Care Home: Westcombe Park Nursing Home

Similar services:

• Henry Nihill House
• Birchwood
• The Infirmary
• Orchard House Nursing Home
• St Josephs Rest Home
• Red Court Nursing Home
• Spinney (The)
• Queen Elizabeth House

What the care home does well The manager is very experienced and provides good immediate direction for staff. All of the residents spoken to said the manager and assistant are "always available and staff are very helpful and friendly". People live in a comfortable, well maintained and mainly safe home, which is clean and hygienic. Staff are friendly and welcoming to visitors at all times, including pre-admission visits. Residents enjoy a good choice of food and they are supported by appropriate levels of well-trained staff. More than half of the care staff have had NVQ level 2/3 training, and about 40% of the overall support staff are trained nurses. All of the residents and relatives who spoke to me said there are generally very happy about the home and that many improvements have been made. Good staff recruitment practices are happening, and the manager has specialist knowledge of monitoring the authenticity of employment documentation. Staff have good induction and ongoing training available to them. The home has staff reward systems in place such as the "personal best" award certificate. Staff are being consistently supervised regarding their understanding of support for residents and their personal development. What has improved since the last inspection? The call bell system used by residents is now being answered promptly and the home now uses a response monitoring system, which shows that a response to a call is now being done within two minutes. Three residents said that staff are "quick in coming and always now explain if they need to attend to something else urgently". The home has improved the system for cleaning and there is now one cleaner working on each floor for 5 hours per day and a full time senior housekeeper is employed to manage cleaning amongst other duties. Smells and unwanted odours are well managed and were not apparent. Work has been done to involve one residents relative in giving feedback to staff about important areas to consider when providing care and support and the staff said that this has been good for improving understanding and working practices. New medication procedures have been introduced in response to some concerns expressed and this needs to continue to be monitored by the home. New hoists have been purchased to improve availability for staff when providing personal care support for residents and staff say that this has helped to avoid delays in waiting when providing personal care for some residents who needed use of a larger hoist. A better choice of food and snacks is now on offer outside of the normal mealtimes and the home has introduced a "nite bites" menu so residents who want it can have suitable snacks at night. Six residents said that the food is very good. What the care home could do better: The home must include in residents care plans better information about residents mental health support needs and about activities in relation to dementia support needs. This should help individual residents to feel they are ready to do activities when they are offered.There must be better recording of residents mood, engagement in activities and any individual expression of wellbeing and happiness in daily records so that these can be used to help staff when reviewing care plans for residents. It should also be easier and quicker to find information about visits by healthcare professionals so that the staff can check that all residents are getting the support they need. Availability of dental care in the home for all residents should continue to be an objective for the home. Staff must be given training about mental health and end of life care so they can provide the residents who need it with good support. All care staff must have basic medication training as part of their induction so that they will be able to support residents by monitoring effects of medication. Management of medication by staff needs some small improvements especially to make sure there is always medication available for residents who use it. Staff must have an annual performance appraisal so they can reflect on the way they work and get support for their development. The home should provide simple written induction information for agency staff and new staff, so that they can easily remind themselves about how to support each resident during personal care. Staff should have some update training in what they are expected to write in daily notes for residents to help the home to review care plans for residents. CARE HOMES FOR OLDER PEOPLE Westcombe Park Nursing Home 112 Westcombe Park Rd Blackheath London SE3 7RZ Lead Inspector Sean Healy Unannounced Inspection 6th June 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westcombe Park Nursing Home Address 112 Westcombe Park Rd Blackheath London SE3 7RZ 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) 020 8293 9093 020 8858 2026 hillsn@bupa.com www.bupa.co.uk BUPA Care Homes (GL) Ltd Nicola Hills Care Home 51 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (51) of places Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd March 2007 Brief Description of the Service: Westcombe Park Nursing Home is located to the rear of a privately owned apartment block, which is managed by Goldsborough Estates. The home is sited on a residential road within walking distance of local shops and public transport links at Blackheath Standard. Westcombe Park Nursing Home is registered to provide nursing care for 51 male or female residents whose primary care needs are old age. Accommodation is provided on three floors. Forty of the bedrooms have en-suite facilities. Approximately 40 of the current residents are privately funded and the remainder are local authority funded placements. Each of the floors has a communal lounge, bathrooms and toilets. On the ground floor there is a dining room and a large lounge, which is used for activities. Kitchen and laundry facilities are provided on site. At the rear of the property residents have access to a shared garden. On the 6/6/08 the fees payable for residents range between; £555.00 £941.00 per week for publicly funded residents and £875 - £1113.61 per week for privately funded residents. There were 9 residents’ vacancies according to the home’s current registration. However as a number of the double rooms were being used as singles at the time to provide higher levels of single occupancy rooms, this translates to 4 vacancies. Information about the service provided is made available to current and potential service users in the homes Statement of Purpose and Service Users Guide, which are given to all residents. The recent CSCI report is kept in the lobby area of the home open for viewing. Westcombe Park Nursing Home DS0000006775.V364771.