Inspection on 14/05/08 for Woodlands Farmhouse

This is the latest available inspection report for this service, carried out on 14th May 2008.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Woodlands Farmhouse 06/01/06

Woodlands Farmhouse 28/09/05

Woodlands Farmhouse 13/01/05

Woodlands Farmhouse 27/05/04

Woodlands Farmhouse 11/03/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Woodlands Farmhouse Woodlands Farmhouse Wrantage Taunton Somerset TA3 6DF Lead Inspector Kathy McCluskey Unannounced Inspection 14th May 2008 09:45 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 Woodlands Farmhouse DS0000016064.V362364.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. Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodlands Farmhouse Address Woodlands Farmhouse Wrantage Taunton Somerset TA3 6DF 01823 481036 01823 481125 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) Mrs Emma K Purvis Mrs Emma K Purvis Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The two rooms on the first floor to be used for low dependency service users, requiring minimal assistance with manual handling. 23rd May 2006 Date of last inspection Brief Description of the Service: Woodlands Residential Care Home is located in the village of Wrantage. The Registered Provider / Manager is Mrs Emma Purvis. Woodlands Residential Care Home is registered with the Commission for Social Care Inspection to provide personal care for up to thirteen people over the age of 65 years. The home is not registered to provide nursing care or care to people who have a primary diagnosis of dementia. Accommodation is provided over two floors. The majority of bedrooms exceed the size recommended in the National Minimum Standards. Each bedroom has en-suite toilet facilities and there are three assisted bathrooms, one of which is a wet room. There is a pleasantly furnished lounge, smaller lounge and dining room on the ground floor with a further small lounge situated on the first floor. The home has ample parking for cars and the very large gardens are in the process of being landscaped. All areas of the home have been decorated and furnished to a high standard. Woodlands Residential Care Home also provides some day care & respite care. The current fee levels at the home are between £495 and £595 per week. People using the service also meet the cost of hairdressing and chiropody. The home provides newspapers and general toiletries for those not wishing to purchase their own. People are not charged for activities though contributions are made to cover admission fees to the theatre etc. Woodlands Farmhouse DS0000016064.V362364.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 3 star. This means the people who use this service experience Excellent quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service for each outcome group under four general headings. These are; - excellent, good, adequate and poor. This unannounced key inspection was conducted over one day (6hrs) by CSCI Regulation Inspector Kathy McCluskey. The registered provider/manager and the home’s manager were available throughout this inspection. At the time of this inspection ten people were living at the home and we were able to speak with the majority of them during this inspection. We were also able to speak with the two staff members on duty. We were given unrestricted access to all parts of the home and records requested for this inspection were made available to us. We observed staff interactions with people using the service and were able to see lunch being served. A selection of records were examined relating to staff, people using the service, and health and safety. As part of this inspection the Commission sent a selection of comment cards to people living at the home, relatives, staff, care managers and healthcare professionals. We received 4 comment card from people using the service, 3 from staff, 4 from relatives and 2 from healthcare professionals. Comments have been included in this report. The registered provider/manager was also required to submit an Annual Quality Assurance Assessment (AQAA). This was received by the Commission by the required date. The AQAA well completed and gave very detailed information. Extracts from the AQAA have been included where appropriate, within this report. We would like to thank all involved, for their time and cooperation with the inspection process. Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 6 The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: Woodlands Farmhouse provides a very homely and ‘family’ type environment for up to 13 older people. The home is situated in the countryside and benefits from 2 acres of grounds, which are in the process of being landscaped. People are encouraged to make Woodlands their home. People are able to bring their personal possessions including their furniture. Pets are also offered a home. This was evident at the time of the inspection. The standard of décor and furnishings is of a very good standard. All but three rooms exceed the National Minimum Standards for size. All bedrooms have the provision of en-suite toilet facilities. There are three communal bathrooms each one offering a different assisted bathing facility. There is a parker bath, walk in hydrotherapy bath and a wet room. The home has been well adapted to meet the needs of older people and for those with mobility difficulties. All but two bedrooms are located on the ground floor. A stair lift gives access to the first floor. Grab rails and ramps are appropriately