Care Home: Westholme

What the care home does well The staff team has remained stable for some time, meaning that staff have got to know the people living at the home very well. The relationships between staff and those living at the home appear warm and affectionate. Staff keep good daily records, with the monthly review report giving a good picture of how each person is. These clear recording systems make it easy to find information and monitor any changes. The range of communal living space gives different options regarding where people living at the home spend their time, allows for different activities to take place and provides quieter areas for visitors. What has improved since the last inspection? There has been a great deal of effort put into improving the arrangements for activities at Westholme. The programme of activities has been extended, several people are now supported to attend church and more individual activities are provided. On the afternoon of the inspection visit two people were supported to take a pleasure flight, from Blackpool airport. The trip was a great success; with the two people returning to the home enthused about their experience. The afternoon snack trolley has proved popular and is helping some people, who prefer to eat little and often, to maintain a health weight. A number of recommendations made at the CSCI pharmacy inspection last year have been responded to. This has helped to strengthen medication procedures at the home. The last two years has seen major alterations and building work at the home. This is now completed and has resulted in many improvements. The spacious dining room, conservatory and three lounges provide people with a choice of where they want to spend their time and allow for more privacy when entertaining visitors. The new lift has made access to the upper floors easier for staff and residents. Training for staff has greatly improved. Recent courses have addressed dementia, which included responding to challenging behaviour, health and safety, moving and handling, infection control and food hygiene. Safeguarding training has also been provided during the last year. These courses help to equip staff with the knowledge and skills for their work role. The arrangements for the formal supervision of care staff have improved. Most staff now have regular supervisions meetings and appraisals with one the care managers. These meetings give opportunity for work practice to be discussed and for senior staff to provide guidance regarding the work of care staff. What the care home could do better: Although the information gathered during the assessment process is generally good, this does need to be monitored, as good information at this stage will help to produce effective care plans. When handwritten records of prescribed medication have to be made, these should be checked and signed by two members of staff. This would help to reduce the chance of errors being made. Progress with qualification training for staff should continue, as this gives opportunity for work practice to be assessed and will increase the skills of staff.The registered provider must carry out quality monitoring visits at the home and produce a report for each visit. This is a good way of checking that progress continues to be made and improvements sustained. Some areas such as training and regular supervision sessions for staff have only recently improved. These arrangements need to be built upon and consistently put into practice. CARE HOMES FOR OLDER PEOPLE Westholme 24/28 Victoria Road St Annes On Sea Lancashire FY8 1LE Lead Inspector Lesley Plant Unannounced Inspection 19th March 2009 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 Westholme DS0000009752.V374642.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. Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westholme Address 24/28 Victoria Road St Annes On Sea Lancashire FY8 1LE 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) 01253 727114 Mrs Vivien Perry Mrs Tracey Louise Gould Care Home 35 Category(ies) of Dementia (35) registration, with number of places Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home only - code PC, to service users of the following gender:Either. Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of service users who can be accommodated is: 35 Date of last inspection 5th March 2008 Brief Description of the Service: Westholme is registered to accommodate 35 people with dementia. The home is located near to the centre of St Annes, close to local services and amenities. The property is large; with accommodation spread over three floors. A lift provides access to the upper floors. The home provides a good variety of communal rooms, including a conservatory. There are attractive gardens to the front of the home and a small enclosed decked patio at the rear. These areas are accessible to those living at the home. The registered provider has owned the home for over 26 years. The homes manager, who is registered with the CSCI, carries out the to day management at the home. Information regarding fees is available from the manager of the home. Westholme DS0000009752.V374642.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 this service experience good quality outcomes. This inspection took place during the course of one day and looked at all the key National Minimum Standards plus supervision arrangements for staff. At the time of this inspection there were 20 people resident at the home. Discussions took place with, the manager, the cook, three care staff and a relative who was visiting. Records and documentation were viewed and a tour of the building was carried out. Time was also spent talking to and observing people living at the home. All those living at Westholme have various degrees of cognitive impairment therefore some conversations were brief and limited. CSCI questionnaires inviting feedback about Westholme were received from five people living at the home and from five members of staff. Information was also gained from the Annual Quality Assurance Assessment completed by the manager of the home. Since the last key inspection in March 2008, a ‘random’ inspection has taken place in September 2008. (Random inspections are conducted to look into particular areas of service provision and do not look at all the key national minimum standards.) A CSCI pharmacy inspector carried out this inspection, looking into how medication is handled at the home. A report relating to this visit is held at the CSCI office and would be made available to enquirers on request. What the service does well: What has improved since the last inspection? Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 6 There has been a great deal of effort put into improving the arrangements for activities at Westholme. The programme of activities has been extended, several people are now supported to attend church and more individual activities are provided. On the afternoon of the inspection visit two people were supported to take a pleasure flight, from Blackpool airport. The trip was a great success; with the two people returning to the home enthused about their experience. The afternoon snack trolley has proved popular and is helping some people, who prefer to eat little and often, to maintain a health weight. A number of recommendations made at the CSCI pharmacy inspection last year have been responded to. This has helped to strengthen medication procedures at the home. The last two years has seen major alterations and building work at the home. This is now completed and has resulted in many improvements. The spacious dining room, conservatory and three lounges provide people with a choice of where they want to spend their time and allow for more privacy when entertaining visitors. The new lift has made access to the upper floors easier for staff and residents. Training for staff has greatly improved. Recent courses have addressed dementia, which included responding to challenging behaviour, health and safety, moving and handling, infection control and food hygiene. Safeguarding training has also been provided during the last year. These courses help to equip staff with the knowledge and skills for their work role. The arrangements for the formal supervision of care staff have improved. Most staff now have regular supervisions meetings and appraisals with one the care managers. These meetings give opportunity for work practice to be discussed and for senior staff to provide guidance regarding the work of care staff. What they could do better: Although the information gathered during the assessment process is generally good, this does need to be monitored, as good information at this stage will help to produce effective care plans. When handwritten records of prescribed medication have to be made, these should be checked and signed by two members of staff. This would help to reduce the chance of errors being made. Progress with qualification training for staff should continue, as this gives opportunity for work practice to be assessed and will increase the skills of staff. Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 7 The registered provider must carry out quality monitoring visits at the home and produce a report for each visit. This is a good way of checking that progress continues to be made and improvements sustained. Some areas such as training and regular supervision sessions for staff have only recently improved. These arrangements need to be built upon and consistently put into practice. 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. Westholme DS0000009752.V374642.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 Westholme DS0000009752.V374642.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): 3 Quality in this outcome area is good. The assessment process helps to ensure that people are only admitted to Westholme if their needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager or senior staff, who have experience in this area, carry out assessments in relation to new people moving into the home. The individual is visited at their home or in some cases, in hospital. Relatives are involved in the assessment process and visits to Westholme may also take place, according to the circumstances of the individual concerned. Records were viewed in relation to three people living at the home, who had been admitted within the last 12 months. Documentation includes an initial enquiry record, assessment details and a record of admission into the home. Assessment information includes a personal profile, information regarding Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 10 personality, social and leisure needs, hobbies and religious needs. Assessments also address mental health, physical health, risk of falls, behaviour, moving and handling and the risk of pressure sores. Information from other agencies was also available on files. For some people this includes a pre discharge assessment from hospital. The information on these files varied in quality and quantity. Although assessments were in place on all the files viewed, for two people the information would have benefited from having more detail. For one person, who had been admitted under emergency circumstances, the information gathered was brief as the nearest relative was not in a position to provide much background information. This was discussed with the manager of the home, who explained the circumstances regarding this admission. The manager is advised to monitor the assessment process to ensure that full information, including personal background information, is gained wherever possible. This will help to ensure that care plans fully reflect the persons needs and preferences. Intermediate care is not provided at Westholme. Westholme DS0000009752.V374642.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. Health and personal care needs are met, with any potential risks being minimised. Medication handling is generally good, with only qualified staff administering medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following the assessment and admission process a care plan is drawn up. Relatives are asked to provide background information about the individuals history and working life and to bring in any photos, which may help staff to get to know the person and understand their past lifestyle. A key worker system is in place, with the two senior care managers having responsibility for certain staff and for ensuring care plans for residents are regularly reviewed. Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 12 Care plans were in place on all the files viewed and address different areas of need such as moving and handling, mobility and any behaviour, which may pose difficulties. Care plans are being reviewed regularly, with the senior care manager writing an overview reflecting upon how the person has been during the past month. Changes are made to the care plan as necessary. For one person, their care plan had been amended to reflect changes in the support needed for personal care and mobility. Two staff are now needed to safely help this person and staff were observed providing this level of support. At lunchtime two care staff helped this person into a wheelchair, to go into the dining room for lunch. Staff appear to be developing a better understanding of the support needs of individuals who may display difficult behaviour. Written guidance was available for staff regarding how best to respond to an individual who could become aggressive. For another person where records showed two incidents of aggression towards staff, the community psychiatric nurse and the GP had been contacted and a medication review and medication changes had taken place, which appeared to be helping the situation. Although care plans are in place and are being reviewed with changes being responded to, one of the records viewed contained very scanty information. This same person had been admitted to the home in an emergency and pre admission information had been difficult to obtain. There was nothing to suggest that his needs were not being met, however the written care plan does require more clarity regarding the actual needs, which are being met. The manager is advised to monitor the quality of the care planning process and to continue to develop individualised person centred care plans. Staff keep good daily records, which include details regarding health care and an overview of how each person has been. Records are kept of all contact with health care professionals, such as district nurses. This means that it is easy to find information and to track any specialist input. Records of each persons weight are maintained and advice regarding specialist input for pressure care is sought as required. A physiotherapist visits the home each week to conduct a group exercise session, which is enjoyed by a number of people at the home. Risk assessments are in place, for people who require bed rails to prevent falling from the bed. This guidance includes the need for the bed rail to be covered with protective padding to prevent injury. Bed rails in use were seen to have protective padding in place. The relative who was spoken to spoke very highly of the standard of care provided by staff at Westholme, adding that input from the GP is sought promptly when necessary. Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 13 Medication is safely stored and the staff who administer medication have received appropriate training. The medication administration records viewed had been completed appropriately. Medication records include a photograph of the individual concerned and there is specific guidance regarding any medication, prescribed to be administered ‘when required’. The majority of medication is provided in blister packs. Medication such as liquids, which cannot be supplied in the monitored dosage system, is being dated when first used. This is good practice and helps to provide an audit trail and also helps to avoid medication being used past its use by date. The pharmacist is available for advice and there are records of his visits to the home. When handwritten records of prescribed medication have to be made, these should be checked and signed by two members of staff. This would help to reduce the chance of errors being made, but is still not happening. The CSCI pharmacy inspector carried out an audit of medication practices in September of last year, reporting that generally medication was being dealt with appropriately but that some improvements could be made. This included asking the dispensing pharmacist to include the time of administration on the medication record and including the name of the resident on the returns records, when returning any unused medication to the pharmacist. These have been put into practice. The management of medication had been discussed at a recent staff meeting, with the minutes showing that all staff had been reminded not to interrupt or distract senior staff when they are dealing with medication. Privacy and dignity are addressed with all new staff during the induction period and also within NVQ (National Vocational Qualification) programmes. Screening is provided in the double bedrooms. During the inspection staff were observed responding gently and sensitively to individuals. The new conservatory provides a pleasant and quieter place to receive visitors. Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 14 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 and 15 Quality in this outcome area is good. Individual and group activities take place, providing stimulation for those living at the home. Visitors are made welcome and the residents enjoy the meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been a great deal of effort put into improving the arrangements for activities at Westholme. The three lounges, dining room and conservatory allow for different activities to take place. In one room people like to watch television and in another DVD films are shown. For one person, it was recorded on their file that they liked listening to and dancing to music and during the afternoon of the inspection visit staff encouraged him to go into the dining room and played different types of music until finding particular music, which he clearly enjoyed. There is a programme of regular activities, which includes exercise sessions with a physiotherapist, karaoke, visits by a hairdresser, sing songs, bingo and Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 15 a monthly performance by a singer. A small group of residents have started to attend a local church one morning each week. The records for one person state that she regularly attended a chapel and this person was supported to attend church. Although the individual did not want to continue church attendance, saying it was not the same as chapel, staff had tried to meet her need for religious worship. Another person likes to walk out for his daily newspaper and he is supported to do this. On the afternoon of the inspection visit two people were supported to take a pleasure flight in a small plane, from Blackpool airport. One had been in the Royal Air Force and the other had expressed a strong desire to go in a plane. The trip was a great success; with the two people returning to the home enthused about their experience. A minibus is hired for certain trips such as visiting a garden centre. Laminated photographs of familiar objects, such as an old fashioned pram, have been put in a file and are used by staff to stimulate conversation with certain residents. Records are kept of how each person has spent their time and what activities they have joined in with. Visitors are made welcome as seen during this inspection visit. The people living at Westholme all have a diagnosis of dementia resulting in various degrees of cognitive impairment. Relatives usually take responsibility for financial affairs. Details of advocacy services are available. People are able to bring personal possessions into the home and so make their bedrooms homely. The cook explained the arrangements for meals at the home and confirmed that there are no budgetary restrictions in place for the food required. A rotating menu was viewed, showing a good variety of main meals. The main meal is served at lunchtime, with the cook knowing the individual preferences of those living at the home. It was explained that some people do not like pork or fish and that alternative meals were provided. The meal served on the day of the inspection visit was tasty and appeared to be enjoyed by the residents. The dining room provides a pleasant environment, with the tables nicely set, soft music playing and a choice of drinks available. The introduction of the afternoon snack trolley has proved popular as seen during this visit. The cook prepares a selection of small sandwiches, biscuits and pieces of fruit, which is made available each afternoon. Several staff commented that this finger food is very popular and appeals to people who Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 16 prefer to eat little and often, resulting in some people who have found it hard to maintain a healthy weight, being able to gain some weight. The people spoken to and the comments on the CSCI questionnaires completed by those living at Westholme confirmed that people enjoy the meals provided. Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 17 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. Arrangements for handling complaints are in place. Staff training, policies and procedures help to protect those living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure in place, which gives a clear timeframe within which concerns would be responded to. Information in the annual quality assurance assessment completed by the manager confirms that no complaints have been received by the home. The CSCI have received no formal complaints since that last inspection. Five people living at the home completed CSCI feedback questionnaires, with four of these stating that they are aware of how to make a complaint, should this be necessary. In reality, for most people it would be a relative or representative who would do this, if needed. There are written policies regarding whistle blowing abuse and protection, which include clear reference to locally agreed procedures. The registered manager is aware of the action to be taken, should a safeguarding issue be raised. Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 18 Since the last key inspection specific training in this area has been provided to staff, with a series of training programmes in April, May and September 2008. This programme being repeated to ensure that all staff were able to attend. Issues regarding vulnerability and abuse are also included within NVQ (National Vocational Qualification) programmes undertaken by staff. Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 19 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 and 26 Quality in this outcome area is good. The home is clean and provides a warm and attractive place to live. The good range of communal rooms mean that people are able to choose where to spend their time. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The last two years has seen major alterations and building work at the home. This is now completed and has resulted in many improvements. The spacious dining room, conservatory and three lounges provide people with a choice of where they want to spend their time and allow for more privacy when entertaining visitors. The new lift has made access to the upper floors easier for staff and residents. Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 20 New carpet has been fitted to the stairs and landing areas and new chairs supplied in two of the lounges. Some more bedrooms have been refurbished with new decoration and furnishings. There are just a few areas, which still need to be attended to such a redecorating where the old stair lift has been removed and where fitted furniture has been removed from one of the bedrooms. There are also plans to refurbish one of the toilets and fit a washbasin in this room. The manager confirmed that these would be attended to as part of the general routine maintenance of the home. There is now a part time maintenance worker employed at the home, meaning that small repairs can be completed more quickly. A housekeeper and a laundry worker are employed at the home. Night staff also carry out certain domestic and laundry duties and the cook carries out specific cleaning jobs in the kitchen. All areas of the home appeared to be clean. Staff have undertaken food hygiene and infection control training and were seen to be wearing different coloured aprons when carrying out different duties, such as helping with meals. Protective gloves and aprons are available for staff when carrying out personal care tasks. Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 21 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. Staffing levels meet the needs of those currently living at the home. Recruitment procedures and staff training help to ensure that only suitable staff are employed and that they are equipped to carry out their role. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection visit there were 20 people living at the home. Staff on duty consisted of three care assistants, a senior care manager, the cook, the maintenance/activities worker and the manager of the home. The manager explained that there are usually three care staff on duty, including the senior care manager, but that a new staff member was on her first day of duty and was therefore in addition to the usual staffing. Rotas show that in the evening there are three care staff on duty with two night staff working throughout the night time period. A housekeeper and a laundry worker are employed but were not on duty on the day of this visit. Observation confirmed that these staffing levels appear to be appropriate in meeting the needs of the current residents. People were able to go out and staff were seen spending individual time chatting to residents. The staff spoken to confirmed that staff work well together and that staffing levels were adequate, but that as and when the number of residents increases, it will be Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 22 necessary to have more staff on duty. This was discussed with the manager of the home, who confirmed that staffing levels would be kept under review as numbers increase. The manager also confirmed that additional staffing could be put in place, should a resident become ill or need extra support. Staff have good access to NVQ (National Vocational Qualification) programmes, with the manager being a qualified NVQ assessor. An external training provider then verifies the assessment of competency for each candidate. At present Four of the 15 care staff have gained an NVQ at level 2 or above and there are seven staff members working towards the level 2 award. Some staff are also working towards higher level NVQ awards and the housekeeper has completed an NVQ programme appropriate to her work role. Staff who complete NVQ programmes have their work practice assessed, which helps to ensure that they are working to the required standard. Qualification training should continue in order to achieve the nationally agreed targets of having 50 of care staff qualified at NVQ level 2 or above. The recruitment records for a staff member, in post for two months, were viewed. Documents include an application form, proof of identity, health questionnaire, record of interview, two references a criminal records bureau disclosure and evidence of a check against the nationally held list of people who have been deemed unsuitable to work with vulnerable adults. These checks help to ensure that only suitable staff are employed at the home. A new member of staff had commenced on the day of the inspection visit, working under the supervision of an experienced member of the team. This was being classed as an introductory trial, to see if the person was suitable for the post and to give a taste of what the job involved. An application form and evidence of a check against the nationally held list of people who have been deemed unsuitable to work with vulnerable adults were available in respect of this person, with other recruitment information to follow. A criminal records bureau disclosure was also seen in relation to the recently appointed maintenance/activity worker. Training for staff has greatly improved. Recent courses have addressed dementia, which included responding to challenging behaviour, health and safety, moving and handling, infection control and food hygiene. Safeguarding training has also been provided during the last year. The training matrix for the home shows when refresher training is due. Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 23 New staff complete an induction to the home, which covers practical information such as fire safety. They then work alongside more experienced staff. A member of staff, in post for just over two months explained that a series of half day training courses had been attended, facilitated by an external training company. This programme covered the induction standards as recommended by the national training organisation Skills for Care. The manager explained that the home has purchased a variety of training materials including DVDs, which new staff could also use as part of their induction. It was clear that recently appointed staff had completed an appropriate induction programme. The manager needs to ensure that this standard is maintained and that any changes to the induction arrangements continue to meet the Skills for Care induction standards. Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 24 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. The home is well managed, with some quality monitoring systems, including staff supervision, in place. This means that areas for improvement can be identified and responded to. Staff training and safety checks help to promote the health and safety of those living and working at Westholme. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last key inspection the manager of the home has successfully registered with the CSCI. The manager has over 20 years experience in the care sector, working with older people and people with disabilities. Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 25 Qualifications include, NVQ (National Vocational Qualification) level 4 in Care, the NVQ Assessors award and the Registered Managers Award. The two care managers, who act as deputies in the managers absence, also carry out certain management tasks such as staff supervisions and the formal review of care plans. Both the care managers have worked at Westholme for a number of years and know the staff and the residents very well. The manager has worked hard to address any service shortfalls identified at the last key inspection. This has included improving her own knowledge of working with people with dementia. A two-day training course has been completed and further more in depth dementia training is planned. This will help to ensure that the manager of the home has the appropriate skills and knowledge to support the staff team to provide a high quality service to people with dementia. Some quality monitoring systems are in place. Feedback from those living at the home is mainly gained from informal day-to-day contact with staff. Occasional questionnaires are sent to relatives, giving opportunity for people to comment on the service being provided. A relative spoken to during the inspection visit stated that staff are approachable and will listen to any suggestions. Although very happy with the care his relative receives, this person did feel confident that staff and managers would accept and act upon, any constructive criticism. Staff meetings take place, giving those working at the home opportunity to suggest any ways of making improvements. The care managers and the manager of the home also have regular management meetings. Minutes relating to both types of meetings were viewed. The owner of the home, who is the registered provider, makes daily telephone contact with the home and meets with the manager each week. In line with regulation, the registered provider must carry out a monthly audit of the quality of service being provided at Westholme and produce a report detailing the findings and identifying any areas for improvement. Whilst these no longer have to be sent to the CSCI, the reports still need to be produced, with a copy being given to the manager and made available to CSCI if requested. No such reports were available and this must be addressed. These monthly quality monitoring visits will help to identify areas for improvement and will also help to ensure that improvements are being maintained. Westholme has achieved the Investors In People Award and ISO (International Organisation for Standardisation) 9000 accreditation, which are external quality awards, requiring that agreed standards are met. The CSCI annual quality assurance assessment completed by the manager provided clear information regarding how the home has improved and plans for future improvements. Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 26 The people living at Westholme all have some degree of cognitive impairment and are unable to manage their financial affairs. A relative or representative, such as a solicitor takes this responsibility. Records are kept of any expenditure, such as hairdressing or trips out and the relative or representative is then periodically billed for this amount. The records viewed appeared to be well maintained, with clear detail of any expenditure by each person. The manager explained that this system works well and that the representative would be asked prior to any unusually large planned expenditure, such as a significant amount of new clothing. The arrangements for the formal supervision of care staff have improved, with records showing that most staff now have regular supervision meetings and appraisals with one the care managers. The manager of the home also has formal supervision with the two care managers. It is important that these arrangements are maintained, as regular supervision of staff appears to be a relatively new process. Regular staff supervision can help to ensure that any performance issues are addressed and that staff receive clear leadership from the management team. Training records show that most staff have completed essential health and safety training, including moving and handling, food hygiene and infection control. Records were viewed which confirmed that safety checks take place. These include servicing of the lift and the hoist, a gas safety check, a check on the electrical installation, legionella testing, checking of fire equipment and the checking of electrical appliances. Records are also kept of any accidents to staff or residents. The cook monitors fridge temperatures and carries out certain safety checks and cleaning jobs in the kitchen, which help to maintain good standards of food hygiene. Records are kept of any maintenance jobs, which need doing and the action taken to complete these. Water temperatures are checked regularly and it was seen that the water temperature in part of the home was recorded as high in January. The corresponding record in the maintenance book showed that this had been remedied. During the inspection visit the call bell in one of the bedrooms was tested, and was working, with staff responding quickly to this. Risk assessments are in place, including for the lift, with signage to remind visitors not to use the lift Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 27 unless accompanied by staff and a keypad to prevent residents from using the lift without staff support. Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 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 X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP33 Regulation 26 Requirement The registered provider (owner) must carry out monthly monitoring visits and complete a report on the findings. This will help to ensure that a good quality service is maintained. Timescale for action 01/05/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations When handwritten records of prescribed medication have to be made, these should be checked and signed by two members of staff. This would help to reduce the chance of errors being made. Progress with NVQ training should continue; in order to achieve 50 qualified staff. This will help to ensure that staff are competent in their work role. 2. OP28 Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Westholme DS0000009752.V374642.R01.S.doc Version 5.2 Page 31 - 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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