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 that the people who use this service experience Good quality outcomes. The inspection was unannounced and was completed over two days on the 6th and 11th of June 2008. The inspection ended on the 27/6/08 following receipt of further information from the home. The registered manager and assistant manager facilitated the inspection. The inspection also included an inspection by the CSCI pharmacy inspector. The pharmacist will provide a separate inspection report for this inspection. Relevant comments are also included in this report. CSCI conducted an Annual Service Review on the 9/4/08 and this is also referred to in some sections of this report. Three care staff, one nurse, the activities co-ordinator, the senior housekeeper and the assistant manager were interviewed and their comments are included in this report. Six staff employment files were examined to check that they had been properly recruited, trained and supervised. Six residents gave their views on the home and three residents files were examined. Resident’s surveys were distributed and comments are included in the report. Two relatives gave their views and experiences of how the home is managed. Comments from the Greenwich adult protection team were also considered. There were nine residents’ vacancies but many of these beds are in double rooms, which are now used as single rooms. The inspection involved a tour of the premises and examination of a range of management documentation. What the service does well: The manager is very experienced and provides good immediate direction for staff. All of the residents spoken to said the manager and assistant are “always available and staff are very helpful and friendly”. People live in a comfortable, well maintained and mainly safe home, which is clean and hygienic. Staff are friendly and welcoming to visitors at all times, including pre-admission visits. Residents enjoy a good choice of food and they are supported by appropriate levels of well-trained staff. More than half of the care staff have had NVQ level 2/3 training, and about 40 of the overall support staff are trained nurses. Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 6 All of the residents and relatives who spoke to me said there are generally very happy about the home and that many improvements have been made. Good staff recruitment practices are happening, and the manager has specialist knowledge of monitoring the authenticity of employment documentation. Staff have good induction and ongoing training available to them. The home has staff reward systems in place such as the “personal best” award certificate. Staff are being consistently supervised regarding their understanding of support for residents and their personal development. What has improved since the last inspection? What they could do better: The home must include in residents care plans better information about residents mental health support needs and about activities in relation to dementia support needs. This should help individual residents to feel they are ready to do activities when they are offered. Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 7 There must be better recording of residents mood, engagement in activities and any individual expression of wellbeing and happiness in daily records so that these can be used to help staff when reviewing care plans for residents. It should also be easier and quicker to find information about visits by healthcare professionals so that the staff can check that all residents are getting the support they need. Availability of dental care in the home for all residents should continue to be an objective for the home. Staff must be given training about mental health and end of life care so they can provide the residents who need it with good support. All care staff must have basic medication training as part of their induction so that they will be able to support residents by monitoring effects of medication. Management of medication by staff needs some small improvements especially to make sure there is always medication available for residents who use it. Staff must have an annual performance appraisal so they can reflect on the way they work and get support for their development. The home should provide simple written induction information for agency staff and new staff, so that they can easily remind themselves about how to support each resident during personal care. Staff should have some update training in what they are expected to write in daily notes for residents to help the home to review care plans for residents. 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. Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each resident has on file a signed and dated contract or statement of terms and conditions, which is adequate. All residents do have fully completed assessments of their care needs in place before coming to live at the home. Intermediate care is not provided. EVIDENCE: I examined three residents files and these showed that each had an assessment of their care and support needs which had been provided by social services, and that separate more detailed care assessments had been carried out by one of the home before a decision was reached to provide a service. These were detailed and usually carried out by the Deputy Manager, who is a trained nurse, and the home’s Head of Care. Information was comprehensive and included residents’ personal data; medication; medical history; activities of daily living (e.g. mobility, communication needs, continence, sleep pattern, Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 10 personal hygiene needs); mental state, skin integrity personal safety issues, communication needs, eating and drinking support and sensory support needs. There is also an assessment statement regarding the residents’ abilities and wishes concerning self-medication, management of personal finances and benefits and whether bedside rails are necessary for support. The home quickly develops a “Map of Life” which shows the residents’ history of places lived, education, employment, family/children, holidays and hobbies. This is then used to plan activities for each resident. A placement is only offered if the home is able to meet the assessed needs of the resident. The Deputy Manager of the home had consulted CSCI when any doubt has arisen regarding the appropriateness of a potential admission in respect of the home’s registration category; this is good practice. The home does not routinely admit residents who have complex dementia care needs and where dementia support is an issue it is identified and included in the assessment. Currently the home is providing support for one resident whom they feel has higher needs than those originally identified on admission and an assessment is being carried out to ensure adequate levels of support can be offered. This shows a responsible approach to ensuring residents support needs can be met by the home. Each resident has a contract, which shows the care to be provided including the cost of care. These have been signed and dated by residents or their relatives. Currently approximately 40 of the residents for whom the home provides support are privately funded and these have contracts on file. The remainder of residents are funded by a number of local authorities in South London. The home does not provide intermediate care support. Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s health, personal and social care needs are not always included fully in their care plans. Although there are generally good health care plans for residents all of their needs are not fully included. Residents are not fully protected by the homes medication practices. Arrangements for personal care support are good and residents are treated with respect. EVIDENCE: Three residents files were examined. These showed that residents have comprehensive personal care plans individual to their identified needs, and that there are a range of appropriate health care professionals involved in providing healthcare support. These files and the homes Annual Quality Audit Assessment showed that there is a high level of support required for bathing/toileting, dressing, continence management and eating. In addition a few residents have low level dementia support needs and about a third of all residents have sensory support needs needing consideration in care planning Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 12 for hearing and sight specialist support. I found that these areas were included in assessments and had been transferred into care plans and that these plans were being reviewed monthly for all files examined. Discussion with residents and relatives showed that they are being asked to be involved in care plan reviews and one relative meets monthly with the care home staff to discuss issues regarding her mothers support. The home’s assessment process includes a scoring system for the support needed in each area of assessment. Those areas scored as medium and high level are specifically included in the care plans and areas of risk such as moving and handling,falls/eating swallowing/tissue viability are then included in the risk assessment process. All files examined had a range of risk assessments, which related to the care assessment issues identified. The home is reviewing these monthly as part of the care plan review process and this is being recorded. The home has up to date Policies and Procedures regarding provision of health care and medication and the Royal Marsden Manual of Clinical Procedures are in use at the home. Company specialists both regionally and nationally can be consulted for advice and support when needed. Self care is encouraged and the care plans describe where individual residents are able to do certain things for themselves and identify where support is needed with moving and handling. There was also clear reference included when residents need two staff for support and where hoists are required when moving and handling. Residents files showed that pressure ulcers are recorded and there is involvement from tissue viability nurses when necessary. Information about moving and handling care needs are collated within the provider organisation, BUPA Care Homes, and the information is used to identify trends and inform the purchase of appropriate equipment. Files examined showed that all residents have a nutritional screen using the MUST nutritional screening tool. Personal food preferences are included in care plans and specialist dietary needs are also included. One residents file showed she was diabetic and this was reflected in the the food provided. Residents handover notes show that good attention is being paid to recording information about eating, toileting and general health care. However there is little information being recorded about residents activities, mood, engagement in activities and any individual expression of wellbeing and happiness. One resident’s file examined had a diagnosis of dementia and another of depression but no mention is made in handover notes about these issues. This is important information, which is useful for helping to inform the monthly Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 13 care plan review process. The home must include better information regarding resident’s activities, mood, and engagement in activities and individual expression of wellbeing and happiness in resident’s daily records, which can easily be used in the monthly review process. (Refer to Requirement OP7) Every resident is registered with a General Practitioner of their choice. The home also ensures that other healthcare professionals are also involved. A private chiropodist visits every 6 weeks to see the majority of residents and a Primary Care Trust podiatrist sees a number of residents who are assessed as needing higher levels of support. However while dental care is provided when necessary and dental care is included in personal care plans, the home does not provide access to routine annual dental care checkups/treatment for all residents. The manager said that the community dentist has spoken with the care homes forum and said that they cannot currently provide this service for all residents routinely. The home should advise all residents of this problem and seek their views regarding the quality of this service. The home should also continue to actively try to resolve this issue within the provider organisation and raise it for further