sited. A call bell system is installed. The home has a good supply of hoists. The home ensures that nobody moves to the home unless they have been appropriately assessed. People are also encouraged to spend time at the home before making a decision to move there. This ensures that all parties are happy that an individuals assessed needs and aspirations can be fully met by the home. The home’s care planning systems are consistently good. Staff are fully aware of peoples’ assessed needs and preferences. People living at the home confirmed that staff knew what they liked. People living at the home are supported to access a range of healthcare professionals. Appropriate procedures are followed for the management and administration of peoples’ medication. All staff have received appropriate training. People told us that they were able to choose how and where to spend their day. They also told us that staff know what time they like to go to bed or get up in the morning. People told us that the staff were kind and that ‘they would do anything for you’. During this inspection we observed staff interactions to be kind and respectful. Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 7 All meals are ‘home cooked’ and the home makes good use of local fresh produce. People told us the food was very good and that there was always plenty to eat. We were able to see that people are involved in menu planning. Staff morale appears high and the home has a very low turnover of staff. The home does not use agency staff and people at the home benefit from a stable staff team. The registered provider/manager ensures that staff are appropriately recruited and that they receive all the training they need. NVQ training is promoted for staff. Staff told us that they felt well supported and that they would not hesitate in raising concerns if they had any. People benefit from a very effective and proactive management team which consists of the registered provider/manager and the home manager. The home follows the correct procedures relating to health and safety. The home’s infection control procedures are good. What has improved since the last inspection? What they could do better: No requirements were raised at this inspection. Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 8 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. Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 9 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 Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 10 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, 4 & 5. Standard 6 is not applicable as the home is not registered to provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that people are only offered a placement once all parties are satisfied that the individuals needs and aspirations can be met. People are encouraged to visit the home before making a decision to move there. The home ensures that staff have the skills needed to meet the needs of people living there. EVIDENCE: The home have produced a Statement of Purpose and Service User Guide which detail information about the home and services offered. We were not Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 11 informed of any changes to these documents and these were not examined at this inspection. Four people using the service completed comment cards for the Commission and all confirmed that they had received enough information about the home which helped them to make the decision to move there. At this inspection we were able to see evidence that people are appropriately assessed by the home before a placement is offered. The home completes detailed pre-admission and risk assessment documentation to ensure that the home is able to fully meet the individuals assessed needs and wishes. Assessments from other healthcare professionals are obtained where available. The home completed an Annual Quality Assurance Assessment for the Commission and in this they state; ‘Prior to admission we carry out a thorough and comprehensive ‘needs assessment’ of health, care and social needs to ensure the home is the right place for the prospective resident. This is carried out in the prospective resident’s home or temporary placement, this process is unhurried and we provide the client with comprehensive a ‘Statement of Purpose’ which contains our ‘Aims and Objectives’, ‘Philosophy of Care’ and ‘Residents Charter’ together with full information and photographs of the home. The home has developed a Website for prospective residents to access which is comprehensive and informative included fee structure to ensure openness and transparency’. People are encouraged to ‘test drive’ the home before making a decision to move there. This includes staying for lunch, meeting the people already living at the home and arranging overnight stays. When we spoke to people during this inspection, they confirmed that they had been given the opportunity to visit the home prior to making a decision to move there. As previously mentioned, the home also offers a day care facility. The registered person is committed to ensuring that staff have the skills needed to meet the needs of people living at the home. Information regarding staff training can be found under Standards 28 & 30. The home has been suitably designed and adapted to meet the needs of older people whilst maintaining a very ‘homely’ environment. Grab rails, ramps and a range of other equipment is available in the home which helps to promote mobility, orientation and independence. Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 12 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, 10 & 11 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. The home’s care planning procedures are very good and promote a person centred approach to care. The home takes appropriate steps to ensure that peoples’ healthcare needs are met. Staff ensure that people living at the home are treated with respect. The home’s procedures for the management and administration of medication are good. People can spend their final days at the home with the support and care they and their family need. EVIDENCE: Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 13 At this inspection we looked at three care plans. These were found to be fully completed and up to date. Assessed needs were clearly identified and instructions for staff gave good information on how these needs should be met. The preferences of each individual had also been recorded. This included preferred times for waking or retiring to bed, bathing preferences and dietary preferences. Assessments relating to moving and handling needs, nutrition and levels of dependency were in place. Environmental risk assessments were also seen. We were able to see evidence that care plans were being reviewed at least monthly. Each care plan contained a ‘social history’ which gave good information about the persons life history and past hobbies. The registered person confirmed that the home had very good links and support from appropriate healthcare professionals. Local G.P and dental surgeries are utilised and visits are made to the home by a chiropodist and optician. Care plans viewed contained details of each persons contact with a healthcare professional. We were informed that there was nobody at the home who had significant healthcare needs and nobody was suffering with pressure sores or acquired infections. Two healthcare professionals completed comment cards for the Commission and in response to the question; ‘Does the care service seek advice and act upon it to manage and improve individuals healthcare needs? both responded ‘Always’. They also stated that individuals’ healthcare needs were ‘Always’ met by the home. The home weighs each person on a monthly basis. Records are maintained so that any significant changes in weight can be highlighted. ‘Sit on’ scales are available at the home. At the end of each shift, staff record details in each individuals’ daily record sheet. During this inspection we spoke with the majority of the people living at the home. All confirmed they felt that their needs were met and that their preferences/wishes were respected. Without exception, all commented on the kindness of the staff stating;, ‘they are marvellous’, ‘Nothing is too much trouble’, ‘They will do anything for you’, ‘They know what time I like to go to bed and get up in the morning’. We observed staff interactions with people to be kind and respectful. People were offered assistance in a dignified and unhurried manner. In completed comment cards for the Commission, four people said that they ‘Always’ received the care and support they needed and three said ‘Usually’. Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 14 We spoke to two members of staff and both confirmed that they were confident in their skills and ability to meet the needs of people currently living at the home. One person’s first language is not English, and the home employs a member of staff who is multilingual who works closely with this person. It was noted at the last inspection that this had brought the person ‘great pleasure’. We examined the home’s procedures for the management and administration of peoples’ medication. All medicines were seen to be securely stored. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). All available MAR charts were examined. These were found to be generally well completed with photo identification attached. There were no gaps in signing, clear instructions were available for staff and medicines received in to the home had been recorded. It has been recommended that where a variable dose has been prescribed, that staff record the amount administered. This related to one person who had been prescribed a variable dose of paracetamol. All staff responsible for the management and administration of medication have received appropriate and up to date training. This was confirmed by staff spoken with and from documented evidence in staff training files. In the Annual Quality Assurance Assessment (AQAA) completed by the home it states; ‘All residents are assessed as to whether they are capable of self-medicating, this is to be encouraged but currently the home does not have anyone suitable for this method to be used safely. A comprehensive Medication, procedure and guidance Policy has been produced and recently reviewed’. People told us that they were treated with respect. We observed staff knocking on bedroom doors before entering. People appeared well attired and comfortable in the presence of management and staff. The registered person was observed passing people their mail unopened. Support was offered to one person who requested the registered person open the mail for them. The home’s completed AQAA states; ‘Our aims and objectives of the home reinforce the importance of treating residents with respect and dignity and these are fundamental to the home’s philosophy of care ensuring Residents receive effective personal and healthcare support using a person centred approach based on their rights to dignity, respect, equality and autonomy’. In completed comment cards for the Commission, healthcare professionals stated that the home ‘Always’ respect individuals’ privacy and dignity. ‘I have never seen anything other than exemplary standards’. The home takes appropriate steps to ensure that the preferences of individuals following death are respected. Documented evidence of this was available in the care plans viewed at this inspection. Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 15 Woodlands offers a home for life providing it can continue to meet an individuals assessed needs. The AQAA states; ‘Accommodation is provided for families wishing to stay with the resident and this is encouraged by the home; where this is not possible, staff volunteer to carry out this support as appropriate. The Home works closely with and seeks the support of the GP and other healthcare professionals and ensures pain is monitored by the staff throughout and the appropriate relief is put in place as necessary by the GP. The home offers support to the Staff during this time and gains agreement from the staff that they are happy to provide the palliative care. Following the loss of a resident the staff are all given the opportunity to attend the funeral, discuss their emotions and counselling can be arranged by the home at the request of the staff members’. Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. People are supported to live a flexible lifestyle and the home provides opportunities for social/recreational stimulation. People benefit from a wholesome and varied menu and the home ensures that the meals offered are in line with their preferences. EVIDENCE: Care plans contained good information as to the social history and hobbies/preferences of people living at the home. Given the size of the home, an activity co-ordinator is not employed. Care staff ensure that an activity is offered each afternoon. Information is clearly displayed for people in the dining area. Staff confirmed that they were aware of peoples’ preferences and that they had time to spend ‘quality time’ with them. During this inspection we spoke to the majority of the people living there. They told us that they enjoyed the activities available. One person living at the home was able to bring their dog to live with them. Other people spoken with said that they ‘loved’ having the dog around. Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 17 Once a month, the home offers a trip out. There was evidence in the records examined that people are also taken out for shopping trips. We were informed that the home does not make charges for activities though where there are admission fees, such as for the theatre, people can make a contribution. Staff maintain a record of all activities offered in each persons plan of care. A hairdresser visits the home once a fortnight. People spoken with confirmed that they could choose how and where to spend their day. The majority of people were observed utilising the main lounge area. Some were enjoying the sunshine outside. Some people chose to spend time in the privacy of their own rooms. The two healthcare professionals who completed comment cards for the Commission both confirmed that the home ‘Always’ supported individuals’ to live the life they choose. ‘A most happy and homely environment’ In their completed AQAA, the home feels that they could further improve their activities; ‘We are building an Activities Pavilion for entertainments together with a Woodland walk and Duck Pond. We would like to increase the range of animals we have at Woodlands as we have found the residents to be highly stimulated by their presence. We currently have ducks and chickens’. The home welcomes visitors in line with the preferences of the individual. Refreshments are made available and people can choose where they see their visitors. In line with fire regulations, all visitors to the home are required to sign the visitors book on arrival at the home and before leaving. The home employs a cook and people benefit from ‘home cooking’ making use of ‘fresh and local produce’. Copies of menus were made available to us at this inspection. Options appeared well balanced and varied. Choices were identified. There was good use of meat, fish and fresh vegetables. People spoken with were very positive about the food at the home; ‘There is always plenty to eat’, ‘It’s good home cooking’, ‘They know what I like’. During this inspection we were able to see lunch being served in the comfortable dining room. The table was nicely laid with table mats, napkins and condiments. The menu for the day was clearly displayed in the dining room. We were able to see that people are encouraged to influence what food/meals are offered. We viewed the minutes of the last meeting for people living at the home and several suggestions had been made by people and had been included in the menus. Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 18 On the day of this inspection the lunch consisted of roast chicken, stuffing, roast potatoes, vegetables and gravy. Two puddings were available and people were also offered cheese and biscuits and coffee or tea to finish their meal. The meal looked appetising and plentiful. We discussed with the registered person that the meal time experience for people could be further enhanced if they considered the use of serving dishes rather than offering plated meals. The registered person confirmed that this was something that she was looking at introducing. Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 & 18 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The home has appropriate systems in place to enable people to raise concerns. The home takes appropriate steps to reduce the risk of harm or abuse to people living at the home. EVIDENCE: The home displays a complaints procedure within the home. We were advised that the home had not received any complaints since the last inspection. In June 2007, we visited the home to follow up on concerns raised with the Commission about the home’s infection control procedures. This was found to be unsubstantiated. Staff and people living at the home did not raise any concerns during this inspection and they confirmed that they would feel confident in raising concerns if they had any. Staff spoken with confirmed that they were aware of the ‘whistle blowing policy’. It has been recommended that the home updates this policy to include appropriate external contacts which include the Commission. The home has an up to date copy of Somersets Safeguarding Adults Policy (May 2007). Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 20 Signed documentation was available for staff confirming that they had read and understood the afore mentioned policy. Staff training records indicated that staff had received training in the protection of vulnerable adults. The home has policies for staff which preclude them from accepting gifts, benefiting from a will or being involved in drawing up a will. The home does not manage any monies on behalf of the people living there and the registered person confirmed that they do not act as financial appointee for any person using the service. We were informed that all people using the service are registered to vote. The AQAA completed for the Commission states; ‘All residents are supported to vote, either by postal ballot or in person, with staff and family giving assistance’. ‘Our Advocacy Policy is up to date and gives residents information on how to contact independent persons for support if they so wish’. Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24 & 26 Quality in this outcome area is Excellent This judgement has been made using available evidence including a visit to this service. The home is maintained and furnished to a very good standard and the environment promotes a ‘homely’ feel. The standard of bedrooms and bathing facilities are excellent. People have access to a range of aids and adaptations which help to maximise their independence. The standard of cleanliness is very good and appropriate steps are in place to reduce the risk of the spread of infection. EVIDENCE: Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 22 Woodlands provides a very homely, comfortable and well maintained environment for people. A programme of refurbishment/redecoration is maintained. The quality of furnishings, furniture and décor are of a very good standard. The home’s completed AQAA states; ‘The home is styled to give a ‘homely’ environment appropriate to the needs of the residents, kept clean and safe to both live and work in. The home is well maintained and has a maintenance programme in place to ensure the standards are kept’. ‘The home is a small community for the elderly without an ‘institutional’ environment, the home involves residents in the decision making process for any changes to the environment and décor. Samples of colour and design are brought into the home for individuals to comment on before a decision to purchase is made’. People living at the home have access to a number of communal areas and can access outdoor space where good quality seating and tables are available. The home’s very large gardens are in the process of being landscaped. When completed the ‘woodland walk’ will also be accessible to wheelchair users. A large pond and very spacious summer house are nearing completion. The home exceeds the National Minimum Standards for bathing facilities. These recommend one assisted bath to eight people. The home can accommodate up to 13 people and it currently provides 3 assisted bathing facilities which consist of a parker bath, walk in hydrotherapy bath and level access shower/wet room. There are 4 communal toilets 3 of which are situated on the ground floor close to communal areas. The home is fitted with grab rails, ramps and a stair lift. A call bell system is installed. The home has a very good supply moving and handling equipment. All but two bedrooms are located on the ground floor and all but three bedrooms exceed the National Minimum Standards for size. All bedrooms are fitted with spacious en-suite toilet facilities. The majority of bedrooms were viewed during this inspection and it was apparent that people are encouraged to personalise their rooms. The spacious rooms also allow for people to bring their own furniture if they choose. The standard of furnishings, fixtures and décor in bedrooms and en-suites were of a very high standard and promoted a very homely feel. Three bedrooms on the ground floor have patio doors which open out onto a private courtyard area. The home’s laundry area appeared clean and well organised. No concerns regarding infection control were noted. In their completed AQAA, the home indicated their intention to improved the current laundry facilities. Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 23 At the time of this inspection, all areas of the home seen were clean and free from malodours. The home takes appropriate steps to reduce the risk of the spread of infection. Liquid soap and paper towels are appropriately sited and staff have access to a good supply of disposable gloves and aprons. Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. Staffing levels are appropriate to the needs of people currently living at the home. The home ensures that staff have the skills/training needed to meet the needs of the individuals. The home follows satisfactory staff recruitment procedures. EVIDENCE: At the time of this inspection, ten people were living at the home. We were informed that during the day two carers were on duty with one waking and one on-call during the night. The registered person and home manager are also on duty in addition to the care staff. When we spoke with staff and people living at the home, no concerns were raised about staffing levels. People indicated that their needs were met and staff stated that they experienced no problems in meeting peoples assessed needs with the number of staff on duty. Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 25 In addition to care staff, the home employs a cook who covers 6 days a week. A cleaner covers 10hrs a week. Staff turnover is very low and we were informed that the home does not use agency staff. Staff morale appeared good. Staff said that they enjoyed working at the home, felt well supported and felt that they had received the training needed to enable them to meet the needs of the people living there. We were informed that ten care staff are currently employed and that 81 have achieved a minimum of an NVQ Level 2 in Care. This exceeds the 50 recommended in the National Minimum Standards. The registered person stated that she was committed to staff training including NVQ training. This was reflected in the home’s completed AQAA which indicates the homes intention to achieve 100 of the care team having completed this award. We looked at the home’s procedures for staff recruitment. There was evidence that the home obtains all required information including a Criminal Records Check (CRB) and Protection of Vulnerable Adults Check (POVA). It has been recommended that where an employee commences employment on a POVAFirst, pending a full CRB, that a risk assessment is completed which clearly identifies the restrictions imposed on that person during this period – ie: that the person will not work unsupervised and the arrangements that will be put in place. We were able to see that staff follow an appropriate induction programme on commencement of employment. The registered person stated that newly appointed staff are also provided with an induction workbook which is in line with the Skills for Care 12 week Common Induction Standards. The registered person has developed a staff training matrix which is in the process of being updated to ensure that all staff receive updated training as required. We were informed, and records indicated that all staff had received up to date mandatory training. Staff have also received training in dementia care, vulnerable adults, infection control and first aid. Staff spoken with were positive about the training they had been given. Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 26 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, 32, 33, 34, 35, 36, 37 & 38 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. People living at the home benefit from an effective management team who promote an open and inclusive style of management. The home has an effective quality assurance programme in place which seeks the views of persons at the home and their relatives/representatives. There is evidence that changes are made based on the views of the people living at the home. The home does not manage any money on behalf of the people living there. Staff are appropriately supervised. The home takes appropriate steps to ensure the health & safety of persons at the home. Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 27 EVIDENCE: The registered provider/manager is Emma Purvis. She has owned and managed the home for the past nine years. Since the last inspection the registered provider/manager has completed the registered manager award. The registered provider/manager is supported by a home manager who is in the process of completing this award. Staff and people living at the home were very positive about the support they received from the registered provider/manager and the home manger. During the inspection we noted staff and people living at the home to be relaxed in their presence. It was evident that an open and inclusive style of management is promoted. Regular meetings are held for staff and for the people living there. When we looked at the minutes from the last meeting, it was apparent that people using the service are encouraged to express their views about all aspects of life at the home. There was also evidence that changes had been made following suggestions by the people living there. Examples of this include changes to the menus and activities offered. In the home’s completed AQAA, the registered person states; ‘A clear structure is in place for the management and leadership of the home. Both the Registered Manager and the Home Manager work continually to improve the services and provide an increase in the quality of life for the residents. We have an ethos of being open and transparent in all areas of running of the home. The home has up-to-date policies and procedures and staff are familiar with these and take them seriously’. The home has a quality assurance programme in place. Comments are sought from people using the service and their representatives on an annual