Care Home: Westbury Grange

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What the care home does well Potential service users receive a thorough needs assessment to ensure the home can meet the care needs of the service users. We spoke with some people who were receiving a service at Westbury Grange and/or their relative and they told us that they were given good information before they moved into the service. People told us that the information they received was sufficient, and that staff at Westbury Grange had explained to them the service the home provides. One visiting relative said they had been able to visit the home and bring their relative to visit the home before making a decision. They said the staff had been very welcoming and answered all their questions. Care plans have been produced for all people who use the service, and these inform the care staff what they must do to meet the needs of the individual. One visiting relative spoken to on the day of the visit said, "the staff work very hard in difficult circumstances. They know just what my relative likes and make sure they get everything they need to make them comfortable and happy, but I am worried this may stop with all the the changes being made and the home becoming bigger". There is a motivated and established staff team that consists of nursing and care staff who respond to service users in a respectful and appropriate manner. Service users spoken to on the day of the visit said that staff are "so helpful and help me with anything." One visiting relative said "the staff are so lovely and work very hard. They are always rushed and sometimes don`t have time for a chat. There has been a lot of staff who have left recently and this worries me." There is an effective complaints procedure with all complaints and concerns being acted upon promptly, within stated time scales. The home provides a pleasant and comfortable environment in which people can live. Individuals are encouraged to personalise their own rooms with their own furniture and personal belongings. Communication between people who use the service and staff was observed to be positive and open. The provision of meals and mealtimes are of a good standard. However the layout of the dining rooms on the upper floor led one relative to comment, "there is a lot of walking up and down at meal times. We tried having just one dining room and one lounge before and it didn`t work so I don`t know why they have gone back to this." There is a good range of policies and procedures, providing staff with relevant information about all aspects of care and the home/organisation. Health and Safety policies and procedures are thorough and records are well maintained. The evidence seen and comments received indicate that this service meets the diverse needs e.g. religious, racial, cultural, disability of individuals within the limits of its Statement of Purpose. What has improved since the last inspection? This is a new registration and this is the homes first key inspection. What the care home could do better: Care Plans would benefit from more detail that provide staff with specific information on how the service users needs are to be fully met. Recording of medicines in the home must be improved to ensure that the health and welfare of people using this service is not compromised. The layout of the dining area on the nursing floor does not ensure that service users are receiving their meals in a timely manner. The organisation need to address this issue. All recruitment checks for staff must be completed before they commence employment and these must be available for inspection purposes. Mandatory health and safety training must be brought up to date for all staff. This includes fire training, moving and handling, basic food hygiene, first aid and infection control. The home must provide appropriate facilities for private phone calls and for private meetings with relatives, doctors and for staff handover tomes. Key inspection report Care homes for older people Name: Address: Westbury Grange Westbury Lane Newport Pagnell Buckinghamshire MK16 8JA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Barbara Mulligan     Date: 2 1 0 9 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 28 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 28 Information about the care home Name of care home: Address: Westbury Grange Westbury Lane Newport Pagnell Buckinghamshire MK16 8JA 01908210322 01908615282 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.mha.org.uk Methodist Homes for the Aged care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 1. the registered person may provide the following category/ies of service only; Care home with nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category -(OP) Dementia (DE) 2. The maximum number of service users to be accommodated is 45 Date of last inspection Brief description of the care home Westbury Grange is a nursing home providing personal and dementia care for older people and is managed by Methodist Homes for the Aged. On the upper floor of the home there are two nursing units, both providing accomodation to ten people in each unit. On the lower floor there will be two dementia care units providing accomodation to twenty five people when building work has been completed. The home is located close to the town centre of Newport Pagnell, which offers a variety of shops, Care Homes for Older People Page 4 of 28 2 9 0 9 2 0 0 8 45 0 Over 65 0 45 Brief description of the care home restaurants pubs and other amenities. All bedrooms have ensuite facilities and can be personalised by the occupant. Nursing fees range from £700 to £743 per weekand the fees for dementia care are £630 per week. There are three large rooms in the dementia care unit that are charged at £700 per week. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over the course of two days and covered all the key National Minimum Standards for older people. Prior to the visit, a detailed self-assessment questionnaire was sent to the registered manager for completion. This was returned to the Commission by the day it was due and was fully completed, giving us the information we needed. Information received by the Commission since the last inspection was also taken into account. The Regulation Inspector was Barbara Mulligan. At the time of this visit the two homes, previously called Westbury and Paganell Grange, had not merged into one home. The residents of Westbury were still living there and the residents of Paganell Grange had recently moved onto the upper floor. Building work was taking place to complete the lower floor to accommodate the two dementia units. Care Homes for Older People Page 6 of 28 A total of nineteen surveys were sent to the home for completion, however these have not been received by the Inspector by the time the report was written. This inspection consisted of discussion with the deputy manager of the home and a service manager working for the organisation, discussion with care and nursing staff, opportunities to meet with people who use the service, examination of some of the homes required records such as care plans, risk assessments and staff files, the medication systems and accompanying records, staff rosters, observation of practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. As a result of the inspection the home has received four statutory requirements. Feedback on the inspection findings and areas needing improvement was given to the management of the home at the end of the inspection. The management of the home, the staff, visiting relatives and service users are thanked for their cooperation and hospitality during this unannounced visit. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? This is a new registration and this is the homes first key inspection. Care Homes for Older People Page 8 of 28 What they could do better: 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 28 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 28 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. Effective needs assessments are completed for prospective service users, to ensure that individual needs are identified and that the home is able to meet these needs. Evidence: Four completed needs assessments were examined, including those for people newly admitted to the home. Each file had a completed needs assessment and showed that all areas and conditions of people using the service were assessed prior to offering them a place in the home. Each assessment contained further information about the persons family and friends, likes, dislikes and preferences. We spoke with some people who were receiving a service at Westbury Grange and/or their relative and they told us that they were given good information before they moved into the service. People told us that the information they received was sufficient, and that staff at Westbury Grange had explained to them the service the home provides. Care Homes for Older People Page 11 of 28 Evidence: One visiting relative said they had been able to visit the home and bring their relative to visit before making a decision. They said the staff had been very welcoming and answered all their questions. The assessment demonstrates that prospective service users, family members or representatives are included in the assessment process if this is appropriate. The home does not provide intermediate care, so this standard is not applicable. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people using the service are well met, with personal care delivered in a way that promotes respect and dignity. However, improvements need to be made to the recording of medicines administered, to ensure people are protected by the homes medication practices. Evidence: The care of four residents including those people new to the service was looked at and their care plans were examined. Two of these care plans were for people receiving nursing care and two for people receiving dementia care. Care plans were up to date and contained sufficient detail for staff to learn about residents they support. Specific needs have been identified within the care plans and there is an action plan in place to provide staff with the details of how these needs are to be managed and fully met. Some entries in care plans lacked detail, for example, I need help with washing and to have a shower and I need help with all my personal care. These are vague statements and should describe in more detail the actions staff need to take to fully meet the needs of the individual. Individual preferences, likes and dislikes and reference to end of life care are recorded in care plans and describes how these will be Care Homes for Older People Page 13 of 28 Evidence: met. Visual observations of people using this service showed that people were smartly dressed including jewelery, make up and nail varnish and people were seen to be wearing the aids needed, for example hearing aids and clean glasses. Staff complete daily record notes and these were examined. Some entries lack detail, for example, had a good day or was unhappy today. This does not provide the care staff with details of how the individual has been through the day or what they have been doing and does not demonstrate that the care given by staff is the same as noted in care plans. The home should address this to ensure records contain full details of how people spend their day. One visiting relative spoken to on the day of the visit said, the staff work very hard in difficult circumstances. They know just what my relative likes and make sure they get everything they need to make them comfortable and happy, but I am worried this may stop with all the the changes being made and the home becoming bigger. The staff spoken to are knowledgeable about service users care needs and preferences. There is evidence that care