Inspection on 11/05/06 for Dean Wood Manor

This inspection was carried out on 11th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Dean Wood Manor 26/02/09

Dean Wood Manor 22/05/08

Dean Wood Manor 22/08/07

Dean Wood Manor 20/12/06

Dean Wood Manor 27/02/06

Dean Wood Manor 11/10/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Dean Wood Manor Spring Road Orrell Wigan Greater Manchester WN5 0JH Lead Inspector Lindsey Withers Second Inspector Kath Key Unannounced Inspection 11th May 2006 08:20 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 Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 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. Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Dean Wood Manor Address Spring Road Orrell Wigan Greater Manchester WN5 0JH 01942 223982 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) www.mimosahealthcare.com Mimosa Health Care Limited Care Home 50 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (7), Old age, not falling within any of places other category (43), Physical disability over 65 years of age (8) Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home is registered for a maximum of 50 service users, to include: Up to 43 service users in the category of OP (over 65 years of age) Up to 8 service users in the category of PD(E) (over 65 years of age) Up to 7 service users in the category of MD (Mental Disorder under 65 years of age). The service should employ a suitably qualified and experienced Manager who is registered by the CSCI. The Home must be appropriately staffed at all times. The numbers and skills mix of the staff must meet the needs of service users. 27th February 2006 2. 3. Date of last inspection Brief Description of the Service: Dean Wood Manor is located off the main Orrell to Standish road. The premises comprising Dean Wood Manor are based around an original Grade II listed building that has been extended to provide accommodation to a total of 50 people. The gardens surrounding the home are extensive and wellpresented. Car parking for visitors is good. The registration categories (i.e. the groups of people who can be admitted) had been revised since the last inspection. The registration now allows a maximum of 43 elderly people with nursing and/or personal care needs, as well as up to 8 elderly people with a physical disability, and up to 7 younger adults (under 65) with a mental disorder to be accommodated at the home. One other person is living at the home under special arrangements. The development of the 7 bedded unit was nearing completion. At the time of the inspection some minor improvements were needed to the premises. Staff had been identified to work on the unit. Formerly known as Orrell Hall, Dean Wood Manor is part of the Mimosa group of homes. The Mimosa philosophy is Where people matter. The stated aim is to provide all residents with the kind of individual care they need, whilst maintaining their independence, dignity and freedom of choice. The scale of fees for the home, as stated in the home’s pre-inspection questionnaire, is £299.68 to £633.00. Fees take account of the size of room the person occupies, as well as the extent of personal and/or nursing care they require. Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection was to look at the main “key” standards in order to assess the level to which Dean Wood Manor meets the needs and expectations of residents. Part of this inspection involved an unannounced site visit to the home on 11th May from 8.20 a.m. to 4.50 p.m. by two Regulatory Inspectors. Part of the time was spent looking at the paperwork that the home needs to keep to show that it is being run and managed properly, and part of the time looking around the home and observing care practice. In order to get a wider view of life at Dean Wood Manor, as well as speaking to residents and staff at the home during this site visit, one of the Inspectors made seven telephone calls to the relatives/friends of six residents. Only two were available for comment. The Inspector also spoke to three health care professionals who visited the home. CSCI had provided copies of comments cards for interested people to complete, and a total of 2 were returned. In making the judgements contained in this report, the Inspectors have also considered: other visits that were made to the home; regulatory processes that have taken place, such as variations to registration (for example, providing accommodation in a separate unit for seven people under the age of 65 with a mental health disorder); information passed to CSCI from other sources, such as local Councils. What the service does well: Residents at Dean Wood Manor live in a clean, fresh home that offers plenty of space in which to move about. There is a variety of lounge and other seating areas, and a safe, well-stocked garden in which to sit in the better weather. Residents appear well-cared for, and dress in clothing that is appropriate for the season. Visitors to the home, including health professionals as well as friends and relatives of the residents, say they are made to feel welcome. Care and ancillary staff appear to have good relationships with the residents and with each other. Residents are appreciative of the food that is provided for them, and made complimentary comments and gestures. Staff appeared to enjoy being at work. One person said she thought the atmosphere at the home was “brilliant”, and that the staff team were “really working together”. In a comment card sent to CSCI, a GP said that the home communicated clearly and worked in partnership with him, and that staff demonstrated a clear understanding of the care needs of the residents. A visiting health professional was very pleased at the quantity of tea and juice that residents were offered on this very warm day. In a telephone conversation with one of the Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 6 Inspectors, a relative said that staff were “very good” with his father, and provided a good service to