discussion with the various commissioning authorities and Primary Care Trust. (Refer to Requirement and Recommendation OP8) Examination of one residents file showed that her assessment showed depression to be an important issue for consideration. While staff and management were clear that the resident had significant periods of time spent in her room feeling tearful and withdrawn, and handover notes showed this to be the case, there is currently no written strategy or guidance for staff included in this residents care plans. Neither are there any records of this being discussed with a healthcare professional with a view to intervention. I met with this resident who at the time was very tearful and although was clearly upset was also happy to speak with me to discuss her worries. The home must raise this issue for discussion as part of the care planning process and ensure that care plans include a clear written approach for staff to follow in their interaction with this resident. There must also be better clarity as to what should be included in the daily records being kept in relation to mental health issues. Consideration should also be given to raising this issue further with the residents GP to gain a view on the best support available. (Refer to two Requirements OP8) The home records visits by healthcare professionals and GPs but this information is being recorded in more than one place making it difficult sometimes to find the information quickly when needed. This is an important consideration when carrying out monthly care plan reviews and in monitoring whether all residents are having the right frequency of healthcare appointments necessary for their care. It is recommended that the home review the system for recording visits by healthcare professionals to ensure Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 14 that information can be quickly and easily accessed for the purposes of review. (Refer to Recommendation OP8) The home’s management and documentation states that: “Privacy and Dignity feature highly in BUPA Care Homes customer service programme, Personal Best”. While the home’s care plans are detailed and take good account of risk and moving and handling needs of residents, it is the case that these plans are kept in large residents files which are not practical for temporary or new staff to use who are not familiar with them. The current system for inducting agency staff to provide personal care support for residents is verbal and demonstration, which is good but would be more risk free if it was supported be simple written guidance. For residents who either have high mobility support needs, or who cannot adequately communicate their own needs verbally, the home should consider providing simple written induction information for agency staff and new staff, about how to support each of these residents during personal care. This should be kept available in resident’s own rooms with their permission. (Refer to Recommendation OP8) The home’s medication policy is up to date and meets the criteria of the National Minimum Standards and the guidance from the Nursing & Midwifery Council and the Royal Pharmaceutical Society. A CSCI pharmacist who carried out a full inspection of the homes medication management system supported this inspection. The pharmacist gave feedback to the manager. The pharmacist will also provide the home with a separate more detailed report. The following are the main findings, which resulted in two requirements: Since the last inspection, a new system for monitoring medication has been implemented. This has been effective in ensuring errors are picked up quickly and addressed, and at this inspection records were generally up to date and accurate. All medicines are being stored safely. Nursing staff have recently had refresher medication training. No permanent residents wish to self-administer their medicines. Safe storage is provided for respite residents who do. Controlled drugs are stored safely, and records were accurate apart from one liquid medicine. There were no major issues, which could have compromised the safety or well being of residents, however there are a number of areas, which still require improvement. These areas are: 1. The home should ensure that it is possible to identify staff who have administered medication. This includes agency/bank staff. The current signature lists of authorised staff are not up to date. 2. Although care staff do not administer medication the home should ensure that that they receive medication training as part of their induction to enable them to monitor any changes in residents conditions, which may Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 15 be caused by medication. This is the subject of a Recommendation as it is not required to meet National Minimum Standards) 3. The home must ensure that all medicines kept at the home can be accounted for, and are recorded by following the homes policy for medication disposal. Medicines consigned for destruction do not always have a witness and a number of receipt quantities were missing so it was not possible to carry out a stock check. 4. The home must ensure that any amendments to the dose or frequency of prescribed medicines are signed and dated by staff so that it is clear that an authorised person has made the change. This is not currently consistently being done. 5. The home must ensure that all creams and ointments have full instructions for use, including the area of application. 6. The home must ensure that the correct administration codes are used on MAR charts, in particular when doses are missed e.g. an x has been used on some charts, and it isn’t clear why the dose has been missed. 7. The home must ensure that all prescribed medicines are in stock at the home to ensure no doses are missed as two prescribed medicines were out of stock for a number of doses during the past month. (This has also occurred on two previous occasions in the previous eight months) 8. The home must ensure that visual stock checks are carried out on liquid medicines, in particular controlled drugs, as there appeared to be a quantity of temazepan liquid unaccounted for. 9. The home must ensure that that eye drops are fully labelled with instructions for use, as at present only the outer boxes are labelled. 