plans are reviewed monthly and updated when appropriate. People using this service are registered with local GP Practices. All residents have access to local NHS Services. Tissue viability assessments are in place for service users and these were seen to be reviewed on a monthly basis and pressure relieving equipment is in place for individuals who need it. Further assessments are in place covering areas such as falls, moving and handling, behaviours that can challenge the service and wound assessment. These are up to date, signed and dated by the person completing the assessment. Nutritional assessments are completed for each person and weight monitoring is undertaken on a monthly basis and recorded. This was evident in the four files examined. Records of health screening was noted in each file and feedback received during discussions with people using the service and/or their relative was positive about how people access medical treatment and healthcare services. The procedures for the administration of medicines were examined during this inspection. At this visit we looked at the medication administration record (MAR) charts, medication supplies and care plans for the four people whose care was being looked at as part of this inspection, and at the medication administration records (MAR) charts for half of the people using this service. At the time of the inspection there were no service users who were able to self-administer their medication. The Care Homes for Older People Page 14 of 28 Evidence: home works closely with the local surgery and pharmacy to ensure an effective and safe medication administration system is operational. The pharmacist visits the home to look at the homes medication procedures. On the day of the visit the home was using controlled drugs in the nursing unit. These were properly stored and records were fully completed and up to date. The medication administration records (MAR) charts showed that there are several hand written entries on them. These were dated and signed by one staff member. When it is necessary to handwrite on a medication administration record (MAR) chart in the home, the member of staff writing the chart should sign and date the chart and a second carer should check the entry for accuracy and then initial the chart. In addition the entry should include a reference to where this information was sourced, such as the prescribers name. There are written guidelines for some as required (PRN) medicines, but these were not in place for all as required medicines. When variable doses have been prescribed, for example give 1 or 2 tablets for pain there is no guidance when 1 or 2 should be given. The home must ensure that service users plans include guidelines for the administration of all when required/when needed medicines and these guidelines must include when the medicine is to be given and when it is not and include a strategy for when variable doses can be given. The medication administration records (MAR) show numerous gaps and omissions. The tablets were not in the blister pack and when questioned the inspector was told that the tablets had been given, but they had not been recorded on the medication administration records (MAR) chart. A requirement is issued for improvement in this area. Preferred terms of address are identified at the initial assessment and the inspector saw evidence of this in care plans. The Statement of Purpose includes information about maintaining the privacy of service users. Residents of the home can have a key to their rooms if they wish to use this facility and it is felt to be safe. Care Homes for Older People Page 15 of 28 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. There is a range of activities available to residents who are encouraged and supported to remain in contact with their families and friends and to use local community facilities, ensuring people do not become socially isolated. The presentation and standard of food is good and meets the nutritional needs of people who use the service. Evidence: Care plans show individual routines of daily living. As part of the admission process, the home complete a personal profile section which is a life history of the individual and gives staff information about previous leisure pursuits, hobbies and other interests. The home employs a volunteer coordinator and her role is to find volunteers to provide activities for residents of the home. It was difficult to assess the level of activities taking place over the two day inspection because building work was still taking place and areas of the home were not accessible. However, a painting session was observed to take place and a music session. The service manager said there will be two organised activities provided every day. The home employs a Chaplin who Care Homes for Older People Page 16 of 28 Evidence: visits service users on a one-to-one basis as well as providing a church service in the home and the home has a qualified reflexologist who visits individuals and will provide hand massage and other treatments. The homes self-assessment tells us that they celebrate residents special days and golden moments Service users are able to receive visitors in the privacy of their own rooms and are able to choose whom they see and do not see. The AQAA tells us there are no restrictions on visiting the home. Family and friends are invited to participate in some of the social events organised. On the day of the visit several relatives were visiting and supporting their relatives with lunch. Service users are offered three meals a day. The menu is rotated on a four weekly cycle. The inspector had the opportunity to observe a lunchtime meal on the nursing unit. There is one dining area that is shared by both units of the nursing floor. Two service users were being supported by relatives with their meals. Meals are brought up from the kitchen in a hot trolley and served in the dining area where