him. What has improved since the last inspection? What they could do better: Although there are a number of requirements and recommendations listed at the end of this report that the home either must do or should consider doing, a high proportion can be quickly resolved and at little or no cost. Staff training and supervision will play a critical part in ensuring some of the work that the home could do better is done. For example, the assessments that are done before a person moves into the home; including all relevant information in the resident’s plan of care; and taking appropriate action following an accident or an incident: with training about how to do the jobs properly, and then by supervising staff so that they know they are doing them properly, improvements for residents should become evident. Other improvements that need to be made, such as engaging residents in activities/events in the wider community, may take a little longer and some concentrated effort. The home does need to place some importance on ensuring all residents are treated equally. For example, residents with dementia run the risk of not being treated equally because staff have not had training other than a basic introduction to the condition. While staff are kind, they may inadvertently Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 7 make an inappropriate judgement, for example hobbies, “none due to dementia”, or be unable to distract an agitated or angry person. Again, appropriate training, followed by regular supervision, will improve care practice and make life better for the residents. In a telephone conversation, one relative said that he was not able to visit regularly and was not kept up to date as had been promised. A health professional said that she had called to make an appointment to visit the home but, on arrival, she had not been expected. Effective communication, therefore, must be addressed with the staff if people are to feel confident about their contacts with the home. 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. Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this home. Quality in this outcome area is adequate. This judgement has been made using available evidence, including visits to this service. The records that are made of pre-admission assessments are not consistently thorough. Some people had not been assessed fully, so there was not enough information on which to base a plan of care. EVIDENCE: The case files of the three most recently admitted residents were examined. These residents had cognitive difficulties so were therefore unable to comment on assessment/admission process. Two of the assessment documents examined demonstrated full assessment of physical needs had been undertaken. Care plans and risk assessments had also been formulated. It was noted in one file that the social assessment had not been completed. Another resident was admitted at the beginning of May 2006. The information in this resident’s file was brief and incomplete. While there was evidence of a preadmission assessment having taken place, the file did not contain a care plan or any risk assessment documentation. Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence, including visits to this service. Care plans were much improved though errors and omissions were still in evidence. Residents are more likely to have a plan of care that sets out the way in which their needs and expectations will be met. Access to health care professionals is better. Residents are now more likely to receive care from community and hospital services. The management is medication is much improved. Progress is being made to eradicate poor practice, so residents can be assured their medication will be dealt with properly. Residents can expect to be treated with respect, and that their right to privacy and dignity will be maintained. EVIDENCE: The care documentation for three residents was looked at. (It is understood new care plan documentation is to be introduced in the near future.) Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 11 Care plans are based on the Roper, Logan, and Tierney Activities of Living which covers 12 areas: maintaining a safe environment, communicating, breathing, eating and drinking, eliminating, personal cleansing, controlling body temperature, mobilising, working and playing, expressing sexuality, sleeping, and dying. The care plans examined were much improved from the last inspection. The plans contain more detailed information of residents’ physical care needs. Regular monthly reviews had also been undertaken. A full range of risk assessments was in place covering areas such as nutrition, pressure care and moving and handling. There was evidence of external reviews have been undertaken. For example one person had external review involving psychiatrist, social worker and named nurse, and another resident had a review on 19/10/05. It was not clear if care plans had been agreed by residents or their representatives. While documentation was improved, some shortfalls were noted. For example in one plan information regarding religion was not detailed. While residents were being weighed more regularly there were still some omissions. This could be due to the practice of care staff recording weights on paper and then giving the information to the nurse in charge to record in the care plan. Discussion took place regarding the reason why care staff cannot make such entries directly into care plans, and the Operations Director said he would certainly consider this, particularly when the new documentation was introduced. Progress notes are kept in each individual file. As a result the nurse in charge needs to take each resident’s progress notes out of the file to make an entry. This must take a considerable length of time and could lead to information not being recorded. For example, if care staff inform the nurse in charge of a change in residents well being, the nurse will then need to document the information. This could lead to important information not