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Care Home: Westbrook House

  • 150 Canterbury Road Westbrook Margate Kent CT9 5DD
  • Tel: 01843254100
  • Fax:

The home is a large new purpose built care home, which is a joint project between the local authority (KCC) and the NHS PCT. The home has the facilities to provide intermediate care. Physiotherapists and occupational therapists are based in offices 60 60 0 within the building. The home is laid out in four units and has day centre facilities. The units are used to provide separate areas of care according to the needs of the resident. These are intermediate care with nursing (2x 15), dementia (15) and mental health nursing (15). The home employs a team of registered nurses, health care assistants, team leaders and care workers. The ancillary & catering services are contracted. The home is situated close to local amenities and is on a main bus route. The grounds have two enclosed garden areas and a car park. Fees are free for 6 weeks intermediate care then a weekly fee of #379.02 for both dementia and intermediate care. Those residents residing at the Ogden unit have been assessed as requiring continuing care. The Welcome Pack clearly sets out which items and services are not included in the fees.

  • Latitude: 51.381000518799
    Longitude: 1.3569999933243
  • Manager: Mrs Sarah Elizabeth Khamsoda
  • Price p/w: £379
  • UK
  • Total Capacity: 60
  • Type: Care home with nursing
  • Provider: Kent County Council
  • Ownership: Local Authority
  • Care Home ID: 17647
Residents Needs:
mental health, excluding learning disability or dementia, Old age, not falling within any other category, Dementia

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Westbrook House.

Key inspection report Care homes for older people Name: Address: Westbrook House 150 Canterbury Road Westbrook Margate Kent CT9 5DD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Anne Butts     Date: 0 6 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Westbrook House 150 Canterbury Road Westbrook Margate Kent CT9 5DD 01843254100 Telephone number: Fax number: Email address: Provider web address: sarah.khamsoda@kent.gov.uk www.kent.gov.uk/SocialCare/carers-and-familysupport/adultKent County Council care home 60 Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 60. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) - maximum number 25 Mental disorder, excluding learning disability or dementia (MD) - maximum number 15. Date of last inspection Brief description of the care home The home is a large new purpose built care home, which is a joint project between the local authority (KCC) and the NHS PCT. The home has the facilities to provide intermediate care. Physiotherapists and occupational therapists are based in offices Care Homes for Older People Page 4 of 33 60 60 0 Over 65 0 0 60 Brief description of the care home within the building. The home is laid out in four units and has day centre facilities. The units are used to provide separate areas of care according to the needs of the resident. These are intermediate care with nursing (2x 15), dementia (15) and mental health nursing (15). The home employs a team of registered nurses, health care assistants, team leaders and care workers. The ancillary & catering services are contracted. The home is situated close to local amenities and is on a main bus route. The grounds have two enclosed garden areas and a car park. Fees are free for 6 weeks intermediate care then a weekly fee of #379.02 for both dementia and intermediate care. Those residents residing at the Ogden unit have been assessed as requiring continuing care. The Welcome Pack clearly sets out which items and services are not included in the fees. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection that was carried out by two inspectors over the course of one day. A short second visit was also carried out to give feedback and review further information. As part of our visit we had a look around the Victoria Unit (which provides intermediate care) and the Appleton Unit (which supports people with dementia). We did not visit the Ogden Unit (which supports people with continuing care needs and mental health needs) as at the time of our visit the this unit had an outbreak of swine flu. We spent time talking to people living in the home and staff. We also looked at a selection of records including assessments, care plans and staff records. A pharmacy inspector accompanied us and looked at medication. An Annual Quality Assurance Assessment (AQAA) had been sent to us. The AQAA is a Care Homes for Older People Page 6 of 33 self-assessment, required by law. This assessment focuses on how the service considers they are meeting the outcomes of the people using the service and where it feels it can make improvements. It also provides statistical information about the service. Information from the AQAA has been used in this report where appropriate. The AQAA was well completed and contained all the information we asked for. Judgements have been made with regards to each outcome area in this report, based on records viewed, observations and verbal responses given by those people who were spoken with. These judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable us (The Care Quality Commission) to be able to make an informed decision about each outcome area. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: The home runs two systems for maintaining their records for service users, including the assessment and care planning records. One is maintained electronically and the other is a manual system. These systems are meant to run in conjunction with each other but we saw during our visit that this was not always the case. Updated information was not readily available in the manual records and has the potential to miss or not identify areas of care and support. The details within the care plans and assessments varied in content with some being better written than others and containing more person centred detail and giving clearer guidance to staff. Records were not always clear about what action had been taken following any identified change in need, for example weight records did not always evidence what action had been taken if there had been a significant weight change. Discussions with staff did evidence that appropriate action had been taken, but records need to reflect Care Homes for Older People Page 8 of 33 this. The stability of the staff group is sometimes compromised due to the need to use agency staff, although the home endeavours to try to maintain continuity by ensuring as far as possible. They are operating an active recruitment programme to address this. The deployment of staff at certain times of the day, such as handovers at shift changes, needs to be reviewed. There are some shortfalls in staff training which need to be addressed. Staff were not always following the homes procedures for the disposal of waste and this needs to be addressed. Security could pose a risk when outside doors are propped open giving people unsecured access. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes Statement of Purpose and Service User Guide are comprehensive and provide prospective service users with the information they need. People benefit from an assessment of need prior to, or immediately upon moving into the home. Some areas would benefit from being more detailed. Evidence: There is a comprehensive Statement of Purpose in place which is made available to prospective service users and their families. People who are staying in the home are also provided with a service user guide and a welcome pack. The Annual Quality Assurance Assessment (AQAA) provided prior to our visit also states that these documents are available in large print. Information folders are provided in peoples rooms and these held useful information about the service, however in two of the rooms we visited this pack was placed out of Care Homes for Older People Page 11 of 33 Evidence: reach and not accessible. We looked at the pre-admission assessments for people in all the units. In the Ogden and Appleton units people undergo a full assessment and this covers all their individual health and care needs. Life histories are explored and assessments are obtained from the placing authority. We saw that the pre-assessments in these units were fully completed and assessed individual level of need. People who stay in the intermediate units primarily stay for a planned six week period. People are referred to this unit via care managers, primary health care teams or from hospital. There were established referral streams both from community and acute trust healthcare professionals. The majority of intermediate care admissions were direct transfers from the acute hospital environment following an acute or acute on chronic health episode and where it was thought that intensive rehabilitation would lead to increased ability and a return home. As part of the assessment process someone from the home will visit the person, usually in hospital, to carry out a full assessment to ensure that their needs are suitable for a rehabilitation programme. However, only three of the six files we looked at on this unit had a full assessment of need in place prior to admission. Records did show that a needs assessment was undertaken within twenty four hours of admission. Some parts of these assessments were not completed and these tended to be areas in which the person had normal ability. Planned discharge dates and individual goals were not always apparent in the information held in the manual records. We saw that this information was more detailed on the computerised records and staff we spoke to were clear about the discharge process. Service users were provided with assessment and treatment from the intermediate care team according to need comprising of the Geriatrician, Psycho-geriatrician, General Practitioners, physiotherapists, occupational therapists, nurses, healthcare assistants and care workers. People are encouraged to visit the home before moving in, although this is not always possible for people who stay in the intermediate units. We spoke to people in these units about their experiences about moving into the home. People did express some initial anxiety before their admission, but everyone said they were assured within hours of actual admission and were comfortable about the decision made on their behalf. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported with their individual care needs. Not all care plans give clear guidance to staff. Individual health needs are well met and people benefited from good multidisciplinary working. In the main medicines are managed well in the service. There is room for improvement in medicine management and recommendations have been made. Evidence: Care plans varied in detail and content. In the Appleton and Ogden Units we saw that on the whole care plans were quite detailed and identified individual needs. They reflected activities of daily living and primarily gave staff information on how to support people. Some parts of the care plans were better written than others, whilst some areas did lack clear guidance. For example a care plan stated that the person liked to take part in activities suitable to their needs, but did not explain what their needs were in this instance. The care plans were reflective of daily living activities and Care Homes for Older People Page 13 of 33 Evidence: did give guidance on what people could or could not manage. There was clear guidance within the care plans on how to support people with any movement and handling needs. Care plans in these units are person centred and there was evidence to show that families are consulted with. In the intermediate units, care is provided on a shorter term basis. As such the care plans are changing on a daily or weekly basis. Goals were set by the contribution of a range of healthcare professionals and the staff working on the intermediate unit. There were weekly multi disciplinary team meeting held for each person which