10.The home must ensure that the date of opening is added to medicines with a finite shelf life after opening. (Refer to Requirements and Recommendations OP9) Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents feel that the lifestyles experienced in the home matches their preferences and expectations. They are supported to keep good contact with family and friends, and to make choices and keep control in key areas of their lives. Good food and a healthy diet are provided by the home. EVIDENCE: The home has now employed a full time activities co-ordinator who meets with many of the residents weekly. Residents say that they know the co-ordinator and that she organises very good activities in and out of the home. Photographs are taken at social and special events and outings and displayed in the home. There is a structured activities programme in place and activities programmes are displayed on noticeboards and given individually to all residents on Mondays. These include: musical events in the home, exercise activities, games and planned outings, visits by family and religios activities. Residents individual activities are discussed with them by the co-ordinator and she then works to include them in the planned schedule. This is well regarded by residents. However the individual residents care plans do not include any Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 17 reference to each residents current activities or about the best time to offer activities in relation to residents personal care and support nedds. For example five residents have dementia support issues, which could prevent them from wanting to participate in activities, but no mention is made of this in planning activities. One resident suffers from depression and spends a lot of time in her room. Activities such as routinely offering her social interaction with staff in her room talking, reading or just listening to her expressing her feelings have not been considered in her care plan. While staff do regularly enter her room and speak with her and the activities co-ordinator does ask her about becoming involved in activities, all staff spoken to said they find it extremely difficult to engage her in activities. This is all the more reason for considering with the resident and her family a structured approach for providing social activity. The home must include written social and leisure activities (including exercise in consultation with the resident), in each residents individual care plans, which are related to their mental and physical abilities, and the times when they should be offered if relevant to their physical or mental support needs. (Refer to Requirement OP7) Photographs are taken at social and special events and outings and displayed in the home. There is a structured activities programme in place and activities programmes are displayed on noticeboards and given individually to all residents on Mondays. These include: musical events in the home, exercise activities, games and planned outings, visits by family and religious activities. A riverboat trip to Westminster and an outing to Margate feature amongst the planned summer activities. While there is some work to do in including individual residents activities in their care plans it is apparent form general activities plans and from feedback from residents that activities including religious, social leisure and relationships are encouraged and facilitated by the home. A copy of the activities plan is given to all residents. It includes skittles, ball games, and special events such as ‘Loud Tie Day’, and evening cocktail party and an exercise and musical events. Many of the residents prefer to stay in their rooms, and several were seen reading or watching television. All the residents spoken to said that there are lots more activities now since the activities person has been in post. Visitors are able to visit at any time, and some visitors were seen on the day of the inspection. Two visitors were spoken to and said that they are always made to feel welcome and staff are very helpful and accommodating. There are no restrictions on the times that residents can visit. The residents and relatives who spoke with me said that there was had problem in accessing their own money and the home was not involved in managing their finances. All residents or their families manage their own finances including bank accounts and benefits. Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 18 All meals are assessed using the BUPA Menu Manager System for their nutrition content. Residents preferred meals are included as part of the assessment process and they are consulted by the home weekly about the meals available and what they would like to eat. In September 2007 some residents had told an auditor that they would like more variety of food on offer at suppertime for residents. The home has introduced a Night Bite system to ensure that food is available 24 hours a day. Residents told me that they are able to have fodd of their choice now both during the day and at night. A good range of food is offered on a menu, which is posted up daily. The home has conducted surveys on resident’s views and opinions about the food. The chef interviewed showed a good knowledge of residents individual preferences and dietary needs. Excellent records are being maintained on the food eaten by residents. One resident said that she “loves scrambled eggs and can have it whenever she wants”. Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a straightforward complaints procedure, and residents and relatives know that their views will be taken into consideration. Residents are protected from abuse by the homes policies and procedures. EVIDENCE: Complaints: There have been six complaints made to the home since the last inspection and all of these were investigated quickly. Outcomes were provided to the complainants and good records were kept. Adult Protection: Generally the home is managing adult protection issues well. Three adult protection referrals were made since the last inspection. The first two of these were discussed and included as part of the CSCI Annual Service Review report on 9/4/08. The third was made since that time. The first of these was included in a complaint from the relative of a resident. The relevant adult protection issue concerned a resident falling and incurring an injury while supported by two staff. The home took appropriate measures to intervene. The home cooperated fully in liaising with the local authority adult Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 20 protection officer to protect the residents. There was a lack of some detail in the providers outcome