being recorded. A separate file containing progress notes may make recording both easier and quicker. Some contradictory entries were also noted. In one care plan the progress notes for the 4/5/06 stated that the resident had “a settled day”. However the key worker notes for the same day indicated that the resident was “quite agitated”. It was also noted that the plans focused on “problems” rather than residents strengths. For example, for one resident, in the section covering mobility it was identified that this resident was “independently mobile”. The care plan identified this as a “problem” rather than a strength. One of the care plans lacked clarity regarding pressure area care. The care plan stated “ no pressure associated problems”. The waterlow risk assessment Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 12 indicated “very high risk” of pressure sores. It was evident that the resident had developed pressure sores but this not reflected in the initial plan. Entries in care plan on the 3/3/06 read “ small pressure sore hip” by the 19/3/06 “ pressure sore healed. An entry for the 7/1/06 stated “grade 4 pressure sore sacrum”. There was no indication in the treatment plan if this had improved. Progress notes for the 2/5/06 read “ dressing renewed” and the 9/5/06 “dressing in situ”. During the afternoon, the inspector discussed this with nurse in charge and Senior Care Assistant indicated the sacral pressure sore had nearly healed but this was not clear in the plan. In addition to daily progress notes a daily diary, communication book and handover sheet are maintained. The communication book was looked at. Entries relating to one resident showed a member of staff had recorded that the resident preferred a nightdress rather than pyjamas as she became hot and uncomfortable. A further entry indicated this had not been addressed as the member of staff wrote “May I request again for X to be put in a nightdress she becomes to hot and agitated in pyjamas”. This demonstrates that at times staff do not always act on relevant information. In the past some concerns regarding if health care needs of residents have been addressed (referred to at Standard 16). In each of the care plans examined details of visits of health care professionals were recorded including GP, dentist, chiropodist, psychiatrist and CPN. On of the residents was experiencing a problem with his teeth. There was evidence staff had been proactive in addressing this. The dentist had been and had said his teeth needed to be extracted. However he was unable to do so as the resident would need to be sedated. He had made a referral to the health authority for this to be addressed. Staff were mindful of the pain the resident had. One of the care staff explained that although the resident could not verbalise discomfort, they knew he was as he kept pointing to his mouth. This member of staff said nursing staff were taking steps to ensure he was seen as soon as possible. A pharmacy inspection was carried out by Stephanie West (CSCI Inspector) on the 7/4/06. In the main medication systems were satisfactory. During this inspection the requirements made following the above inspection were followed up and it was found that all had been addressed. It was observed in the morning that the medication round took some considerable time (3 hours). The member of staff was new. Nevertheless this would suggest an additional nurse would prove beneficial. The nurse in charge was asked what time she finished the morning round she said “about 10.30”. During the inspection staff were observed to treat service users with respect and consideration, were attentive to individual needs and were discreet. Residents were seen to be dressed in clean, well maintained clothing that was appropriate for the weather. Residents were helped by staff to change clothing that had become soiled or stained over the course of the day. Staff also helped residents to adjust their clothing as they became warmer or colder. Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 13 There is some written evidence in some care plans that residents’ needs in respect to dignity were considered important. For example, personal appearance. In one person’s care plan, staff are instructed to “ clean face after meals”, for another person “ ensure neat and clean and shave always, and for another “very smart and well groomed and very aware of privacy”. While staff were observed being caring, the response of one member of staff towards a resident indicated a need for dementia care training. The resident was upset and asking for her mother. The carer told the resident that her mother was at work. However, the approach taken by another member of staff showed good practice. The member of staff distracted the resident by taking her to look for her handbag. Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence, including visits to this service. Staff make efforts to offer residents some activity and occupation during the day, but are limited as to how much time they can dedicate to this area of care. There are few visitors to the home and little contact with the community. Improvements should become evident for residents when an Activities Co-ordinator is recruited. Residents are now more likely to be helped to exercise choice and control over their lives. Residents receive food and drink that they appreciate and enjoy. Food is nourishing and presented in a way that meets residents’ needs. EVIDENCE: The activity co-ordinator post is currently vacant. Senior managers advised that action is being taken to recruit a co-ordinator. In the interim care staff are responsible for undertaking activities. Details of advertised activities are displayed in the dining room (near to the main office). Activities advertised include the following: Monday- crafts (examples of which were displayed throughout the building); Tuesday- afternoon tea dance; Wednesday- knitting Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 15 circle; Thursday-board