basis. Comment cards have recently been sent out and we were able to view one completed comment card from a relative. Comments were noted to be positive. People using the service and their relatives are also encouraged to make comments about the service at any time. A comment/suggestion box is available in the main reception area of the home. The registered person’s completed AQAA states; ‘The Manager has a clear vision for the future of the home based on ‘best practice’ and is committed to the continuous improvement of the ‘person centred’ approach. The manager has put in place a quality assurance system and the development for the business is clearly shown in the Annual Development Plan Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 28 for the home’. The home displays an appropriate and up to date employers liability insurance certificate which expires 10/01/09. We were informed that the home does not manage any personal monies on behalf of the people living there. We were also informed that the home does not act as financial appointee for any person. Any additional costs incurred by people are listed and invoiced. The home has systems in place to ensure that staff receive formal supervision sessions at least six times a year. Documented evidence of this was made available to us at this inspection. At the time of this inspection, the home is taking appropriate steps to ensure the health and safety of persons at the home. We toured the premises and viewed a selection of records; FIRE SAFETY – The home has completed a fire risk assessment. This was seen but not examined in depth at this inspection. We were able to see that the home conducts weekly in-house checks on the home’s fire detection systems and monthly checks on the emergency lighting. Annual servicing by external contractors was up to date. Staff training records indicated that all staff had received fire training in February 2008. This was also confirmed by staff spoken with during the inspection. ELECTRICAL SAFETY – We were able to see evidence that annual testing on portable appliances was up to date. Records indicated that testing last took place on 18/07/07. EQUIPMENT SERVICING – The home has a parker bath, Oxford mini mobile hoist, stand-aid, 1 adjustable bed and a manger elk hoist. We were able to see up to date servicing records, which had been carried out in accordance with LOLER regulations, dated 31/01/08. The home’s stair lift is due to be serviced this month. ACCIDENTS – The home maintains records for all accidents. Records were examined and were found to be unremarkable. The registered provider/manager stated that she looks at records on a regular basis but does not have a formal system for documenting this. On discussion with the registered provider/manager she acknowledged that this would be helpful and it was agreed that she would complete this on a monthly basis. Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 29 As required in the Care Homes Regulations, the registered provider/manager informs the Commission of any death or significant event at the home. The home has a range of health and safety policies and procedures available to staff. There was evidence that staff are encouraged to read these. The staff training matrix identified three staff who had completed formal training in Health & Safety. It is stated in the home’s completed AQAA that; Policies are regularly reviewed and are posted on the notice board for staff to read. A check sheet is included with each policy for staff to sign to confirm they have read and understood the policy. Health and Safety is taken seriously to ensure the well being of residents, staff and visitors. The policies and procedures are reviewed and updated to reflect current good practice advice’. To ensure the safety of persons at the home, upstairs windows are restricted and radiators are covered. Hot water outlets are fitted with a thermostatic control to ensure that temperatures do not exceed the Health & safety Executive safe upper limits of 44c for bath outlets and 42c for shower outlets. We were informed that staff check temperatures before a person is assisted to bath/shower. It has been recommended that a formal system is introduced so that all hot water outlets are checked on a monthly basis with records maintained. Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 18 3 4 3 4 3 4 4 x 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? N/A 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. Standard Regulation Requirement Timescale for action 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. 2. 3. Refer to Standard OP9 OP18 OP29 Good Practice Recommendations The registered person should ensure that staff record the amount administered for variable dose medication. The home’s whistle blowing policy should be updated to include appropriate external agency contact details. A risk assessment should be completed for any staff member who commences employment on a POVAFirst pending a full CRB so that they are fully aware of the restrictions upon them during this period. The home should also ensure that the person responsible for supervising staff during this period are clearly identified. A formal recording system should be introduced to ensure that the temperature of all hot water outlets are checked on a monthly basis. 4. OP38 Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Woodlands Farmhouse DS0000016064.V362364.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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