. The two cooks, two care staff and the Hotel Service Manager have food hygiene training. The kitchen was clean and organised and fridge/freezer temperatures were recorded, which helps to ensure food is stored and handled safely. Westbourne Nursing Home DS0000069818.V348652.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. This judgement has been made using available evidence including a visit to this service. The home has a good complaints procedure, which people have a copy of, and the manager takes all complaints seriously and investigates them well. The knowledge of the staff and the policies and procedures of the home help to protect people from abuse, and give staff the information they need to identify and report issues of abuse. EVIDENCE: The home had records of two complaints dealt with, both were related to food provided. There was a record of a written response and a verbal response, and the manager had dealt with both adequately. A relative was spoken to during the inspection and was satisfied with the outcome of one of the complaints. The complaints procedure is in the Service User Guide and is displayed in the hall. The surveys from two relatives, returned to the Commission, said that ‘they did not know how to make a complaint’. However, the two relatives stated that staff always respond appropriately when concerns were raised. The home has quarterly relatives meeting where issues are raised and a record of the actions taken by the home are sent to all relatives. There is a suggestions and compliments book in the hall, which together with the complaints record forms part of the homes quality assurance assessment. Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 19 Most of the people living in the home were spoken to and all said they felt safe in the home. Staff spoken to had received training in the protection of vulnerable adults and knew what to do when asked should they need to report an abuse issue. The home has adult protection policies and procedures including the Department of Heath ‘No Secrets’ guidance about ‘whistle blowing’. Most staff have received POVA training, three staff were interviewed and only one required a specific adult protection update, as identification of abuse and ‘whistle blowing’ had been covered during NVQ level 2 in care training. There was evidence that a recent safeguarding issue had been managed well, with the help of the local adult protection team, this was discussed with the manager. Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. The home is well maintained, bedrooms are personalised and it is clean throughout. There have been many improvements since the last inspection. The grounds are well kept and people are secure and safe. Laundry facilities are adequate and infection control procedures are followed to prevent cross-infection. EVIDENCE: The inspector looked at all the rooms in the home and there was a good standard of decoration and furniture. Since the last inspection the lounge, dining area and hallway had been redecorated. Paintings have been purchased to enhance the home and some old style divan beds had been replaced by profiling beds that can be adjusted to the different heights. Several rooms have been decorated and some carpets and curtains replaced. Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 21 New furniture has been ordered for the dining room, which will include separate small tables with matching chairs, some will have sliders to aid manoeuvrability. People’s rooms were personalised with mementos and looked homely. Some bedrooms did not have a chair for visitors, it is recommended that the managers complete an audit to ensure that where required this need can be met. The cleaning systems of the home have improved under the control of the housekeeper/hotel services manager. The home was clean throughout and people said their rooms were kept clean. People also said the laundry service was good. The laundry accessed from outside was seen, and was well organised and clean. The laundry machines have sluicing and disinfection cycles. All infection control information is currently kept in the office. It is recommended that there is an infection control procedure in the laundry for staff to follow, as this can be where some antibiotic resistant micro-organisms need to be eliminated to prevent cross-infection. The Dept of Health website has the latest guidance available. The sluicing facilities use a disinfector and a commercial company collects all clinical waste. There are plans to make the conservatory cooler in the summer with the purchase of new blinds and provide ramps for direct access to the garden, where raised flowerbeds will be provided for people to tend if they wish. The gardens were well maintained and provide a large area for people to enjoy. The home employs a maintenance inspector four days a week, and he is on call 24 hours for any urgent issues. The home is well maintained and a faulty radiator was immediately repaired during the inspection, as the person was cold in her bedroom. A relative raised the question of security of the home and the manager agreed to look into providing an improved secure environment for people who may wander, and easy access for regular visitors to the home. The safety and security of people living in the home is important. The manager will bring the subject up for discussion at resident/relatives meetings. Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 22 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. This judgement has been made using available evidence including a visit to this service. The home has an experienced and well qualified team of dedicated staff, which helps to ensure that people are treated with respect and their needs are well met. Recruitment procedures help protect people but there is a need for the manager to ensure that all records are correct. EVIDENCE: The staff rota was seen and several staff were interviewed to judge that the home has adequate staff and the skill mix to provide good care. The AQAA stated that there are adequate staffing levels at peak times of activity and that staffing levels and skill mix meet the needs of people in the home. During the inspection staff were calmly completing care tasks and did not appear to be rushed. There have been several changes since the new providers took over the home and although staff morale was low due to the change staff spoken to said they felt well supported now. Staff take part in the annual quality questionnaire so that the Providers can understand their views and needs. There is a low turnover of staff, which helps people living in the home to feel secure with good continuity of care provided by staff they know and trust. Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 23 There has been no adverse outcomes for people living in the home as they said the staff were kind and caring, treating them with respect and dignity at all times. There is a team of domestic and catering staff organised by the part-time hotel service manager, and changes have been made to free care staff from catering duties at tea and supper times. Staff spoken to and surveys said; • ‘There are meetings for qualified staff and care staff, where supervision issues are discussed’ • ‘there have been lots of improvements recently and I feel well supported now’ • ‘there is an open management structure and the new manager is doing a very good job’ • ‘we don’t have formal one-to-one supervision yet but it is planned’ • ‘there has been an improvement of staffing levels in the morning’. Staff said that the information they provided in the surveys had been acted upon and some were under review. An example was that hoists were now in place where they were needed. One relative said that there appeared to be a shortage of staff during the weekend recently, as staff were slow to answer the front door, but they were confident that the care of their relative was not affected in any way. Care staff had received NVQ training and at least 50 had reached NVQ level 2 in care, which meets the minimum standard for care staff training to help ensure people are well cared for, and one carer had achieved NVQ level 3 in care. The new manager was in the process of organising the staff training records, which will be looked at in more detail at the next inspection. The qualified nurses had recently updated their knowledge on wound care, and learnt about a new tool used for nutritional assessment to help identify people at risk. It was evident talking to the manager that staff training is taken seriously and qualified staff are encouraged to develop professionally. In the last twelve months all staff have completed fire and moving and handling training and there has been a range of in-house training from the nurse advisory teams and commercial companies. The three recruitment records were seen and improvements could be made. Criminal Records Bureaux and Protection of Vulnerable Adults checks had been completed. Two records required more proof of qualifications and the two references for one carer were from the same family where domiciliary care had been given. To protect people the manager must try to ensure that there are at least two relevant references. The spelling of the surname on one CRB check was incorrect, which the manager had not noticed and agreed to investigate. The requirement to record why people ceased to work in a Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 24 previous care position has been added to the homes application form, which will enable verification if required. It is recommended that interviews with potential staff are formally recorded, where, for example, gaps in employment can be explored and recorded to protect people. There were some brief notes made at one interview. The new induction programme, which meets the Skills for Care standards, was seen as more detailed and will be used for all future recruitments. Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 25 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. This judgement has been made using available evidence including a visit to this service. The management structure of the home is good and regular contact with people living in the home, relatives and staff help to ensure that people are listened to. Finding out what people think through quality assurance methods is improving and surveys are regularly given to people to fill in. People’s personal monies could be managed more safely and accurately. The welfare of people is taken seriously, risk assessments are completed and heath and safety issues are addressed to help ensure their safety. EVIDENCE: The new registered manager has worked at the home for many years, is a qualified nurse and has the relevant management qualification to run the home. The manager’s hours are not included in the care hours for the home, Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 26 this enables sufficient time to be spent on management duties well. The provider was available during the inspection and there is also an area manager to help support the registered manager. The clear lines of accountability and regular contact within the management team is a good indication that the people accommodated have staff they can rely on. The nursing staff interviewed said there had been lots of improvements and they felt well supported now. The registered manager has an administrative assistant in the office, Internet access at the home and at home to enable her to keep up with latest guidance and update policies and procedures. A relative told the inspector the following; • ‘real improvements can be seen and suggestions I have made have been completed’ • ‘the Service User Guide is a tremendous improvement, as is the communication