games; Friday- skittles; Saturday-walks; Sunday- video afternoon. Details of the activities that residents take part in are recorded. The activity record was examined to find that at times the advertised activities do not place. For example, in one resident’s record there was a gap of twelve days between activities. There was evidence of one to one activities taking place. One of the domestic staff takes a resident for a walk every day. Discussion with member of staff indicated she took this resident for a walk on the days she worked. Observation of this member of staff and the resident demonstrated they had a good relationship. It was evident this daily walk was beneficial to the resident’s well being. After lunch it was noted the resident was becoming very upset and unsettled, asking staff to let her out (though it would have been unsafe for her to do so unsupervised). However, once she had been for this walk she was much happier and at ease. Following her walk she was calmer and was happy to show the inspector her bedroom and pictures of her family. Opportunities for residents to access community facilities are limited. There was no evidence in the advertised activity programme of regular organised outings taking place (apart from one resident going for a daily walk) but information in the pre-inspection material provided by the Manager did indicate outings did take place. It was evident from speaking with staff that they know a great deal about residents’ interests. However, this is not always reflected in care plans. For example, in some of the plans examined social care profiles were blank or the content brief. In one plan the section relating to hobbies in the social profile read “none due to dementia”. Staff were observed taking time to socialise with residents when their duties allowed. For example, staff were seen sitting with residents in the lounges. A friendly but respectful banter was seen between residents and staff. This is much improved from the last inspection where interactions between staff and residents were much less frequent. While visiting is open, no visitors were present during the course of the inspection. Examination of the visitors’ book showed some friends and relatives Therefore, information regarding if they are made welcome when visiting or invited to social events was could not be confirmed. Staff made inspectors very welcome and spoke freely and openly with them. Residents who were able to comment expressed satisfaction with the care provided and the organisation of life at the home. For example, one person said, “I’ve been here five years and I love it”. It should be noted that a high proportion of residents have cognitive difficulties so were unable to confirm Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 16 they were able to exercise choice. Nevertheless, observation of care practice indicated residents could make choices. For example, in respect to food and where they spend their day. A choice of menu is available and some residents were seen to choose to spend time in their own rooms. It was also noted that personal choice was now being included in care plans. For example, one plan stated, “Will retire early but rises early and likes to get washed and dressed early”, in a second “Likes to talk to staff”. Four-week menus are in place. Menus showed a variety of meat fish and vegetables. Catering staff were until recently employed by Hopkinson. Staff are now employed directly by the home. Discussion with the cook indicated that new menus were soon to be developed once “teething problems” with new suppliers had been resolved. It was evident the cook was very knowledgeable about residents’ food preferences. The cook advised when new menus were developed that residents would be involved in the process. The lunchtime meal in the West Dining Room was observed. The dining areas were clean and efforts had been made to give an air of domesticity. Dining tables were tastefully set with linen tablecloths and floral displays so ensuring a congenial atmosphere. Menus were displayed. The cook served the meal. Two care staff supported 12 residents. None of the residents needed assistance with eating the meal though some required prompting. One resident required a plate guard, which was provided. A choice is offered at every meal. On the day the meal consisted of vegetable soup, steak and kidney pie or chicken pie with mixed vegetables and potatoes followed by fruit and cream. The inspector sampled the meal and it tasted good. Staff were sensitive and discreet when providing assistance and no one was rushed. Second helpings were offered. Staff asked residents which option they preferred. Where one resident was unable to verbalise which option she wanted, a member of staff took her to the serving trolley to choose. One resident was reluctant to sit down between courses. Staff did not force the issue but when the next course was served made sure the resident did not get forgotten. Residents who commented expressed their satisfaction with the quality, quantity and choice of food provided. One resident described the food as being “ very good”. There was very little wastage. In the East Dining Room, residents were more dependent upon staff for assistance. Three care staff supported 10 residents in the dining room, one person in the lounge, and one in the bedroom. Here residents did not have a menu and did not know what to expect. Staff served soup either in a bowl or cup, according to the resident’s need. Two residents had a substantial pie, potatoes and vegetable main course. Staff were unable to tell what the pureed meat was, guessing it was tuna. In fact it was chicken. To the inspector’s eye, the plate of food offered to those residents who had a pureed diet – Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 17 chicken, mashed potatoes and cauliflower – while substantial in quantity and pureed separately, was bland in appearance. However, residents ate the food offered to them and made appreciative noises. One resident had a cheese