were documented in a separate file. This information was not always cross referenced either to the main electronic or manual records. Goals were not always clearly defined within the care plans and planned support tended to state what needed to be done not how it would be achieved. The manual records held in peoples rooms were not kept up to date and did not give an accurate picture of the persons current level of need. The electronic records were more comprehensive, but not as easily accessible, which is particularly important as the home has used a high number of agency staff. We spoke to members of staff who were clear about individual needs and were able to explain where people were in their rehabilitation programme. Person centred planning was not as apparent in the two intermediate care units. People told us that they had not actively been involved in their care decisions. However all the people we spoke to told us that they were happy with the care provided in the home. The home maintains two systems for care planning, one which is managed electronically and this is supported by a manual system. All units use both systems. However, the information held on the manual records did not always reflect those which were held electronically. The use of the computer system and paper based system does not make sure that all the information flows or is easily accessible for staff and this does have the potential to miss or not identify areas of care and support. This is compounded by a lack of terminals available for staff to use, with only one available on each unit. The level of computer knowledge also varied amongst staff, and although staff have been supported with training in this system, some staff were evidently not comfortable using the computerised system. All staff contributed to the daily record some of which were manually recorded and some electronically. All manual records were legible but not all were dated, timed and signed. The content of the daily records varied in quality. For example in the Appleton unit daily notes tended to show sweeping statements such as all care given and lunch eaten. Care Homes for Older People Page 14 of 33 Evidence: Care plans are supported by a range of risk assessments which identify any particular risks. Again the level of content varied and risk assessments were seen to be more comprehensive in the Appleton and Ogden Units. Not all of the assessments had been fully completed in the intermediate units, in particular in relation to movement and handling. Each unit contained appropriate equipment to assist people with their mobility needs and we saw that staff used this in line with current good practice. People we spoke to all confirmed that staff supported them with their mobility. Nutritional assessments are undertaken on admission and on the Ogden and Appleton units we saw that these were reviewed regularly for people. In the intermediate units not all service users had a recorded nutritional assessment. In the Ogden unit, we saw that food record charts were not always completed thoroughly and did not always identify if people had eaten their meals. There are weight monitoring records in place, but records did not always identify what action had been taken if there had been a significant change in weight. Staff we spoke to were knowledgeable about individual needs in this area and were clear about what action they would take. In order to promote continuity these records need to fully record action taken. Some assessments are only undertaken on admission if there is a known need, for example skin integrity. This does have the potential not to identify the full needs of the person, and the home needs to ensure that they are confident that each person has received a full assessment for all their healthcare needs. Healthcare needs are well met with people having access to the GP of their choice and all relevant health care professionals. There was a mental health assessment in each individual file. However, none of them were completed in the intermediate unit and there was no corresponding section of the care plan completed. No behavioural assessments were seen in the intermediate unit. The Appleton and Ogden units did, however, contain assessments for mental health needs and care plans were in place to show how to care for people with any their behavioural support needs. The arrangements for support with health and personal care ensured that peoples privacy and dignity was respected at all times. People we spoke to all said that staff were kind, courteous and respected them. Care Homes for Older People Page 15 of 33 Evidence: The Pharmacist inspector from CQC assessed medicine management in this service. There is a good system of management of medicines in this service. A regular audit is performed to check completeness of medicine management records which picks up and deals with any concerns. There are care plans for consistency for medicine prescribed to be taken only when needed. On a small number of charts a post-it note gave some guidelines and this although giving guidance for consistency is not good practice as post-it notes can get accidentally moved to another chart. The post-it note did not have names and initials and this could be potentially a risk to misuse of medicines. There are two controlled drugs cupboards in the service. One of these cupboards is not used to store controlled drugs only. In addition two areas use the same controlled drugs cupboard needing to have two keys in use for the same controlled drugs cupboard . This could pose a risk of mismanagement of controlled drugs. Most of the residents are under one doctor. This doctor visits three times a week and so there is good medical input. However although we were informed that resident are given a choice to stay with their own doctor if possible there is no documented evidence of this choice. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities are provided with a range of choices available that are creative and provide stimulation and interest for people living in the home. Residents are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. People receive a wholesome appealing balanced diet in pleasing surroundings. Evidence: There are planned activities arranged in the individual units suitable for the differing needs of people living in the home. The home promotes therapeutic activities which take into account peoples individual interests. People are encouraged and assisted to participate as they choose. In all units there are planned activities and also time is spent, where possible, with people on an individual basis. Different activities include music and sing-a-longs, music therapy, dedicated game times, quizzes, manicures, one to one time with people and reminiscence. Care Homes for Older People Page 17 of 33 Evidence: The home has use of a mini bus which is used for outings. The Forget-me-not cafe is open two afternoons a week and is used by people living in the home and their relatives. The home regularly holds events such as summer and Christmas fayres and encourages people living in the home to participate in these. In the Ogden unit some staff have been trained in dementia care mapping, which they are using to promote positive interactions with the people in this unit. There is a senior member of staff who is currently leading the activities in this unit and also in the Appleton unit. She told us that they are currently developing sensory workshops for people and have also introduced a memory walk, which consists of photographs and pictures of times gone by. Also in these units life histories of people are explored so that pastimes can be tailored to their needs. For people with an assessed need occupational therapy and physiotherapy is available. Individualised programmes are drawn up with people. People in the intermediate units are also supported with daily living activities in order to promote their independence ready to return home. Observations showed that staff interacted well with the people living in the home and treated people with respect. People were very complimentary about the staff and said that they felt well looked after. Family members and friends were observed to be visiting freely and made welcome. We spoke to four relatives who were visiting and they all said that they were welcome at any time and can stay for as long as they wished. All special diets could be catered for and all food was cooked on the premises. Diabetic dietary needs were seen to be recorded on individual care plans. Care plans also indicated peoples preferences. The kitchen stores were well stocked, with varied choices and an appropriate range of fresh, frozen and dried foods. Menu choices each day reflected current good eating guidance and included the opportunity for service users to access five a day. People are assisted in making their meal choices two days in advance, which meant that when people first move into the home they have to have what is chosen for them. Two people told us that they usually forgot what they had ordered on the day. Kitchen staff told us that they would cook something different for people if there was nothing on the menu that they liked. People we spoke to confirmed this. We saw a comments book which did identify that sometimes the meals were lukewarm and that sometimes the quantity sent up from the kitchen was not always sufficient. Care Homes for Older People Page 18 of 33 Evidence: On the day of our visit, however, we saw that the meals were nicely presented, plentiful and hot. People we spoke to all said that they enjoyed the meals. We observed the meal time in the Ogden unit and saw that where people needed assistance they were supported in a sensitive manner by staff. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home and their relatives or representatives can be confident that their complaints are taken seriously and acted upon. The home has robust adult protection policies and procedures to ensure that residents are protected from abuse. Staff training is not up to date in this area. Evidence: There was a complaints policy and procedure in place that reflected current national guidance and legislation. The policy was in date and there was evidence of regular review. There has been three complaints made in the last twelve months and records showed that these had all been investigated with appropriate action being taken. We (the Commission) have not received any complaints about the service. People living in the home told us that they did not have any complaints and felt well looked after. We spoke to visitors who told us that if they had any concerns then they felt confident in speaking to the manager about them. Visitors said that they did not have any complaints although they did voice some concerns about the level of agency staff used, which they felt did not promote continuity of care for their relatives. There are adult protection procedures in place and we spoke to staff about their understanding of these procedures. Not all staff were clear about the protocols for adult protection, but all staff were aware of the need to report any concerns to their Care Homes for Older People Page 20 of 33 Evidence: line manager. The training matrix showed that not all staff have completed training in adult protection procedures and this needs to be addressed. Staff records showed that all staff are subject to a criminal records bureau (CRB) and protection of vulnerable adults (POVA) check prior to starting work. The home takes its responsibilities for adult protection seriously and if they have any concerns they make a referral the appropriate investigating body. There have been two adult protection investigations carried out in the last twelve months, which have been resolved. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a modern, spacious, well-maintained, purpose built care home, which offers privacy and comfort. Evidence: Westbrook House is situated on a main road leading into the town of Margate. There is good road, rail and local bus transport and there is ample parking including several protected disabled spaces. Access to the care units is via a reception area which is manned by dedicated reception staff. It is a purpose built care home which provides a modern, spacious and well maintained living environment. The care units are set out in four areas. The Victoria Unit which has two areas for intermediate care, the Appleton Unit, which is for people with dementia needs and the Ogden unit for people with mental health and continuing care needs. Gardens are available for all residents and people living in the Ogden and Appleton Units have direct access to secure and well maintained gardens. Access to the upper floor, which is where the intermediate units are located are either via stairs or a lift. The home has additional facilities such a large activities room and people also have access to well equipped gym facilities. There are also additional assisted bathrooms in Care Homes for Older People Page 22 of 33 Evidence: each area and a whirlpool bath is available in one of these. All four units are set out around a large open dining area with separate lounge areas. There are also kitchen facilities available to make drinks and snacks. The Annual Quality Assurance Assessment (AQAA) identified that improvements had been made to the environment in the Ogden Unit, in that they had replaced many of the carpets with vinyl flooring. This has helped to reduce an ongoing problem they have experienced with odour. The AQAA identified that the furniture had been re-arranged, so that seating was now arranged so that it provided a more homely setting. All bedrooms have en-suite facilities including assisted walk in shower facilities. We looked at a selection of bedrooms and saw that they were clean and people are able to have their own possessions and personalise their rooms. We spoke to people in the intermediate unit and they all said that they felt comfortable and one person said it is a home from home. Laundry tasks are undertaken by ancillary staff under external contract. The laundry was staffed seven days a week and all laundry was undertaken on the premises. On the day of our visit the laundry room was cluttered and untidy and one of the washing machines was leaking. This had been reported and a planned engineer visit arranged, but it was still in use and staff had to mop up the water at frequent intervals. The washing machines are industrial sized and able to cope with heavily soiled linen with sluice cycles available. The home uses a red bag system. We saw that there was a mix of general waste with clinical waste in dedicated clinical waste bins, and the home needs to ensure that they follow their disposal procedures. At the end of each of the two intermediate units, which are located on the first floor, there was a fire door which opened out on to a stair way down to the main car park and other grounds. On the day of our visit these doors in the intermediate unit were propped open which has the potential to represent a security risk as there was easy external access to the unit via outside steps. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they are cared for by staff who have a good understanding of their needs. Staff training needs to be further developed in order to ensure that all care staff have the skills and knowledge to meet the needs of the people living in the home. Continuity of staff has room for improvement. Evidence: The staffing structure at Westbrook House is complex with staff being contracted with Kent County Council, the Primary Care Trust and the National Health Service. There are different pay scales, job descriptions and shift start times. Training is also provided for the individual staff by the different organisations. We spoke with staff including the senior manager in charge at the time of our visit and looked at a selection of staff rotas for a four week period. Records showed and discussions with staff and relatives indicated that not all shifts were covered with a full staff compliment. There was a heavy dependency on agency staff to supplement the core staff group. Steps are taken to try to use staff who are familiar with Westbrook House, although this is not always possible. The home is currently recruiting and is taking positive steps to address the staffing levels. Care Homes for Older People Page 24 of 33 Evidence: Relatives told us that in the Appleton unit, when the staff shift changed, staff would then meet for a handover and this meant that there was no one available on the floor to look after the service users. We also observed this in the intermediate unit. This was partially due to the different staff contracts which meant that staff employed by Kent County Council did not have any handover time built in to their shift, and also all other staff would be attending handover. The registered provider needs to ensure staffing levels are maintained at all times. People staying in the home and visiting relatives were complementary about staff. People told us that staff were always polite and nothing was too much trouble. Westbrook House employs a range of staff including nurses, both qualified general and mental health nursing staff, healthcare assistants and ancillary staff. The Annual Quality Assurance Assessment (AQAA) identified that the percentage of care staff who have achieved a national Vocational Qualification at level two or three in care has improved with now over sixty percent of staff having achieved this. We looked at selection of staff records in relation to recruitment procedures. Staff records are also held by the employing organisation. We viewed eight staff files and we saw that the employment records were maintained in line with regulation. Each file had an employment check list which was fully completed and recorded that all the appropriate documentation had been received. All staff were seen to be in receipt of a criminal records bureau (CRB) check and protection of vulnerable adults (pova) check. All staff files contained two references. Checks are carried out on nurses and the home