Care Home: Westholme

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Annual service review Name of Service: Westholme The quality rating for this care home is: The rating was made on: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection We do an annual service review when there has been no key inspection of the service in the last 12 months. It does not involve a visit to the service but is a summary of new information given to us, or collected by us, since the last key inspection or annual service review.   Has this annual service review changed our opinion of the service?   No You should read the last key inspection report for this service to get a full picture of how well outcomes for the people using the service are being met. The date by which we will do a key inspection: Name of inspector: Christine Walsh Date of this annual service review: 0 1 1 2 2 0 0 9 Annual Service Review Page 1 of 8 Information about the service Address of service: 55 Harestock Road Winchester Hampshire SO22 6NT 01962881481 Telephone number: Fax number: Email address: Provider web address:   Name of registered provider(s): Conditions of registration: Category(ies) : dementia old age, not falling within any other category Conditions of registration: Hampshire County Council Number of places (if applicable): Under 65 Over 65 67 0 0 67 The maximum number of service users who can be accommodated is: 67 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Have there been any changes in the ownership, management or the No service’s registration details in the last 12 months? If yes, what have they been: Date of last key inspection: Date of last annual service review (if applicable): Brief description of the service Westholme is owned by Hampshire County Council and provides nursing care, personal care and accommodation for up to 67 older persons. Any within this number can have been diagnosed with dementia. The home, which is purpose-built, is organised into five small self-contained units, each with their own kitchenette, dining room and sitting room. Accommodation is Annual Service Review Page 2 of 8 arranged on two floors with a passenger lift providing access to the first floor. Six communal bathrooms are available to service users, two of which benefit from assisted baths. Other aids and adaptations have been fitted throughout the home, to assist residents to maintain their independence. Accommodation is arranged around a central paved courtyard, providing additional seating areas and raised flowerbeds. The home is located on a main residential road on the outskirts of Winchester, and is accessible to local amenities and transport. Annual Service Review Page 3 of 8 Service update since the last key inspection or annual service review: What did we do for this annual service review? We looked at all the information that we have received, or asked for, since the last key inspection. This included: The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. What has this told us about the service? The service was last inspected on the 29 November 2007 and received a 2 star (Good) rating. There has not been any further inspection activity such as an annual service review or random inspection in the last twelve months. In order to carry out an annual service review (ASR) it is required of the service to complete an Annual Quality Assurance Assessment (AQAA) and return to the Care Quality Commission by the required date stipulated in the covering letter. The CQC received Westholms AQAA on time. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. It provides us with information about service users, staff and the services administrative procedures. At the point of writing this review five surveys have been received from relatives, staff and a healthcare professional. Their comments have assisted in informing this review. The AQAA refers to the people who use the service as residents and therefore will be referred to as residents throughout the body of this review. In respect of meeting the diverse needs of residents and staff the AQAA told us, At Westholme we apply these policies for both residents and staff, including in our recruitment programme, we do not enquire about the specific gender identity and sexual orientation of the residents or staff, and may not have this information unless they choose to disclose it, or it becomes evident as part of their care planning. The AQAA went onto tell us specific cultural and religious needs are incorporated in care planning and the involvement of carers, families, friends and community groups are encouraged in the daily life of the residents. The service told us whilst they do not plan to make future changes at the time of writing the AQAA in respect of equality and diversity, it will listen and respond to the Annual Service Review Page 4 of 8 needs and requests of residents. But will identify lead staff members to undertake specific needs training as relevant to residents needs and at all times apply the principles of the Mental Capacity Act to enable maximum independence in choice for all of residents. Comments received from representatives and healthcare professional tell us Westholm usually responds to residents diverse needs and sometimes support the people to live the lives they choose. A representative told us they felt their relative could be afforded more dignity and privacy when meeting personal care needs. The representative tells us their relative does not like carers in the room whilst dressing and undressing. This concern has been addressed but the representative feels this is a basic care need and should not have happened in the first place. The service is advised to ensure all staff apply the basic principles of care and respect individuals wishes. The last report told us the people are consulted about their daily