sandwich, which she was very pleased to be served. One or two residents indicated verbally and by gesture that the food was good. One person said she did not like her lunch but had eaten it all. Staff in this dining room were mindful of residents’ difficulties, perhaps with swallowing, visual impairment, lack of spatial awareness, and served food in a way that allowed residents to eat as independently as possible. Full assistance was given to those who could not manage to eat a meal on their own. Assistance was discreet, staff carried on a conversation with the resident, and maintained good eye contact. A number of these more dependent residents had, up until recently, spent the whole of the day in one area of the home, including at meal-times. These residents now join with others, even if they are taken in their nursing chair, so that meal time becomes a social occasion. During the course of the day, residents were offered a choice of hot and cold drinks. Each resident was offered a choc ice mid-afternoon on this warm day. Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 18 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence, including visits to this service. The home has a complaints procedure that is clearly advertised. Residents and their supporters can be sure their complaints will be acted upon. The safe-guards that have been put in place for protecting residents from harm have improved this area of care. However, there are still some staff training issues that need to be addressed. EVIDENCE: The home’s complaint procedure is displayed at the main entrance and sets out the process a person should follow if they wished to make a complaint or raise a concern, including with organisations outside of the home and Mimosa. The CSCI’s telephone number is incorrect and needs to be amended. The nurse in charge was asked for the complaints book. She indicated the complaints book was kept in the upstairs office, which was locked as the administrator had finished work (the manager was also on leave). Information in the pre-inspection material received prior to the inspection indicated no complaints had been made. No complaints have been received by the CSCI since the last inspection. When asked what she would do if anyone wished to make a complaint the Nurse in Charge replied “ I would report it”. Discussion also took place with a senior carer regarding how a concern or complaint would be dealt with. She said that if it was of a minor nature she Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 19 would try to “ try to deal with it at the time” but report what action she had taken. In the case of a major concern or complaint the senior carer indicated she would report it to the person in charge. The three residents case tracked were unable to indicate if whether they could speak to staff about any problems. One resident spoken with (whose care was not tracked) indicated that she felt able to discuss concerns or problems with staff and that they would take them seriously. One of the inspectors saw this person take a concern to a member of staff, and saw that the resident was treated respectfully and told that her comments would be noted. No visitors were present during the inspection so their views are unknown. Two investigations, alleging neglect of residents, were in progress under the Local Authority’s “Protection of Vulnerable Adults” procedure. The results of the investigations were not known at the time of this inspection. In early March 2006, Mimosa ran training sessions for the staff team with the aim of raising awareness so that residents were kept safe from abuse in any form. In conversations, staff were able to confirm that they understood what “abuse” meant, and what they would do if they saw abuse taking place. The recruitment records show that the appropriate checks have been made on employees, including with the Criminal Records Bureau and Protection of Vulnerable Adults register, before employment is confirmed. The accident records showed 10 incidents between 24th March and 9th May 2006 when one resident had hit another, or where a resident had hit a member of staff. (Two such incidents occurred on the day of the inspection.) Some records did not indicate which resident had been the perpetrator. These incidents had not been reported to CSCI and had not been followed up in the home. The home’s Area Support Manager agreed to investigate this matter. The inspectors noticed a resident with a hand injury. A nurse said that this person had frequent hand injuries which were caused, probably, by the resident catching her hands on the hand-rails – which the Nurse thought might have rough or sharp areas – but the hand-rails had not been reported to maintenance. This is an example of where a resident is not being protected from physical harm by the home. The home’s Area Support Manager said he follow up this training issue, and made arrangements for hand-rails to be repaired or replaced. During this inspection, one incident of improper moving and handling was seen. The type of moving technique used is out-dated and degrading for the resident. The incident was reported to the home’s Operations Director for attention. Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 20 One person with a physical disability could not release the lock on her bedroom door from within the room because the lock was placed too high up on the door for her to reach. Therefore, she was not free to leave her bedroom when she chose to. This could be seen as inhuman treatment and was reported to the home’s Area Support Manager, who arranged for the lock to be lowered and made more accessible to the resident. Only one resident was being nursed in their own bedroom. Although this person was, effectively, behind a locked door, the Manager had reported that room checks were being made hourly, and that other alternatives were being considered to keep the resident safe and quiet but without the need to close the bedroom door. Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including visits to this service. Residents live in a home that is well-maintained. Improvements continue to be made so that the space is used in ways that suit the residents. Bathrooms have been improved so they have a more homely feel. There are sufficient bathrooms and toilets to meet residents’ needs. Residents live in a home that is clean and fresh. Attention to hygiene and the spread of infection has improved with only minor shortfalls in evidence. EVIDENCE: Work continues on improving the environment. There was evidence of painting and redecoration in areas used by all residents. Doors on the main corridors have been painted different colours. Doors to bathrooms and toilets now have signs to show what the function of the room is. Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 22 Since the last inspection, the Manager had been monitoring the temperature and ventilation in the West Lounge but was considering changing the use of this room before the winter. Changes have already been made to the way lounge space was used. Those residents who are more frail have been moved to a brighter lounge where there is good visibility to the outside, and where the residents are more visible to the staff. These residents are now using the adjacent dining room, including those who are nursed in chairs. Dorguards have now been fitted to residents’ bedroom doors. These allow doors to remain open but release if the fire alarm sounds. The dorguards meet the requirements of the local fire service. The home has a system for notifying repairs such as unacceptable room temperatures, carpet odours, blown light bulbs, etc. Staff record the repairs in a file which the maintenance man checks each morning. He signs them off when the repairs have been made. Work had been completed on a number of action points identified by CSCI in February 2006 when the registration of the lower ground unit was nearing completion. The inspector noted some outstanding work that needed to be done. These included: ensuite lighting level insufficient; ensuite pipework to be boxed in; hole in the wall to be repaired; towels rails/coat hooks to be fitted in bathrooms; light diffuser required in one bathroom; exposed pipework in one bathroom, plus holes in the tiling that required repair; curtains reaching into the sink in three bedrooms. Double glazing units had broken down in three bedrooms obscuring the view to the outside. Vanity units had been fitted in bedrooms but were not the size or quality that had been discussed. The Operations Director agreed to look at this and the other issues identified. Bathrooms have now been made more domestic in style. Bath panels have been replaced; pictures and mirrors have been put up on the walls. A further improvement would be to provide storage cupboards for continence products, yellow bags, etc. as displaying these items is a constant reminder that they are needed and compromises the dignity of the residents. One bathroom had neither bath plug nor bath thermometer: both would be needed to use the room properly and safely. There was a rusting pipe in the toilet near room 21, but otherwise toilets were well-maintained. On the day of this inspection the home was clean and smelled fresh throughout. Ventilation of the home was being managed well on this very warm day. Staff were following good practice to minimise the risk of spreading infection, including for transporting foul or infected linen and clothing to the laundry, which is located well away from areas where food is prepared. Plastic aprons were in plentiful supply and staff were wearing them. No staff were seen wearing protective gloves, which was significant because the home had had an Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 23 infestation of scabies that had affected a number of residents and staff. Staff did not carry hand gel as they said it could not be attached to the uniform. This was raised with the home’s Operations Director who said the gel contained alcohol and so was not appropriate for use at Dean Wood Manor because it posed a risk to the safety of the residents. He said he expected staff to follow good hand washing techniques. In the East dining room, where staff serve the meals, staff were seen to be handling cutlery at the end opposite to the handle. The Operations Director said he would address this. Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence, including visits to this service. Overall, the staffing numbers are appropriate to the assessed needs of the residents, and the size and layout of the building. However, the working practice of the nursing staff in the morning needs to be reviewed, as currently nurses are taken away from providing nursing care for too long a period of time. The skill mix will improve as the training programme progresses. The home has not yet achieved the minimum 50 of care staff with National Vocational Qualification level 2. If staff have this qualification, the competence of the staff team is better, which ensures better care for residents. The home has a procedure that is followed when recruiting staff. Care needs to be taken to ensure the home’s equal opportunities policy is followed, so that the make-up of the staff team reflects that of the residents. Training has been taking place but has not included all staff. The Manager’s intention to plan training around the aims of the home and changing care needs of the residents, will improve the quality of the service provided by the home. EVIDENCE: A copy of the staff rotas were provided to CSCI with the home’s pre-inspection material. These showed that, for 33 residents, a staffing level was being Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 25 maintained of one nurse plus 5 carers in the morning, one nurse plus 4 carers in the afternoon, and one nurse plus 3 carers overnight. Given the dependency levels of the residents, including those with mental health conditions and those who require considerable nursing input, and the size and layout of the building, this