report about the areas looked at during the management investigation, such as staff training in moving and handling, staff induction, including that of one of the staff who was an agency worker, and the availability of the necessary equipment at the time of the incident. This was discussed with the registered manager as part of the Annual Review process. The manager has now confirmed that suitable hoists were available for staff to use, and the care plan of the resident concerned showed that a hoist must be used in providing personal care support for this resident. The home subsequently provided additional training for the staff concerned and reported the issue to the agency who provided one of the care staff. Therefore the home acted appropriately and effectively in intervening and investigating this matter. Discussion with a number of staff who provide care support showed that they understood the homes policy an safeguarding adults, but that there is a need to remind staff generally that any allegations or suspicion of abuse must be immediately reported to the homes management before starting to undertake any form of investigation. (Refer to Recommendations OP18) Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, comfortable, clean and well-maintained home, and their own rooms are safe and comfortable and suit their own personal needs. Appropriate specialist equipment is available in accordance with residents needs. EVIDENCE: The home is wheelchair accessible with lifts to take residents from the ground floor to the first and second floors. These lifts are well maintained. The home has a good kitchen, laundry facilities and dining room space. Each of the three floors has a communal lounge, bathrooms and toilets. On the ground floor there is a dining room and a large lounge, which is used for activities. At the rear of the property residents have access to a shared garden. Forty of the bedrooms have en-suite facilities. Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 22 There was a recommendation made at the last inspection for the home to repair a repair a bathroom and this has now been done. All of the bathroom and toilet facilities are now fully functional. The home has a large comfortable lounge on the ground floor, a separate dining room, and quiet areas on each floor. These are well decorated, and have good quality furniture and furnishings. The kitchen area was inspected and the food was stored appropriately and regular temperature checks made in respect of fridges and freezers and the temperature of cooked food. Fly screens are in place and cooker hoods are clean and regularly maintained. Since the last inspection the following improvements have been made: • New carpet and curtains for 5 bedrooms. • Dining room was redecorated and new carpet and servery flooring was laid. • A Malibu bath was installed on one floor and a new shower and flooring was installed in one shower room • A number of bedrooms were redecorated • The staff room and training room were refurnished and redecorated. Plans are in place to: • Upgrade the sensory garden • Continue redecoration programme for bedrooms • Redecorate ground floor corridor, It is strongly recommended that this be done as currently it looks tired and in need of recarpeting (Refer to Recommendation OP19) There was a requirement made at the last inspection for the home to ensure that staff are always available to answer the call bell when residents need emergency support. Since that time the home has taken action to ensure that sufficient bleeps or pagers are available and in use, and that staff are fully aware of the obligations to respond immediately to requests for help. Three residents confirmed the situation has improved saying that: “staff are very quick in coming and we need them”. The manager and a deputy manager monitor the system monthly through a recorded printout system, which shows that all current calls are being answered within two minutes. There was a requirement made at the last inspection of the home to ensure that any bad odours are dealt with as soon as is possible, and since that time this requirement was also repeated during an audit carried out by commissioners. During the two-day inspection I found out despite continence management being a significant feature of the care provided, there were no smells or unwanted adours apparent in the home. Discussion with the home’s head housekeeper and with staff showed that the system for cleaning has Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 23 been much improved and in addition new equipment for cleaning carpets has now been ordered. Good hygiene standards are maintained throughout the home. Resident’s bedrooms were seen to be very clean and well maintained, and there is minimal damage to walls and doors, despite the use of wheelchairs. Repairs are carried out quickly when necessary. Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff meet the resident’s needs and residents are in safe hands at all times. They are protected by the home’s recruitment practices, and staff are trained to do their jobs. EVIDENCE: The home is currently staffed by 22 staff nurses and 30 carers, providing care and support for 44 residents. (There are four residents’ vacancies). The rota showed three staff nurses and ten carers on shift between 8am and 8pm, and two staff nurses and three carers throughout the night, between 8pm and 8am. Generally feedback from residents and families showed a feeling that this is adequate staffing. There is a senior housekeeper and supporting domestic staff who are sufficient to provide the cleaning and laundry support needed. Discussion with residents, relatives and staff suggested that the domestic support in the home has been rearranged and now works well. As at the last inspection the ratio of day care staff is usually 1 nurse and 2 care staff on the ground floor; 1 nurse and 3 care staff on the first floor; and 1 nurse and 3 care staff on the second floor. Care staff members are assisted in their duties by ancillary staff comprising a cook and 2 kitchen staff; a laundry assistant; two maintenance persons; and 1 domestic assistant for each floor. Night staffing consists of 2 nurses and 3 care staff for the whole building. Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 25 The home employs it’s own bank staff, and occasionally uses agency staff to cover for sickness or holidays. Where possible, the same agency staff members cover shifts, as they already know the home and the service users. Nursing and care staff are enabled to carry out training to keep their professional standards up to date, and to develop their skills and competencies. New staff members carry out a 12-week induction programme, with the first 3 days as supernumerary. Untrained care staff work through foundational standards for 6 months, with the assistance of a senior staff member to mentor them. Care staff members are encouraged to study for NVQ 2 and 3, and at the time of the inspection 50 of the care staff had had completed or were about to complete NVQ 2 or 3. It is recommended that the home arrange for more care staff to enrol on this course to avoid this level dropping below the 50 level. (Refer to Recommendation OP28) Six staff files were examined. These were well ordered and included current criminal records bureau check, two references, and proof of identity, health declaration, job description and evidence of qualifications where they existed. Files had a helpful checklist at the front to show quickly any documents that might be outstanding. Checks are being done via the internet to ensure that NMC registration for nursing staff are up to date. The homes recruitment practices overall are very good with an emphasis being placed on ensuring staff are thoroughly checked before commencement of employment. The system for provision of staff training and induction is of a high quality and is supported by an annual training plan for the home. The home has a comprehensive training and development plan for staff, which includes training in: health and safety, infection control, moving and handling, first aid, food hygiene, palliative care, NVQ3 in care, POVA and elder abuse, use of bedrails and mental capacity act. Records show that all staff receive at least three days training per year and in most cases more than this level is achieved. With reference to the care needs of residents as discussed under Standard 7 and Standard 8 of this report, the home must ensure that training in the following areas are included in the homes training plan for all care staff: Understanding mental health, End of Life Care. (Refer to Requirement OP30) Medication training recommendations are discussed under Standard 9 of this report. Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 26 With reference to Standard 7 of this report it is recommended that training for staff in handover report writing (Daily records report writing) is provided as part of the homes training plan and discussed in supervision. (Refer to Recommendation OP30) More in depth adult protection training should be scheduled for staff immediately following completion of their induction. (Refer to Recommendation OP30) Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home that is safe and run in their best interests. Service users’ financial interests are protected. Staff receive appropriate levels of supervision. EVIDENCE: As at the last inspection the Registered Manager is a trained nurse with many years of experience in nursing the elderly and has also completed NVQ 4/RMA (Registered Managers’ Award) in management. She has received training on immigration checks and regular contact is made with the Home Office to verify eligibility to work with regards to documentation. The manager gives a lead to staff in carrying out their duties, and in ensuring that service users are well Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 28 cared for. Residents and relatives said that the manager is always around to speak with if they need to and they feel comfortable raising any problems or concerns with her. The manager is assisted by a Deputy Manager who is the training co-ordinator, and who works some hours working alongside nursing and care staff, and some supernumerary hours to oversee training and documentation. The current registered manager is to leave her post by the end of June to take up another post within the provider organisation. It is proposed that the current deputy manager will act up in this post while recruitment takes place. The deputy manager is also a trained and experienced nurse and manager. The deputy manager has acted previously in the manager’s absence and both said they were confident that this arrangement will work, and the home will continue to be well managed. There is also support form a regional manager who will provide supervision. The home uses registered providers “One Life Ideas and Awards to staff recognition scheme” in order to reward staff and make them feel valued. Several staff commented that they had received this award and that they feel valued and supported by the management and organisation for the work they do. The registered provider has achieved the “Investors In People” (IIP) acreditation, and Westcombe Park was audited by IIP and received an excellent rating. The registered provider has appointed a Director of Quality and Compliance and has developed a national Quality and Compliance team of experts to lead in quality assurance. Regular meetings attended by residents are conducted and minutes of these meetings are kept. Customer satisfaction surveys are carried out annually and results of these are discussed with residents and staff. As a result of this an action plan is produced with target dates and expected outcomes. This is monitored by the Quality and Compliance team. This survey can be found in the Managers office. In home customer satisfaction surveys are carried out three times a year to monitor all aspects of care and service and provision. However the results must be written and published and made available for residents and relatives to read. (Refer to Requirement OP33) Complaints and compliments are monitored monthly and evidence kept in the Managers office. This information is shared with our regional office and monitored centrally. Unannounced visits are done every month by the responsible person, as required under Regulation 26 and the reports are kept for inspection by CSCI. A copy of the most recent inspection report was available and clearly on display in the reception area of the home and requirements and recommendations made at the previous inspection had been complied with. The home encourages feedback from both relatives and outside professionals Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 29 and the manager ensures that she is visible to service users via regular “walk abouts” on the units in order to facilitate service users giving their views on the running of the