Care Home: Westwood Hall

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What the care home does well Westwood Hall enjoys a pleasant rural setting and the well-tended grounds and gardens provide an attractive outlook for the people who live at the home, and places to walk and sit when the weather is good. All parts of the building were clean, wellmaintained, tastefully decorated and comfortably furnished. People`s needs are assessed before they go to live at Westwood Hall to ensure that it will be the right home for them. A care plan is written for each person and the care plans we looked at had been particularly well constructed and kept up to date to reflect people`s changing needs. We observed warm and positive interactions between staff and residents and it was apparent that staff support residents to maintain a high standard of personal appearance. This was reflected in the written comments we saw from relatives: `Thank you all so much for the care and attention you gave to G. She couldn`t have been looked after better anywhere else. The devotion you gave to her was first class.` `From the bottom of my heart and all my family, a huge thank you for all the love, care and attention you gave for seven years. Westwood became a second home where I knew there was always a welcome, smile, cup of tea and a chat. Mum was so well cared for which made her increasing frailty so much easier for me to bear. I shall miss you all. The fact that staff even came on their day off to her funeral bears witness that you are special people.` The people who live at the home are given a choice of dishes at all mealtimes. We observed that lunchtime was a pleasant and unhurried experience for residents. What has improved since the last inspection? No requirements or recommendations were made following our last visit to Westwood Hall. Since our last visit the home has gone through a period of change and uncertainty, however the home now has a new manager and the staff we spoke with, and the area manager, expressed their confidence in her. What the care home could do better: There is room for improvement of the bathrooms. Residents who choose to have their bedroom doors open should be provided with an automatic door closing device to ensure that they are protected from fire. Key inspection report Care homes for older people Name: Address: Westwood Hall Brimstage Road Brimstage Wirral CH63 6HF     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Wendy Smith     Date: 0 4 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Westwood Hall Brimstage Road Brimstage Wirral CH63 6HF 01513422150 01513424076 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Activecare Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 52 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 52. The registered person may provide the following category of service only: Care home with nursing - Code 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 - Code OP. Date of last inspection Brief description of the care home Westwood Hall is registered to provide nursing and personal care for up to 52 older people. It is situated in a rural location near to Heswall on the Wirral. The home is in its own grounds with ample car parking spaces. 0 Over 65 52 Care Homes for Older People Page 4 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is three stars. This means that the people who use this service experience excellent quality outcomes. We (the Care Quality Commission) visited Westwood Hall unannounced on 4 May 2010 as part of this inspection. Two inspectors carried out the visit. During the visit we spoke with some of the people who live at the home and some members of staff, to find out their views about the home. We walked round the building to see all the communal areas and some of the bedrooms. We checked records kept at the home and spent time talking with the manager. We also looked at any information that we had received about Westwood Hall since our last visit. Before the inspection the area manager completed a questionnaire (AQAA) to give us up to date information about the service. Four members of staff and six people who live at the home completed a CQC survey form to give us their views of the home. Care Homes for Older People Page 5 of 25 Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Care Homes for Older People Page 7 of 25 order line 0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed before they go to live at Westwood Hall to ensure that it will be the right home for them. Evidence: In the annual quality assurance assessment the area manager told us that All prospective service users, family and friends are encouraged to view the home before making an informed choice. There is a detailed brochure which includes all the information about Westwood Hall Nursing Home, the brochure is issued to all enquirers and copies are available on request. Some brochures are available in the reception area for casual callers. The current fees range between £630 and £680 per week, depending on the chosen room and level of care required. This includes all nursing charges. The manager told us that six people have come to live at Westwood Hall since she started working there in February 2010. The all came from hospital. The manager Care Homes for Older People Page 10 of 25 Evidence: went out to meet them and to assess their needs to make sure that Westwood Hall would be the right home for them. We looked at the care plans for the two people who had moved there most recently. They contained comprehensive and detailed preadmission assessments which gave staff information about the care the person would require. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of the people living at the home are met to a high standard and people are treated with dignity and respect. Evidence: Each person living at the home has a care plan. We looked at a sample of care plans on each floor of the home and found that they had been completed to a very good standard. They were clear and detailed and had been kept up to date with monthly reviews. The care plans included risk assessments with action plans for all identified potential risks. The manager told us that she was reviewing all of the care plans, in consultation with the resident and/or their relatives, and was encouraging the nurses to write the care plans in a more person-centred style. We saw detailed daily wound care records for a person who has a serious pressure sore. The care plans record communication with relatives and visits by health care professionals including GPs, district nurses, tissue viability specialist nurse, dietician and chiropodist. The manager told us that they receive good support from the tissue viability nurse and last week she provided training for the staff about pressure Care Homes for Older People Page 12 of 25 Evidence: relieving mattresses. The home has policies and procedures for the management of medicines. There is a storage room and a drugs trolley on each floor. We found that all medicines were stored securely and appropriately and there was a minimal amount of stock kept in the home. Arrangements are in place for the disposal of unwanted medications through a contract with a disposal company. Medicines had all been checked in on the medicines administration (MAR) sheets. Most are dispensed in monitored dose blister packs. A running total is kept of tablets not supplied in blister packs. The MAR sheets were were generally completed well, however there was not always any record of prescribed creams/ointments being applied. Throughout our visit we observed that the people living at the home were treated kindness and respect. We spoke with several members of staff who were all pleasant and helpful and were happy to give us their views of the home. We considered that the staff seemed to be very committed to the home and some have worked there for a number of several years. The staff we spoke with had a good knowledge of the needs and preferences of residents and showed affection and respect for them. The people living at the home were appropriately dressed and a high standard of personal care was apparent. We looked at a number of thank you cards that had been received recently and comments made by family members included the following: Thank you all so much for the care and attention you gave to G. She couldnt have been looked after better anywhere else. The devotion you gave to her was first class. From the bottom of my heart and all my family, a huge thank you for all the love, care and attention you gave for seven years. Westwood became a second home where I knew there was always a welcome, smile, cup of tea and a chat. Mum was so well cared for which made her increasing frailty so much easier for me to bear. I shall miss you all. The fact that staff even came on their day off to her funeral bears witness that you are special people. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home have choices in daily living and they enjoy a good standard of catering. Evidence: The homes activities organiser retired earlier this year and some of the people who completed our pre-inspection questionnaires considered that activities could be improved. On the day we visited, a new activities organiser had just started working at the home. She had good previous experience in a similar role and told us that she was looking forward to her new job. She was sorting through the equipment available and said that she has more equipment of her own to bring in. In the AQAA, the area manager told us that Visits from family and friends are encouraged and arrangements can be made for visitors to join the Service User for meal times if requested. Trips out with relatives are also encouraged as this maintains contact with the family, friends and the local community. Visitors are welcome at any reasonable time of the day and people may meet with their visitors in their own bedroom or in one of the communal areas. Ministers of religion provide a weekly services in the home. Care Homes for Older People Page 14 of 25 Evidence: On the day we visited, most people were having lunch in the dining room, but people can choose to have meals in their bedroom or in a lounge if they prefer. The dining room is light, bright and spacious. Some of the more able people were sitting together and chatting; those needing support had a member of staff sitting with them. The days menu was displayed on a white board and showed that there is always a choice available. People who require a soft or liquidised diet have the same choice as others. The chef was serving out individual meals from a heated trolley. We were offered a meal from the trolley and it was very tasty and nicely cooked. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Westwood Hall are protected from abuse. Evidence: The home has a complaints procedures that is displayed in the entrance hall of the home and in the first-floor corridor. It is written clearly and gives people information about who to contact if they have a complaint and the reponse time they can expect. We saw records of concerns/complaints received, the action taken and the outcome, including copies of written replies to complainants. There are company policies and procedures about safeguarding and all relevant checks are made on staff before they commence employment at Westwood Hall. In the AQAA, the area manager told us that New starters are made aware of the complaints procedure and the Protection of Vunerable Adults information is in their Induction Packs. Training records showed that all staff have had safeguarding training so that they are aware of their responsibilities. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A clean, pleasant and well-maintained environment is provided for the people who live at Westwood Hall. Evidence: Westwood Hall is set in extensive gardens that are well-tended and provide a very pleasant outlook from the lounges and most bedrooms. There is also seating in the gardens. A gardener is employed to work three days a week. We walked around the building, looking at the communal areas and some of the bedrooms. We found that all parts of the building were warm, comfortably furnished, and tastefully decorated. The two lounges and the dining room are spacious and have plenty of natural light. People are encouraged to personalise their bedrooms with photographs, pictures and items of furniture. Some bedrooms have en suite facilities and there are enough shared toilets and bathrooms throughout the building. The bathrooms are in need of some refurbishment and we noticed that the floor covering in the shower room was not intact. One bedroom door was wedged open at the residents request. It is recommended that a doorguard device is fitted to ensure that the door will close automatically if the fire alarm is activated. Aids and equipment, for example profiling beds, pressure relieving mattresses, hoists of various types, are provided to meet the needs of the people living at the home and to ensure that staff can work safely. The manager told us that a new, larger capacity Care Homes for Older People Page 17 of 25 Evidence: boiler has been ordered to ease problems with the hot water supply during busy periods. We found that all parts of the home were clean and fresh and there were no unpleasant smells. Infection control policies and procedures are in place and the staff have been made aware of these through training. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Enough qualified and experienced staff are employed to ensure that peoples needs can be met. Evidence: We looked at the staff rota which showed that enough nurses and care staff are provided to ensure that peoples needs can be met. There are two nurses on duty between 8am and 8pm, and one nurse from 8pm to 8am. There are usually four care staff during the day, sometimes five, but the day before our visit there were only three. There are usually three care staff at night, but the night before we visited there were only two. Some members of staff completed survey forms before our visit and were concerned that staffing levels had been reduced. The manager told us that staff had fixed rotas and this did not give flexibility to adjust staffing levels to cover for holiday, sickness and other absences. She has held meetings with staff to discuss the need for more flexible working patterns. The company has a bank of staff that can provide cover. Other staff employed are the manager, an administrator, seven catering staff, five housekeeping staff, a maintenance person, a gardener and an activities organiser. The homes recruitment procedure is thorough and each member of staff has a personnel file. There have been few new staff recently but we looked at records for the most recently recruited person and for another staff member who started in 2009. Care Homes for Older People Page 19 of 25 Evidence: They had both completed application forms and attended an interview. Criminal Records Bureau disclosures had been applied for and received. There were two references in place for the most recent recruit but only one for the person who started in 2009. The manager was aware of this and told us that an administrator from head office was visiting weekly to help the new manager make sure that all required records are complete. More than half of the care staff have an NVQ in care and the manager said that she was looking for a reliable training company to ensure that other staff, who are keen to do NVQ, are able to get started. The company employs two trainers. New staff follow a company induction training programme. Electronic training records are kept and these showed that all staff up to date with fire training. Updates have been arranged as needed for for health and safety training, which includes moving and handling. The manager told us that she is going to arrange more training with a local hospital for the nurses to extend their skills. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed to ensure that people are kept safe and the quality of the service is monitored and maintained. Evidence: The registered manager retired earlier this year after a period of illness. A new manager started working at Westwood Hall in February 2010. She has just completed a probationary period and intends to apply to the CQC for registration as manager without delay. She is an experienced registered nurse and has been working as a home manager in the south of England where she completed the Registered Manager Award. She has already identified areas where improvement to the management of the service was needed and has made good progress in addressing issues. A deputy manager has been appointed and she has been working at the home for several years. A full time administrator deals with day to day office work and this has given the manager time to spend getting to know the people who live at the home and the staff. Survey forms that we received before our visit indicated that staff morale was low, Care Homes for Older People Page 21 of 25 Evidence: and the manager was aware of this. She told us that members of staff now felt able to come to her to discuss any concerns. During our visit we spoke with several members of staff including the deputy manager and the other nurse on duty that day. They considered that staff morale was low due to the decline in occupancy of the home and a period of time when they lacked leadership. All of the staff we spoke with felt that the home was improving with the leadership of the new manager. We were told that she is strict but fair with the staff and the staff are now feeling more optimistic about the future. The manager completes a monthly company audit of complaints, pressure sores and accidents. There is a bi-monthly medication audit. The area manager is currently visiting weekly to support the new manager. Regular staff meetings are held and are minuted. There have been no recent relative meetings, but a fete is planned for August and the manager intends to invite relatives and members of the local community to get involved; the new activities organiser will also support residents to contribute. Staff at the home do not look after the financial affairs of any residents, but people may deposit personal spending money for safekeeping. These monies are paid into a bank account and an individual record is maintained for each person. In the AQAA, the area manager provided dates for all routine maintenance and servicing of plant and equipment, and these were all up to date. A fire risk assessment of the building had been completed and testing for Legionella had been carried out recently. A weekly fire alarm test and a monthly emergency lighting test are carried out and recorded. There have been a number of unplanned fire drills recently due to a faulty detector. This has now been replaced and the manager told us that fire drills will continue bi-monthly. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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