Care Home: Westbury House Nursing Home

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What the care home does well What has improved since the last inspection? The assessment documentation had been revised and extended to ensure more information about new clients was available, particularly with reference to health and clinical needs, to inform the staff and to enable more individual care plans to be produced. Since the previous site visit the home had made individual agreements with clients where limitations of their rights had been imposed for their protection. Instances were with regard to smoking and alcohol consumption. Improvements over the previous twelve months with respect to healthcare, as recorded in the AQAA, included the purchase of new medical equipment consisting of two new hoists, a new bath chair, new slings, new suction and other various specialist clinical equipment, new profiling beds and several new mattresses. A new weighing machine enabled an accurate record to be kept of any fluctuations in residents` weight, which might require the involvement of a dietician. The manager recorded in the AQAA with respect to improvements in the residents` lifestyles, that, `residents are now having interviews for outside Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 7college courses and more holidays are being booked for them. There are plans in place to involve residents in more gentle exercise, for example chair aerobics and ball games`. Comfortable seating had been purchased for the main lounge since the previous site visit and carpeting in the corridors had been replaced for the comfort and pleasure of the residents. The manager was in the process of improving the outdoor entertainment area by having a safe ramp constructed, leading down from the dining room. New garden furniture had been ordered and the manager had plans for a pagoda and archways with colourful climbing plants for the enjoyment of the residents and their visitors. Since the previous site visit, smoking had been restricted to a separate smoking room so that this activity did not impact upon other residents, who had previously complained and also to comply with legislation concerning smoking in the workplace, which came into force in July 2007. The Fire and Rescue service had been consulted about the practice of wedging bedroom doors and the storage of materials in the second floor corridor and advice had been acted upon thus ensuring that the home`s fire safety arrangements were not undermined and that people living and working in the home were not exposed to avoidable and unnecessary risk of harm. A new fire alarm system had been installed and magnetic closures had been attached to the doors on the ground floor, which had previously been wedged open, and plan was in place for the same arrangements on the other two floors. Staff training had improved particularly with regard to specialist clinical procedures for the nursing staff, for the health and safety of the residents. Since the previous site visit, the proposed manager, who had worked at the home for many years in various roles, had completed a National Vocational Qualification at level 4 in care and achieved the Registered Managers` Award, which meant that she had the relevant formal qualifications to manage the home. She had also applied and been accepted as registered manager for the home. What the care home could do better: The home could collect more information with respect to equality and diversity, record the aspirations of the prospective residents and more details about their wishes, preferences, interests, goals and social and emotional needs so that care plans would be more person-centred. Details of residents` goals and aspirations, social and cultural needs and wishes and the support required to retain and regain life skills and maintain an independence lifestyle should be recorded in the care plan to inform the staff and to ensure all the residents` needs are metThe reviewed application form must require a full employment history with an explanation of any gaps in employment explained so that only suitable candidates will be considered for employment at the home. Advice should be sought from the Criminal Record Bureau with respect to the recording and destruction of Criminal Record Bureau checks. It is recommended that the information in the staff personnel files be bound to safeguard it and that an audit sheet to show when the information has been requested and received be added to clarify the process. Adequate facilities must be provided for the residents to wash, dry or iron their own clothes, or to prepare their own food and thus retain or regain the life skills necessary for an independent lifestyle. Private spaces must be available for residents to meet with their visitors in private in addition to their bedrooms. CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Westbury House Nursing Home West Meon Nr Petersfield Hampshire GU32 1HY Lead Inspector Christine Bowman Unannounced Inspection 2nd May 2008 11:00 X10029.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westbury House Nursing Home Address West Meon Nr Petersfield Hampshire GU32 1HY (01730) 829511 01730 829108 whnursinghome@aol.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Irvine Navid Naqvi Dr Usha K Naqvi Mrs Jane Gladys Sims Care Home 70 Category(ies) of Physical disability (70) registration, with number of places Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing (N) to service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Physical disability (PD). The maximum number of service users to be accommodated is 70. 2. Date of last inspection 23rd May 2007 Brief Description of the Service: Westbury House is a care home situated on the edge of the rural village of West Meon. The home is registered to provide accommodation and nursing care for up to seventy service users, though at the present only up to fifty service users are accommodated at any one time. The home caters for persons that have an acquired brain injury or an illness affecting the nervous system. The home has an occupational therapy facility and a facility for service users to purchase private physiotherapy. People wishing to move into the home are given written information about the services that it provides and they and/or their representatives are invited to visit to look around for themselves. Weekly fees ranged from £600 to £800 a week. This does not include hairdressing, toiletries, and some of the cost of trips out. Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. This unannounced site visit was conducted as part of a key inspection using the Commission’s ‘Inspecting for Better Lives’ (IBL) process. The site visit took place over seven and a half hours commencing at 11.00 am and ending at 18.30 pm and was undertaken by Ms Christine Bowman, Regulation Inspector. The Registered Manager, Ms Jane Sims was available throughout the day and assisted with the inspection process. The Head of Nursing gave up her day off to offer specialist input and seven staff from different departments were spoken with. A tour of the premises was undertaken and several residents allowed their bedrooms to be viewed. Residents and visiting relatives were spoken with and all expressed satisfaction with the service offered by the home. One resident stated, ‘It is much better here than in my last home and the staff are nice and listen’. The key inspection standards for care homes for older people/younger adults were inspected because the home caters for a wide age range, offering continuing care to enable residents to remain at the home for life. The statement of purpose and the service user guide were viewed. Resident’s files including assessments, care plans, medication administration records and risk assessments were viewed and staff personnel files, including recruitment, induction and training records were sampled. The home’s quality assurance system, complaints and compliments, policies and procedures and maintenance certificates were also sampled. The service had completed an Annual Quality Assurance Assessment (AQAA) and information recorded in this and on the inspection record since the previous site visit has been taken into consideration in the writing of this report. Two residents completed surveys and comments from these sources have been included in the report. Thanks are offered to the management and the staff of Westbury House for their assistance and hospitality on the day of the site visit and to those who completed surveys for their contribution to this report. What the service does well: The home was located in a position of outstanding natural beauty, retaining many original features of historic interest, and the extensive parkland surrounding the home contained mature trees and shrubs, a pond and an ancient monument. Residents spoken with appreciated the elegance of their living environment and the beauty of its rural location. Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 6 The food was nicely presented including the meals for those residents who required a soft diet. The home had a store for the fruit and vegetables, which was well stocked. The chef was enthusiastic about her role and had recently updated the menus, which included variety and choice, as well as the ‘five a day’ recommended fruit and vegetables, which she had creatively included. The recreational therapy department was popular with some residents and the products of their creative work were displayed, encouraging their endeavours and recognising their talents. Examples of clay work, glass painting, mosaic, papier-mâché, flower arranging and decorated bowls were on display and a visiting relative, whose husband had produced some fine paintings stated, ‘This is the best occupational therapy department my husband has ever been in because he has been encouraged to use his talent.’ Residents who completed surveys confirmed they could do what they wanted during the day, in the evening and at the weekend. One resident commented, ‘I sometimes go home and visit my family, but am always happy to return.’ At the time of the site visit one resident was staying with their family in Italy, which had been arranged by the home, the manager stated, and a holiday in Dorset had also been arranged for a group of residents. A notice board provided information to the residents about activities and trips arranged. The home benefited from a stable and loyal staff group, providing consistency for the residents. One resident spoken with stated, ‘the staff are nice and the food is fantastic.’ What has improved since the last inspection? The assessment documentation had been revised and extended to ensure more information about new clients was available, particularly with reference to health and clinical needs, to inform the staff and to enable more individual care plans to be produced. Since the previous site visit the home had made individual agreements with clients where limitations of their rights had been imposed for their protection. Instances were with regard to smoking and alcohol consumption. Improvements over the previous twelve months with respect to healthcare, as recorded in the AQAA, included the purchase of new medical equipment consisting of two new hoists, a new bath chair, new slings, new suction and other various specialist clinical equipment, new profiling beds and several new mattresses. A new weighing machine enabled an accurate record to be kept of any fluctuations in residents’ weight, which might require the involvement of a dietician. The manager recorded in the AQAA with respect to improvements in the residents’ lifestyles, that, ‘residents are now having interviews for outside Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 7 college courses and more holidays are being booked for them. There are plans in place to involve residents in more gentle exercise, for example chair aerobics and ball games’. Comfortable seating had been purchased for the main lounge since the previous site visit and carpeting in the corridors had been replaced for the comfort and pleasure of the residents. The manager was in the process of improving the outdoor entertainment area by having a safe ramp constructed, leading down from the dining room. New garden furniture had been ordered and the manager had plans for a pagoda and archways with colourful climbing plants for the enjoyment of the residents and