home. Records of all financial transactions are kept in the home. The home does not manage either bank accounts or benefits for any residents. Residents and relatives said that they manage their own finances and the residents always have money available for day to day spending. Examination of six staff files and discussion with five staff showed that staff are consistently receiving supervision at least every two months from a trained supervisor. Good records are being kept and staff said they feel that supervision is supportive and gives them a good opportunity for meeting their training and development needs. There is supervision schedule for all staff showing that good thought is given to planning supervision and recording that it has actually happened. The home has an Annual Performance Appraisal system in place but it is currently being implemented for only 40 of the staff. This is agreed as an area for development. The home must ensure that Annual performance Appraisal takes place for all staff and that a record of this is kept on each individual staff member’s records. (Refer to Requirement OP36) Health and safety is well managed in the home. The home has an up-to-date health and safety policy, which was last reviewed in December 2006. The health and safety responsibilities are shared between the registered manager and the registered provider. The portable appliance tests have been done and certified, and electrical and gas certificates and are up-to-date. The registered manager and assistant carry out the fire risk assessments. There is a detailed action plan in place following this. Fire tests are done weekly with drills taking place every few months. This includes an evacuation drill and a contingency plan in for relocating residents in the event of damage to the home. The registered provider employs a fire consultancy company to carry out an annual audit and this was happening on the day of inspection. The residents care risk assessments are completed for all residents and are reviewed regularly (See more information under Standard 7 of this report). Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 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 3 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15.1 Requirement The registered provider and manager must include written social and leisure activities (including exercise in consultation with the resident), in each residents individual care plans, related to their mental and physical abilities, and take into consideration the times when they should be offered where appropriate. Timescale for action 31/12/08 2 OP7 12.1 a & b 31/10/08 The registered provider and manager must include better information regarding residents activities, mood, engagement in activities and individual expression of wellbeing in their daily records, which can readily be used in the monthly care plan review process. 30/09/08 3 OP8 12.1 a & b The registered provider and manager must ensure that the care plans for the resident discussed in this report, be revised to include mental health support, and include a clear written approach for staff to follow in their interaction with this resident. There must also be DS0000006775.V364771.R01.S.doc Westcombe Park Nursing Home Version 5.2 Page 32 better clarity as to what should be included in the daily records being kept in relation to mental health support issues. 4 OP9 13.2 The registered provider and manager must ensure that staff adhere to the homes policies and procedures for the receipt, administration and disposal of medication as discussed in this report. The registered provider and manager must include understanding mental health and End of Life Care in the homes training prospectus for care staff The registered provider and manager must ensure the results of residents surveys are published and made available to residents and their relatives The registered provider and manager must ensure that all staff have an annual performance appraisal scheduled and that appropriate records are maintained 31/08/08 5 OP30 18.1 c (i) 31/10/08 6 OP33 24.2 31/12/08 7 OP36 18.2 30/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP8 Good Practice Recommendations The registered provider should advise all residents of the problem being experienced in the provision of annual dental care and seek their views regarding the quality of this service. The home should also continue to actively try to resolve this issue within the provider organisation and raise it for further discussion with the various commissioning authorities and the Primary Care Trust. The registered provider and manager should review the DS0000006775.V364771.R01.S.doc Version 5.2 Page 33 2 OP8 Westcombe Park Nursing Home current system for recording visits by healthcare professionals to ensure that information can be quickly and easily accessed for the purposes of review. 3 OP8 The registered provider and manager should ensure for residents who either have high mobility support needs, or who cannot adequately communicate their own needs verbally, that the home consider providing simple written induction information for agency staff and new staff, about how to support each of these residents during personal care. The registered provider and manager should remind staff generally that any allegations or suspicion of abuse must be immediately reported to the homes management while avoiding discussion with other staff The registered provider and manager should carry out refurbishments to the home as discussed in this report Standard 19 The registered provider and manager should arrange for more care staff to enrol on an NVQ level 2/3 course in order to maintain levels of qualified care staff The registered provider and manager should provide training for staff in the information to be recorded in the daily written records for residents as discussed in this report Standard 30 Following completion of induction the registered provider should ensure more in depth safeguarding adults training is scheduled for care staff at the earliest opportunity The registered provider and manager should consider providing all care staff with basic medication training as part of their induction, and also include this training in the homes training plan for all care staff. 4 OP18 5 6 7 OP19 OP28 OP30 8 9 OP30 OP9 Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Westcombe Park Nursing Home DS0000006775.V364771.R01.S.doc Version 5.2 Page 35 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!