routines and preferences and their views are taken into account. We looked at the information in the AQAA, which identifies the areas of good practice, and areas for improvement the home has made in the last twelve months. The AQAA told us where they feel the service dose well: We are very proactive in looking at the changing needs of the residents, with an holistic, person centred outcome, to address the very diverse and individual needs that they have. We build this holistic approach into individual care plans to ensure a true reflection of each residents needs. The AQAA went onto tell us the system of keyworking (Keyworking is a system where a member of care staff is assigned to one or more residents and responsible for ensuring their daily needs and wishes/preferences are met), participation of families and other professionals, is crucial to meeting changing needs and providing a holistic approach. Residents representatives, staff and healthcare professionals told us: Care staff at Westholm are very friendly, patient and helpful. Staff are always happy, smiley. The home is kept clean and tidy with no smells. On the nursing side, they are always friendly, polite to all the family who come and see mum, and they look after her well. Westholm is one of the best homes to work in, in Hampshire!. The last report told us the service provides good outcomes in all eight outcome areas viewed as part of the inspection process, which includes choice of home, individual needs and choices, staffing and management. The report told us the service is well managed and there are effective quality assurance systems in place. This means the service is regularly evaluated as to how well it is meeting its aims and objectives. The report also told us One particular area of good practice is that the manager or senior in charge walks around the home every morning and visits all service users. Any concerns are noted and are discussed with staff on the unit. Annual Service Review Page 5 of 8 No requirements are recommendations were made following the last visit to the service, (Requirements and reccomendations are made when there the service is not meeting required standards as laid out in the National Minimum Standards and Care Homes Regulations). The AQAA told us it is aware of where improvements are required and the services plans for the next twelve months, these include the importance of listening to and acting upon the views, comments, concerns and wishes of everyone associated with the resident and his/her care. Residents Representatives told us they felt the home could do better to: The service could do better to discuss care plans with relatives about care. (This is one view and is dependent on the residents mental capacity and ability to make the decision not to share information about themselves with others). Another representative told us they feel the home could improve tele communications. Relatives wanting to speak with a relative or a member of staff have waited long times and even hung up. For one relative this means they have given up trying to contact their relative. The Representative has suggested an alternative phone line nearer the nurses/carers station. A relative told us the service usually helps them to keep in touch with their relative. The service is advised to consider reviewing the homes communication system to establish if it meets the needs of the residents and the people who wish to keep in contact with them. This will be viewed as part of the inspection process during the next visit to the home. The Commission has not received any complaints in the last twelve months. The AQAA told us the home has received five complaints in the last twelve months, it is indicated in the AQAA that the service responded to the complaints within the stipulated timescale of twenty - eight days and the complaints were not upheld. The AQAA told us they provide all new residents with written information on how to make a complaint and provide easy access to written information on the complaints procedure for families and other visitors. The last report told us there are good outcomes in the areas of complaints and protection. Complaints and adult protection procedures are followed to ensure that peoples wellbeing is protected. Surveys tell us residents representatives know who to speak to if they have a concern and know how to make a complaint. The Commission has received a small number of notifications (Regulation 37) in the last twelve months. Regulation notices are sent to the Commission when an incident has occurred in the service, which has affected the health and welfare of the residents. The notice tells us what happened and what action the home took to manage and minimise the risk of the event occurring again. In this instance the Commission has been notified of incidents that have adversely affected the wellbeing of the resident, such as an infectious disease, fall and bruising that could not be established how it Annual Service Review Page 6 of 8 occurred. What are we going to do as a result of this annual service review? We are not going to change our inspection plan, and will do a key inspection by 28 November 2010. However we can inspect the service at any time if we have concerns about the quality of the service or the safety of the people using the service. Annual Service Review Page 7 of 8 Reader Information Document Purpose: Author: Audience: Further copies from: Annual service review CQC General Public 0870 240 7535 (national contact centre) Our duty to regulate social care services is set out in the Care Standards Act 2000. The content of which can be found on our website. Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a copy of the findings in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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