book mum has in her room’ • ‘the nursing care is brilliant’. Another relative said that ‘the relatives and residents meetings were a positive improvement’, and ‘the manager is very good. Comments like this mean people are able to have their say at meetings. The home produces a newsletter for people to see what has been happening in the home and what plans the management have for improvements. People living in the home completed quality assurances surveys in June and November 2007, and the relatives completed them in October 2007. Recently there was a tea and coffee tasting session for people to decide which brands the home should purchase. It was recommended that people living in the home and relatives should have a copy of the survey results and any action taken, to help ensure that comments are followed up. The next staff survey is planned for January 2008. The providers complete the annual development plan. There have been many improvements already and shortly all bedding in the home will be replaced. The records of two peoples personal monies, which the home manages, were seen and were incorrectly recorded. The home should provide receipts for any toiletries purchased from the in-house shop. The administrator agreed to complete a new spreadsheet to include a running total, numbered receipts, date of entry and two signatures for each transaction, this will help to ensure staff and people living in the home are protected. There was a clear record of the hairdressing provided and costs for each person. The supervision dates for all staff had been planned and were on the staff notice board, which will help to identify any training requirements and where staff need support or guidance. However, the nurses have their own meetings where general supervision takes place and issues of concern are discussed. Formal supervision should be completed and recorded six times a year for care staff. Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 27 The manager had completed heath and safety risk assessments for each room in the home, which was seen as well recorded and a review is completed every six months. The manager stated that health and safety matters are covered during staff induction and an update for all staff will be completed soon. It is recommended that people responsible for health and safety in the home have completed some training for this important function. The home has the guidance ‘Essential Steps in Infection control’ and one staff member has completed training in infection control to enable information to be passed on so that polices and procedures are completed with the correct information and staff know their responsibilities. Fire safety records seen were well recorded and staff fire training is recorded on individual records. The manger stated that fire risk assessments were currently being reviewed. The AQAA and dataset information indicated that the servicing and maintenance of equipment in the home was complete, which helps to ensure a safe environment for everyone. All accidents in the home are audited monthly, it is recommended that any actions taken as a result of the audit is recorded. Staff interviewed said their first aid training will be renewed in 2008. Many policies and procedures have been reviewed by the manager in 2007, which helps to ensure that the latest guidance is added and people are safe and well protected. Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A 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 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 2 x 3 Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 29 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 OP29 Regulation 19 Requirement The registered person must ensure that the recruitment records are improved in that the manager must check the references are relevant, CRB information is correct and qualifications can be verified. This helps to ensure that people are protected with robust information. The registered person must ensure that a record of people’s personal monies, kept by the home for safekeeping, are correctly maintained by including; • a running total • numbered receipts • the date of entries • two signatures for each transaction. This helps to protect everyone involved. Timescale for action 31/01/08 2 OP25 17 (2) Schedule 4 (9) 31/01/08 Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations It is recommended that an annual assessment of all aspects of care is completed to help ensure that new problems and risks are identified. It is recommended that a tablet count is included in the monthly medication audit. It is recommended that the home has an up to date copy of a BNF as a medication reference. It is recommended that care staff join in as much as possible with activities, otherwise the activities co-ordinator has to try and support everyone. It is recommended that people choose the day before what they want for lunch, in order that an alternative can be given. It is recommended that the laundry room has an infection control procedure posted, to help ensure that staff complete the laundry duties to prevent cross infection. It is recommended that people living in the home and their relatives have a copy of the homes quality assurance survey results, and any action taken, to help ensure that comments are followed up. It is recommended that all care staff have a formal and recorded supervision every two months. It is recommended that staff completing heath and safety risk assessments obtain training for this important task. 2 3 4 OP9 OP9 OP12 5 OP15 6 OP26 7 OP33 8 9 OP36 OP38 Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Regional Office Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Westbourne Nursing Home DS0000069818.V348652.R01.S.doc Version 5.2 Page 32 - 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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