there is a small kitchen. Due to the layout of the dining room on the nursing floor one visiting relative said there is a lot of walking up and down at meal times. We tried having just one dining room and one lounge before and it didnt work so I dont know why they have gone back to this. The meal was unrushed and people were well supported by staff, although several service users had to wait before others had finished before they could commence their meal with the support needed. Staff spoken to said the layout of the dining area made meal times more time consuming than they needed to be and very often people werent receinig their meals in a timely fashion. This was observed to be the case on te day of the visit. The organisation need to address this. The food was attractively presented. Some people chose to take their meals in their rooms on the day of the visit. Care Homes for Older People Page 17 of 28 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. The home is able to effectively manage complaints and safeguard service users ensuring that people who use the service are listened to and kept safe from harm and abuse. Evidence: The inspector examined the homes complaints procedure which illustrates timescales for responding to complaints. This is clear and accessible to service users. A summary of the complaints procedure is included in the Statement of Purpose and a feedback complaints, comments and compliments form is available at the reception desk. The AQAA tells us that the home has received two complaints in the last twelve months. These have been responded to within the stated timescales and have been well recorded and resulted in satisfactory outcomes. Procedures are in place for safeguarding vulnerable adults (SOVA) and staff have access to a whistle blowing policy. The home has a copy of the local authority SOVA policy. Training records demonstrate that most staff have completed Safeguarding training and this is regularly updated. However some staff still need to complete this training. The Annual Quality Assurance Assessment tells us that there have not been any safeguarding referrals in the previous twelve months. Care Homes for Older People Page 18 of 28 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. The standard of the environment on the upper nursing floor is good, and two purpose built units that will provide dementia care on the lower floor when building work is completed, will ensure people who use the service live in a safe, attractive and homely environment. Evidence: At the time of this visit building work was still taking place to the lower floor of the home that used to be called Paganell Grange. When this has been completed the lower floor will provide two dementia care units and service users presently living in the sister home, previously called Westbury, will then move into these units. The upper floor has been refurbished and bedrooms have been redecorated and provided with en suite facilities. One person spoken to on the day said I dont like it upstairs and I dont like the colour of my room. The staff are lovely though and they keep me going. They also praised a particular member of the housekeeping staff and how well they kept the room clean. One visiting relative said there was a shortage of chairs and at weekends when numerous relatives were visiting they had to kneel on the floor to feed their relative. The organisation need to address this. Care Homes for Older People Page 19 of 28 Evidence: There are refurbished communal areas which are spacious, well decorated and comfortably furnished. There is a new reception area on the lower floor and a small coffee shop which has recently been provided as part of the new building work. On the nursing floor however, there are no private areas or an office to conduct staff handover sessions, to hold private and confidential meetings with relatives or staff and no area to hold a private phone call. During the lunch time period a nurse took a phone call from a doctor. The phone is in a small alcove next to the dining area. The call was regarding a service user with a medical problem and private , confidential and personal information was divulged so people within close proximity could hear. The organisation must be able to ensure the privacy and confidentiality of people using this service and a requirement is issued for improvement in this area. There are accessible toilets available for service users throughout the home and several are close to the lounges and dining area. Bathrooms and toilet areas have the appropriate aids and adaptations to meet the needs of individuals and to promote independence. Laundry facilities are sited so that soiled articles,clothing and infected linen are not carried through areas where food is stored, prepared, cooked or eaten and do not intrude on service users. The laundry floor finishes are impermeable and these and the wall finishes are readily cleanable. The home has an infection control policy and the AQAA tells us that 39 staff have received training in prevention and control of infection. Care Homes for Older People Page 20 of 28 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. The staffing numbers and skill mix is presently satisfactory to meet the needs of people using this service. Staff recruitment practices and staff training needs to be strengthened and improved upon to ensure that people who use the service benefit from staff who have been subject to robust recruitment procedures and who are trained and competent to do their jobs safely. Evidence: The homes staff rota demonstrates that there are adequate numbers and skill mix of staff on on duty at all times. However, concerns were raised by staff working in the home and visiting relatives, about proposed reductions in staffing numbers. Staff spoken to said this would not ensure service users needs would be met. The care team are also supported by full time housekeeping