has a record of all pin numbers. All staff receive an induction and this is delivered at Westbrook House. Of the records viewed we saw that all staff had undergone an induction. An orientation programme was also being developed in the Appleton unit, for agency staff to give them an awareness and understanding of the needs of the people in this unit. Training is provided from a range of sources and each of the individual employers are responsible for providing their staff with the appropriate mandatory. Other training which is specific to the needs of the people living in the home is provided by Westbrook House. The training is coordinated by Westbrook House. We looked at the training matrix, staff files and spoke to the senior manager in charge and staff. Records showed that some staff had not completed all the mandatory training for example movement and handling and adult protection. The senior manager in charge at the time of our visit confirmed that action is being taken to ensure that all staff undertake all required mandatory training. There is a range of specialist training Care Homes for Older People Page 25 of 33 Evidence: provided including catheter care, managing challenging behaviour, mental capacity act training. Although the training matrix for staff working on the Appleton Unit, which is for people with dementia needs, indicated that dementia training had not been provided for all staff. It is the providers responsibility to ensure that staff are trained in the needs of the people living in the home. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed is best interests of the people living there and there is leadership, guidance and direction to staff to ensure are for service users is promoted. This is a well run care home, which has appropriate quality assurance systems in place that identify and rectify any concerns. Evidence: Westbrook House consists of four units and is overseen by the manager, who is registered with us (the Commission). She is supported by two assistant managers, nursing staff and a team of seniors. The home also benefits from senior management support. The management team in the home has developed close working partnerships with multidisciplinary teams and regular clinical governance meetings are held. There are quality assurance processes in place, with surveys sent out to stakeholders Care Homes for Older People Page 27 of 33 Evidence: and regulation 26 visits (which are quality monitoring visits carried out by the registered provider) in place. The home promotes regular meetings with relatives and permanent residents so that they are able to have a say in the running of the home and voice their opinions. As part of the quality assurance processes complaints, incidents and accidents are monitored and reviewed so that the home can monitor any patterns and take appropriate action to prevent reoccurrence. The Annual Quality Assurance Assessment (AQAA) told us that all health and safety checks are carried out in line with appropriate legislation. The health and safety within the home was generally well maintained. At the time of our visit one of the units had an outbreak of swine flu. The home told us that they had taken appropriate clinical advice and were following infection control procedures. There were some shortfalls in the infection control procedures of the home, in that some of the dispensers for hand cleaning fluids were empty and staff did not always dispose of waster via the correct medium. We discussed the implications of the Mental Capacity Act and Deprivation of Liberty safeguards for people living in the home. The manager told us that no one living in the home was subject to a deprivation of liberty authorisation. Training is also being implemented for staff with regards to the Mental Capacity Act. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 17 The registered person shall maintain records in respect of each person in accordance with Schedule 3 of the Care Homes Regulations and ensure that these are kept up to date. This must ensure that care records fully identify needs and outcomes and are consistent. To have a care plan around the use of medicine to be taken only when needed. So that there consistency and a person centred approach in the use of these medicines. 30/11/2009 2 9 13 30/11/2009 3 27 18 The registered person shall 30/11/2009 having regard to the size of the care home, the statement of purpose and the number and the needs of service users: ensure that at all times suitably Page 30 of 33 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action qualified, competent and experienced persons are working at the care home is such numbers as are appropriate for the health and welfare of the service users In that the number of agency staff are kept under review. 4 30 18 The registered person shall 15/01/2010 ensure that staff are trained in the specialist needs of the people living in the home. This is so that people with dementia can be confident that they are cared for by people staff who have a good understanding of their needs. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 It is recommended that goals and discharge dates are clearer and more transparent for people staying in the intermediate units. To review the storage arrangement for controlled drugs to minimise any risk of misappropriation of these drugs by reserving the controlled drugs cupboard for storage of controlled drugs only and to risk assess the controlled drugs key management. To have clear documentation available to indicate that 2 9 3 9 Care Homes for Older People Page 31 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations residents have a choice when chosing their doctor. 4 5 26 30 It is recommended that the homes waste disposal procedures are followed. It is recommended that the training programme continues with particular emphasis on the mandatory training. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - 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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