their visitors. Since the previous site visit, smoking had been restricted to a separate smoking room so that this activity did not impact upon other residents, who had previously complained and also to comply with legislation concerning smoking in the workplace, which came into force in July 2007. The Fire and Rescue service had been consulted about the practice of wedging bedroom doors and the storage of materials in the second floor corridor and advice had been acted upon thus ensuring that the home’s fire safety arrangements were not undermined and that people living and working in the home were not exposed to avoidable and unnecessary risk of harm. A new fire alarm system had been installed and magnetic closures had been attached to the doors on the ground floor, which had previously been wedged open, and plan was in place for the same arrangements on the other two floors. Staff training had improved particularly with regard to specialist clinical procedures for the nursing staff, for the health and safety of the residents. Since the previous site visit, the proposed manager, who had worked at the home for many years in various roles, had completed a National Vocational Qualification at level 4 in care and achieved the Registered Managers’ Award, which meant that she had the relevant formal qualifications to manage the home. She had also applied and been accepted as registered manager for the home. What they could do better: The home could collect more information with respect to equality and diversity, record the aspirations of the prospective residents and more details about their wishes, preferences, interests, goals and social and emotional needs so that care plans would be more person-centred. Details of residents’ goals and aspirations, social and cultural needs and wishes and the support required to retain and regain life skills and maintain an independence lifestyle should be recorded in the care plan to inform the staff and to ensure all the residents’ needs are met. Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 8 The reviewed application form must require a full employment history with an explanation of any gaps in employment explained so that only suitable candidates will be considered for employment at the home. Advice should be sought from the Criminal Record Bureau with respect to the recording and destruction of Criminal Record Bureau checks. It is recommended that the information in the staff personnel files be bound to safeguard it and that an audit sheet to show when the information has been requested and received be added to clarify the process. Adequate facilities must be provided for the residents to wash, dry or iron their own clothes, or to prepare their own food and thus retain or regain the life skills necessary for an independent lifestyle. Private spaces must be available for residents to meet with their visitors in private in addition to their bedrooms. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,3, 6 (Older People) and Standards 1,2 (Adults 18 - 65) People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Sufficient information is available to prospective clients to help them to make a decision about the suitability of the home to meet their needs and expectations. Prospective residents’ individual needs are assessed prior to the offer of a placement to ensure the home is able to meet them. The home does not provide intermediate care. EVIDENCE: Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 11 Since the previous site visit, the statement of purpose had been reviewed to reflect the management changes at the home, but the contact details of the Commission for Social Care Inspection (CSCI) had not been updated to inform residents, their relatives and representatives should they wish to contact us. Copies of the statement of purpose and the service user guide were available in the home. Two residents who completed surveys stated they received sufficient information about the home before they moved in so they could decide if it was the right place for them and confirmed they had been asked if they wanted to move into this home. One resident commented, ‘I always do as I wish,’ and another resident stated, ‘Two people visited me before I moved in. We heard about the home from our General Practitioner and my parents were suitably impressed by the place and the nursing staff.’ ‘Prospective residents are made aware of the fact that they can bring as much of their own furniture as they wish according to the dimensions of the bedroom’, the manager stated. The assessment documentation of residents, admitted since the previous site visit, was sampled, confirming that sufficient information with respect to the individual needs of residents was collected prior to admission to ensure nursing and care needs had been identified and to enable individual care plans to be produced. The manager stated that the assessment form had been revised and that she completed the assessments accompanied by a trained nurse. Information with respect to equality and diversity had not been recorded prior to admission to inform the staff of the resident’s ethnic background, first language and cultural needs, however, special dietary, communication, mobility, and sensory needs and specialist aids requirements were recorded. Some references to the prospective residents interests, social needs, likes and dislikes were also included, however, this information was limited and needed to be expanded upon and recorded in a person-centred way to ensure the individual’s care plan would be more informative to the staff delivering the care. Observations of and discussions with staff on the day of the site visit confirmed a comprehensive understanding of individuals; their needs and aspirations and the manger and matron demonstrated an extensive knowledge of all the residents whose documentation was sampled. Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service Users, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7, 8, 9 and 10 (Older People) and NMS 6, 9, 16, 18, 19 and 20 (Adults 18 - 65) People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are recorded to inform the staff of how to support them and access to health and social care professionals is promoted. Medication is handled safely, the residents are treated with respect and their right to privacy is upheld. Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 13 EVIDENCE: The files of two older people and two adults in the eighteen to sixty-five age range were sampled. Each contained care plans, details of monthly reviews and daily records. Since the previous site visit, improvements had been made in the documentation of residents’ care and nursing needs, the manager stated. Care plans sampled included information to the staff with respect to supporting individuals with their personal hygiene, including oral care. Details of the specialist aids and number of carers required for moving and handling were recorded and risk assessments with respect to falls, nutrition, the development of pressure areas, accessing the community, smoking and the use of bedrails had been completed. Individual nutritional needs, the need for complimentary foods, the assistance required with eating and drinking and residents’ preferences were also recorded. Communication and other sensory needs and levels, continence needs, and residents’ behaviour and awareness levels were included for individuals where necessary. Details of residents’ goals and aspirations, social and cultural needs and wishes and support required to retain and regain life skills and maintain an independence lifestyle had not been recorded. A record of intervention by healthcare professionals was kept. Records showed that physiotherapist had assessed a resident for the use of a walking frame and that a dietician had been involved in the support of another resident, who had gained weight. A key worker system was in operation to offer continuity of care to the residents. The AQAA recorded that, ‘a named nurse or key worker supports the resident, ensuring that they have access to a dentist, optician, podiatrist, specialist nurse support and to attend outpatients and other appointments. They also support residents in choosing their General Practitioner, in making descisions about their own healthcare/medical treatment and give support with respect to personal issues such as buying new clothes and making sure the their bedrooms are as they would like them to be.’ Regular visiting professionals included a Physiotherapist, a Chiropodist, a Dentist, a General Practitioner, an Aromatherapist and a Masseur. The manager stated that specialist community services were sought from the tissue viability nurse and the community psychiatric nurse when the need arose. Improvements over the previous twelve months with respect to healthcare, as recorded in the AQAA, included the purchase of new medical equipment consisting of two new hoists, a new bath chair, new slings, new suction and other various specialist clinical equipment, new profiling beds and several new mattresses. A new weighing machine enabled an accurate record to be kept of any fluctuations in residents’ weight, which might require the involvement of a dietician. Care plans sampled had been reviewed to include individual agreements with clients where limitations of their rights had been imposed for their protection. Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 14 Instances sampled were with regard to smoking and alcohol consumption. A specific area of the home had been designated for smoking to ensure those residents not partaking were not affected, although some residents chose to smoke outside. The manager recorded in the AQAA, ‘we respect the rights of the residents to make decisions and that right is limited only through the assessment process, ensuring that all changes and needs are recorded in their care plans’. She also stated that ‘The Mental Capacity Act’ training had been accessed and she was in the process of assessing some residents’ capacity to make decisions for themselves. The manager confirmed that the local advocacy service was easy to access and information on how to make contact was also posted on the residents’ notice board for their information. Medication was safely stored in secure trolleys in the nurse stations on each floor of the home. Some residents had been risk-assessed as self-medicating and had a lockable facility in their bedrooms in which to store their medication. ‘Qualified nursing staff administer medication’, the manager stated, and records confirmed that up-to-date training had been accessed. A list of approved signatures for the administration of medication was kept. A local pharmacist supplied medication monthly and records confirmed an audit was kept of drugs brought into the home, drugs administered and those returned to the company commissioned to dispose of the drugs. The home held controlled drugs, which were stored in a controlled drugs cabinet and recorded appropriately for the safety of the residents. A check was made to confirm the number of remaining tablets was in agreement with the number recorded. Medication administration records had been signed by two nurses. The staff observed interacting with residents, did so with respect, and when entering residents’ bedrooms, waited to be invited in after knocking. Two payphones were provided for the residents to contact relatives and friends and in-coming calls could be transferred from the main telephone line to extensions around the home for the convenience of the residents. Some residents had their own mobile telephones and some had their own telephone lines. The Skills for Care Common Induction Standards were used, the manager stated, to ensure new staff were aware of how to support individuals with respect to privacy and dignity, to promote equal opportunities and to give support respecting diversity, different cultures and values. Although the home was registered for seventy residents, actual numbers were much lower to enable residents to have single bedrooms. Double bedrooms were only shared from choice thus promoting residents’ privacy. Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12, 13, 14 and 15 (Older People) and NMS 12, 13, 15 and 17 (Adults 18 - 65) People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. This judgement has been made using available evidence including a visit to this service. Residents enjoy individual lifestyles, maintain social contacts, access the community according to their needs and wishes, exercise control over their lives and receive a wholesome, appealing balanced diet in pleasing surroundings. Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 16 EVIDENCE: Residents spoken with on the day of the site visit expressed satisfaction with the leisure and social activities available to them. One resident was on their way out, manoeuvring their wheelchair down the ramp from the front door, and smiling as they chatted about living at the home. The resident felt there were opportunities for going out on trips and pointed to the mini-bus, stating it was equipped to carry up to seven residents and their wheelchairs and that some residents had been to Beaulieu motor museum the day before. They felt that sufficient social activities were organised at the home, in the evenings as well as during the day. This resident stated that religious services were also conducted at the home for those who wished to attend, but some residents took community transport to church. Another resident spoken with stated they enjoyed attending college, playing games, taking part in quizzes and watching television. They also liked their bedroom, where they were surrounded with photographs of grandchildren, listened to music and enjoyed visits from relatives, whom they stated were welcome to visit at any reasonable time. This resident was looking forward to attending a college course on office skills and computers, which was in the process of being arranged for four sessions each week. The recreational therapy department was popular with some residents and they were busy playing card games, making cards, painting pictures and decorating bowls. The products of the residents’ creative work were displayed around the room and pictures were hung in the corridors encouraging their endeavours and recognising and valuing their talents. Examples of clay work, glass painting, mosaic, papier-mâché, flower arranging and decorated bowls were on display and a visiting relative, whose husband had produced some fine paintings stated, ‘This is the best occupational therapy department my husband has ever been in because he has been encouraged to use his talent.’ One resident attended mouth-painting classes at a local college and many of their paintings were displayed in the corridors and another resident took pleasure in completing large jigsaw puzzles, the manager stated, and these had been mounted and were also displayed. The manager recorded in the AQAA that visiting services included a hairdresser, a manicurist, an aromatherapist and a masseur. ‘Relationships are encouraged’, the manager stated, ‘two residents, who had developed a relationship requested a move to a shared bedroom and had been supported in this.’ Residents who completed surveys confirmed they could do what they wanted during the day, in the evening and at the weekend. One resident commented, ‘I sometimes go home and visit my family, but am always happy to return.’ At the time of the site visit one resident was staying with their family in Italy, which had been arranged by the home, the manager stated, and a holiday in Dorset had also been arranged for a group of residents. A notice board provided information to the residents about activities and trips arranged. Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 17 Photographs displayed in corridors showed residents sailing, partying, on day trips to The New Forest, Goodwood races, Eastleigh steam railway, a zoo and partaking in dog therapy, which the manager stated, ‘is a two-weekly event’. She also pointed out that theatre trips, cinema club and other social events were arranged for the residents. The manager recorded in the AQAA with respect to improvements in residents’ lifestyles, ‘residents are now having interviews for outside college courses and more holidays are being booked for them. There are plans in place to involve residents in more gentle exercise, for example chair aerobics and ball games’. ‘Residents have keys to their bedrooms’, the manager stated, ‘and a lockable facility such as a drawer or cupboard is provided’. Some residents handled their own financial affairs and relatives supported some. Advocacy services were readily available and the manager confirmed this service was easy to access. Residents were encouraged to bring their personal possessions including furniture to personalise their bedrooms. A large dining room was located on the ground floor and residents were observed enjoying lunch seated at tables of thee/four places. Those residents who required assistance were appropriately supported by staff who were seated beside them and residents who required a soft food diet had their food nicely presented and shaped to look as if it were solid. One resident spoken with stated, ‘the staff are nice and the food is fantastic.’ The main dishes of the day were scampi, chips and peas or sweet and sour pork and vegetables and the meals were nicely presented and the ambiance was calm and relaxed. Special diets were catered for and one resident had chosen a baked potato with filling. The chef was very enthusiastic about her work and had recently changed the six-weekly menu. She was very keen to ensure residents received their ‘five a day’ fruit and vegetables and had incorporated this component into the menu. She was fully aware of the special dietary requirements of the residents. The chef stated that the home encouraged the staff in gaining qualifications and the two kitchen assistants and two kitchen porters had accessed National Vocational Qualifications and that she had attended courses on menu planning and nutrition. The home had a dedicated fruit and vegetable store, which was well stocked and a large up-to-date kitchen in which to prepare the meals. Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16 and 18 (Older People) and NMS 22 and 23 (Adults 18 - 65) People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Policies, procedures and training ensure the staff are informed of how to protect the residents from abuse, neglect and self-harm and the home takes appropriate action when issues arise. The residents are confident that their complaints will be listened to and that they will be protected from abuse. EVIDENCE: The home’s complaints procedure was included in the Service User Guide, giving clear guidance on how and to whom a complaint should be made and informing the complainant of the timescale for a response. With respect to the contact information for the Commission for Social Care Inspection (CSCI), an update is required to enable residents and their relatives and representatives to make direct contact should they wish to do so. No complaints had been received by the CSCI since the previous site visit. Residents spoken with on the day of the site visit and those who completed surveys were clear about whom they could speak to if they were not happy and knew how to make a complaint. One resident commented that he found the manager and the matron approachable and another resident wrote, ‘I do not know how to make Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 19 a complaint, but I don’t have anything to complain about.’ The home’s complaints and compliments log contained two concerns, which had been dealt with immediately and appropriately, and one complaint, which was in progress. Cards containing messages of thanks from relatives were also viewed and one relative commented, ‘thank you very much for your help and hard work involved in supporting my daughter to spend a holiday with her family in Italy.’ The local authority safeguarding adults policies and procedures were available to inform the staff at the home of how to protect the residents from harm, how to identify and respond to abuse and how to refer suspected abuse to the appropriate authorities. Staff training logs confirmed that the Protection of Vulnerable Adults training had also been accessed. Since the previous site visit there had been two safeguarding investigations, one of which had resulted in the home completing an action plan with respect to improving care planning and other documentation, medicine management, nutrition and hydration and some aspects of clinical care. The second investigation had led to the home looking at security arrangements at the weekends when no receptionist was available. The home’s ‘open door policy for visitors’ could potentially put residents at risk and a plan to install a bell to call a staff member when visitors arrive at the weekend and to require them to sign the visitors’ book was in place. Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19 and 26 (Older People) and NMS 24 and 30 (Adults 18 - 65) People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a comfortable, safe and pleasant environment, which is clean and hygienic. EVIDENCE: Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 21 The home was located in a position of outstanding natural beauty, retaining many original features of historic interest, and the extensive parkland surrounding the home contained mature trees and shrubs, a pond and an ancient monument. The drive leading up to the house from the road was in need of repair as holes had developed in the surface caused by the winter weather and were potentially hazardous to both car and wheelchair users. The manager stated that the provider was aware of the urgent need to ensure these repairs were carried out without delay. A tour of the premises confirmed that, although the premises were not purpose built, efforts had been made to achieve a homely and pleasant living environment for the residents. The house retained its original decorative features, including fireplaces and moulding around ceilings, wooden panelling and flooring and was very attractive. Residents spoken with appreciated the elegance of their living environment and the beauty of its rural location. Communal space included three sitting rooms, one situated on each of the three floors. The largest was located on the ground floor and contained a grand piano, widescreen television, music centre, games and puzzles and comfortable seating, which the manager stated, had been purchased since the previous site visit. Radiators had protective covers to prevent the residents from burning themselves. The lighting was domestic and the windows large, allowing natural light into the room. New carpets had been laid in some corridors and some carpets were in the process of being replaced. A lift was provided to enable wheelchair users to gain access to all floors and ramps had been fitted, where required, for access. The manager stated that she was in the process of developing an outdoor entertainment area on the terrace. A safe ramp led down from the dining room to outdoor dining area. New garden furniture had been ordered and the manager had plans for a pagoda and archways with colourful climbing plants for the enjoyment of the residents and their visitors. On the tour of the premises, two leaks were noticed, a broken window in the attic and some damage to doors and walls caused be wheelchairs. The maintenance department were aware of the problems and a record was kept of reported and completed work. The home did not provide adequate facilities for the residents to wash, dry or iron their own clothes, or to prepare their own food and thus retain or regain the life skills necessary for an independent lifestyle. There were no spaces set aside for residents to meet with their visitors in private, except in their own bedrooms. Since the previous site visit, smoking had been restricted to a separate smoking room so that this activity did not impact upon other residents, who had previously complained and also to comply with legislation concerning smoking in the workplace, which came into force in July 2007. The dedicated room was in need of refurbishment and the manager stated that it was included in the development plan. Residents spoken with in the smoking room were happy with the provision. Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 22 Areas of concern noted during the tour of the building at the previous site visit, had been dealt with appropriately. No bedroom doors were wedged open on this occasion and advice had been sought from the Hampshire Fire and Rescue Service with respect to providing magnetic door closures and installing a new fire alarm system. The practice of storing spare bedding on the top of cupboards in the corridors had ceased, ensuring that people living and working in the home were not exposed to avoidable and unnecessary risk of harm with respect to them home’s fire safety arrangements. Several residents’ bedrooms were sampled, with their permission. ‘The residents are encouraged to bring with them their own furniture should they wish to do so’, the manager stated. Residents spoken with were satisfied with their bedrooms and had personalised them with photographs, decorative objects and plants. One resident had a huge collection of miniature buses, reflecting their interest in transport and another had a large collection of compact discs and videos. Furniture was domestic and some bedrooms had been supplied with new beds. Residents confirmed they had been consulted with respect to the décor of their bedrooms. Throughout the home, equipment and adaptations to support people with physical disabilities were available, including assisted baths, level access showers, hoists, profiling beds, a nurse call system, handrails and safety grips. The home was clean and there were no unpleasant odours. A team of cleaners were observed carrying out their duties during the tour of the building and it was noted in the AQAA that domestic staff are encouraged to obtain National Vocational Qualifications in Housekeeping. Of the two residents who completed surveys, one thought the home was always clean and fresh, and one that it usually was. Laundry facilities were appropriate and infection control was promoted by the supply of alcohol gel and the provision of protective clothing, including gloves and aprons and the supply of liquid soap dispensers and paper towels. The AQAA confirmed that staff training in infection control including, train the trainer in respect of senior staff, had been accessed. Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27, 28, 29 and 30 (Older People) and NMS 32, 34 and 35 (Adults 18 - 65) People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. A stable, well-trained staff team meet the needs of the residents and ensure they are in safe hands. Although most recruitment documents and information had been obtained, one aspect of the recruitment procedures and practice needs to be reviewed to ensure the protection of residents. EVIDENCE: On the day of the site visit sufficient staff were available to attend to the individual needs of the residents and residents spoken with expressed satisfaction with the availability of staff. Two registered nurses were on duty Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 24 and the manager stated that this was the minimum number of qualified nursing staff on duty, including over night. Staff rotas showed that seven/eight nursing/care staff were on duty during the day. A chef, kitchen assistants, laundry assistants, cleaning staff, a handyman, a receptionist and an occupational therapist in addition to the manager and/or matron, supported this team. The personnel files of two staff recruited since the previous site visit were sampled. The revised application form did not require a full employment history with any gaps explained to ensure prospective candidates are suitable to be considered for work with vulnerable adults. The recruitment process, as described by the manager, was based on equal opportunities. There were always at least two senior staff involved in carrying out the interviews and notes had been filed to verify the decision making process. Two references had been received on behalf of each prospective employee before the post had been offered to them. Criminal Record Bureau (CRB) and POVAFirst (Protection of Vulnerable Adults) checks had also been carried out prior to employment to safeguard the residents and these had been safely stored to protect the sensitive nature of their contents, however, advice should be sought from the CRB on the recording, destruction and up-dating of this information to ensure this sensitive information is dealt with appropriately. Staff personnel files sampled were not bound to safeguard the information contained in them and there was no audit sheet to confirm the requests for and receipt of references and other checks to clarify the process. The manager wrote in the AQAA, ‘the residents are invited into interviews of possible employees and encouraged to give their views.’ Staff personnel files sampled confirmed that induction was in line with the Skills for Care Common Induction Standards, notebooks completed by the staff over the first three months of employment and certificates of completion were seen. The manager stated that new staff were supernumerary for the first three weeks of their employment. Files sampled included certificates to confirm up-to-date training in moving and handling (including patient hoisting), food hygiene, infection control, health and safety, the protection of vulnerable adults, First Aid, communication, managing challenging behaviour, MRSA, continence, catheter care, falls awareness, pressure area care and National Vocational Qualifications at level 2 and 3. The matron confirmed that the qualified nurses received the required training and study days in order to maintain their registered status and pin numbers and a training schedule to confirm this, was displayed on the office notice board. Recent training included the handling and administration of medication, care planning, the Mental Capacity Act, wound care, vena puncture and catheter care. The manager was in the process of collating the staff training matrix, recording the care staff training and future dates for the up dating of mandatory and specialist training. A staff office on the first floor was visited and on the notice board was a list of training, which the staff could access including ‘epilepsy, wound care, palliative care, handling medication, MRSA, Huntington’s disease and a mental Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 25 health study day on depression.’ The home had a dedicated training room for the staff. The AQAA confirmed that more than 50 of the staff had achieved a National Vocational Qualification at level 2 or above or were working towards one and that the home benefited from a stable and loyal staff group, providing consistency for the residents. Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 27 NMS 31, 33, 35, 36 and 38 (Older People) and NMS 37, 39 and 42 (Adults 18 - 65) People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Good leadership and systems are in place to ensure the home is run safely and in the best interests of the residents. EVIDENCE: Since the previous site visit, the proposed manager, who had worked at the home for many years in various roles had completed a National Vocational Qualification at level 4 in care and achieved the Registered Managers’ Award, which meant that she had the relevant formal qualifications to manage the home. She had also applied and been accepted as registered manager for the home. A matron, who was also a State Registered Nurse, supported the manager in clinical matters and the nursing staff in their developmental and training requirements. Both displayed openness and a shared enthusiasm for providing a homely, happy, comfortable and safe environment for the residents to live in and demonstrated a deep understanding of the individual residents needs and of their rights to make their own decisions and choices. Observations of interaction between the senior staff, nursing and care staff, domestic staff, residents and visitors was of mutual respect and inclusion in a community where everyone was valued as an essential part of the whole. ‘The necessary changes undertaken over the past six months particularly with respect to documentation had not been easy to implement’, the manager stated, ‘and it had been difficult to convince some staff of the benefits of some of the changes such as improved documentation.’ The new manager had also set up an internal audit system to review all the systems and processes of the home and she was in the process of updating all policies and procedures. Systems were in place to ensure the views of the residents, their relatives and representatives and the staff contributed to the running of the home. Quality assurance questionnaires were completed on a regular basis and included the views of residents, their relatives and representatives. The results had been collated and colourful pie charts indicating percentages of positive/negative responses had been produced to feed the results back and show areas of improvement to be included in the home’s development plan. Staff and residents meetings were held to enable their views to be sought to contribute to the continuous development of the service. Some comments in the feedback included, ‘I enjoy living at Westbury and am happy with the care I receive’, Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 28 ‘the staff are generally co-operative and good at understanding my needs and wishes.’ In the instances where residents do not have support from relatives/representatives with respect to their finances, the home ensures that individuals have their own bank accounts. Appropriate records and receipts were kept with respect to the small amounts of cash held on behalf of residents. The health, safety and welfare of the residents were promoted by staff training in moving and handling, fire safety, first aid, food hygiene and infection control. Certificates were viewed on staff personnel files to confirm this. The Annual Quality Assurance Assessment, completed by the manager confirmed that policies and procedures with respect to health and safety had been reviewed since the previous site visit, and that the essential maintenance of equipment had been carried out according to manufacturers’ recommendations. A sample of certificates to verify this was seen on the day of the site fashion. Accidents and incidents had been recorded and dealt with appropriately and the CSCI had been notified of serious events, which could adversely affect residents. The COSHH (Control of Substances Hazardous to Health) cupboard was appropriately secured. The responses to requirements made at the previous site visit with respect to Health and Safety have been included under the ‘Environment’ section of the report. Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 3 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 X 37 X 38 3 Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 YA34 Regulation 19 Schedule2 Requirement Timescale for action 27/06/08 2. YA28 The reviewed application form should require a full employment history with an explanation of any gaps in employment explained so that only suitable candidates will be considered for employment at the home. 23 (2)(i) Adequate facilities must be 16(2)(f)(h) provided for the residents to wash, dry or iron their own clothes, or to prepare their own food and thus retain or regain the life skills necessary for an independent lifestyle. Private spaces must be available for residents to meet with their visitors in private in addition to their bedrooms. 02/02/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 31 1. OP3 YA3 2. YA6 OP7 3. OP29 YA34 4. OP29 YA34 More information with respect to equality and diversity including the prospective residents’ interests, background, social and cultural needs, likes and dislikes and aspirations should be sought prior to admission to enable personcentred care plans to be developed. Details of residents’ goals and aspirations, social and cultural needs and wishes and the support required to retain and regain life skills and maintain an independent lifestyle should be recorded in the care plan to inform the staff and to ensure all the residents’ needs are met. Advice should be sought from the Criminal Record Bureau with respect to the recording and destruction of Criminal Record Bureau checks to ensure this sensitive information is protected. It is recommended that the information in the staff personnel files be bound to safeguard it and that an audit sheet to show when the information has been requested and received be added to clarify the process. Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Westbury House Nursing Home DS0000011525.V363764.R01.S.doc Version 5.2 Page 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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