laundry and catering teams. Service users spoken to on the day of the visit said that staff are so helpful and help me with anything. One visiting relative said the staff are so lovely and work very hard. They are always rushed and sometimes dont have time for a chat. There has been a lot of staff who have left recently and this worries me. The AQAA tells us that the home employs 40 permanent care workers and that 39 of these staff have completed level 2 or above NVQ training. Care Homes for Older People Page 21 of 28 Evidence: The recruitment files for a selection of staff were examined, including those new to the service. Three files examined did not contain an update photograph of the staff member . A further file looked at for a newly recruited staff member contained only one reference. This needs to be addressed by the organisation and a requirement is issued for improvement in this area. All staff complete an induction programme that covers the common induction standards for social care and a recently completed pack was examined. This is detailed and informative and covers a period of six months. Training records show that not all staff are up to date with their mandatory training. This includes moving and handling, fire, basic food hygiene, infection control, safeguarding and first aid. There is specialist training available for staff, and an example of this is dementia care, continence training and nutritional training. Care Homes for Older People Page 22 of 28 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 adequate 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 by an experienced management team and service users are protected by safe working practices ensuring the health and safety of people using the service. However some updating of mandatory health and safety training is required to ensure staff remain competent to undertake their jobs safely. Evidence: The registered manager for Westbury Grange is Linda Stubbs. She is a registered nurse and has completed the Registered Managers Award. The registered manager regularly undertakes training to update her knowledge and skills. The registered manager was not available during this visit to the home and the deputy manager assisted with this inspection. The organisation and the home has a clear and accountable management structure and the manager is supported by the organisation. The inspector noted good teamwork in progress and all the staff spoken to had a good working knowledge of the individual residents and their care needs. Staff meetings take place regularly and staff spoken to confirmed this and copies of minutes of the Care Homes for Older People Page 23 of 28 Evidence: meetings are held on file. The annual quality assurance assessment (AQAA) was returned to us by the date it was requested and was completed fully and in detail. Regular meetings have been held with relatives to keep them informed of building progress. The deputy manager said that service satisfaction questionnaires had recently been sent out to service users relatives and representatives and these are returned to an independent auditor, however there was no action plan available to look at following this quality assurance exercise. Service users are encouraged to look after their own financial affairs where at all possible. If this is not practicable then families will undertake this role. There are secure facilities available for the safe-keeping of money and valuables and record and receipts are kept of possessions left for safe keeping. Records were seen for fire safety. These cover the homes fire procedures, practice fire drills, fire prevention, fire alarm testing and emergency lighting testing. Testing of the homes fire alarm system is undertaken on a weekly basis and evidence was seen of this. There is a fire based risk assessment and this was dated 19th August 2009. Staff training records show that some staff need to update their health and safety mandatory training and this includes moving and handling, fire training, basic food hygiene training, first aid and infection control. A requirement is issued for improvement in this area. Service reports are in place for the maintenance of hoists and the lift. There are service certificates for electrical installation on 14/12/2007, Portable Appliance Testing on 18/02/2009 and 23/02/2009 and gas appliances on 07/08/2008. Care Homes for Older People Page 24 of 28 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 25 of 28 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 9 22 Staff practice in the recording, handling, safekeeping, safe administration and disposal of medicines in the home must be consistent. This is to ensure that the health and welfare of people using this service is not compromised. 30/10/2009 2 19 23 The registered provider is 30/12/2009 required to ensure the home provides facilities for private phone calls, private meetings and staff handover periods. To ensure the privacy and confidentiality of people using this service is maintained. 3 29 17 The registered person must ensure that all recruitment checks for staff are completed before they commence employment and 30/09/2009 Care Homes for Older People Page 26 of 28 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 these are available for inspection purposes. To ensure service users receive care from staff members who have been properly vetted. 4 38 18 Mandatory, health and safety training must be brought up to date for all staff. This includes fire training, moving and handling, basic food hygiene, first aid and infection control. This is to ensure that the health and welfare of people using this service is not compromised and people are trained to undertake their jobs safely. 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 30/12/2009 Care Homes for Older People Page 27 of 28 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. 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