level appears satisfactory for this number of residents. However, the morning medication round has been taking between 2 and 3 hours to complete, and so the nurse is unavailable for other duties during this time. A requirement had been made previously to the home for an additional nurse to be available at this peak time, and was discussed again during this inspection. The view of management is that it is not about the length of time it takes to administer medication, but more about the nurse keeping control, perhaps resisting help from carers who have experience of managing medication. Whatever the reason, the home must be able to demonstrate that sufficient staff are on duty to meet the needs of the residents and this includes having a nurse available, other than the Manager who is supernummary and not included in the rota. A Registered Mental Nurse had been recruited to supervise the new unit on the lower ground floor. As he is contracted only for 30 hours per week, other appropriately qualified nurses have been identified within Mimosa who can cover the remaining hours. Additionally, care staff have been identified who wish to transfer to the new unit, some of whom have experience of working with people with mental health disorders. The home’s Operations Director said that admissions to the new unit are expected to be done slowly, and that additional staff will move to the unit, as they become needed. Because of the changes to the management of the home, and because of the turnover of staff over the past several months, the minimum 50 ratio of staff with National Vocational Qualification level 2 in Care has not been achieved. Three carers were currently studying for the award, having completed their foundation (key skills) training with Mimosa. Two of the three carers said they expected to have completed the level 2 by Christmas 2006. One member of staff was hoping to progress on to the level 3, but another wanted to get a good grounding, perhaps with further knowledge of care at level 2, before moving on to the level 3. The personnel files were looked at for four members of staff including one nurse and three carers. Each contained sufficient information to show that the home’s recruitment process had been followed. Raised as a point to consider at the last inspection, Mimosa’s interview questionnaire has yet to be improved upon. Currently it asks questions that are closed - requiring yes/no answers and so does not provide sufficient evidence to confirm a person’s suitability to work in care. Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 26 Equal opportunity monitoring sheets had been completed, but appear just to have been filed – there was no evidence, therefore, to suggest that the home had collated the information or that any conclusion had been reached. The breakdown of the staff employed at Dean Wood Manor shows that there are a high number of care staff under the age of 25, compared to other age groups. However, they are supervised by more mature and long-serving members of staff. There are no male carers and only one male nurse. This does not reflect the ratio of male to female residents accommodated at the home. People from an ethnic minority have only been recruited to nursing posts. No resident is from an ethnic minority. These are matters that should be borne in mind when recruiting to vacant posts. The records showed that staff had been given a copy of the code of conduct from the General Social Care Council. One member of staff was able to describe what the code meant; another could not remember. The home must take care when writing to staff, for example, terms and conditions of employment, or letters relating to disciplinary matters, to make sure that the correct date is included in the letter and that duplicates are clearly marked as such. Two examples were seen where duplicates had been produced and signed by the new Manager. However, the dates of the letters were before the time when the new Manager started working at the home. The staff training schedule is kept on computer and was made available for the inspector to look at. The computer record showed that some training had taken place over the last year, for example, continence promotion and basic dementia awareness. The training in relation to the Protection of Vulnerable Adults had not been recorded. However, the staff files showed that it had been done in March, and staff were able to describe what the training was about. The new Manager is beginning to put together a training schedule. Future training will include dementia, challenging behaviour, venepuncture, and infection control. The files for three members of staff showed that they had completed an induction period when they had joined the team at Dean Wood Manor. One person said she had been introduced to residents, given a tour of the premises, and given a handbook. She said she did not work unsupervised until the induction programme had been completed. Another person said she had been told about the home’s rules and been given a talk about fire safety. This person said she, too, had only worked under supervision during the induction programme. Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence, including visits to this service. Residents can be sure that the home is being managed properly by a competent person. The home is not yet being run in the best interests of the residents, but plans are being made that should improve this situation. Money kept on behalf of residents is managed properly, but the home does not ensure the financial interests of residents are consistently protected. Some staff supervision is taking place but has yet to be planned for all staff. Informal supervision is eradicating poor practice. In general, safe working practices are carried out. However, there are improvements that must be made if the welfare of residents and staff is to be assured. Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 28 EVIDENCE: The new Manager, Lynda Brandon, had started at Dean Wood Manor in midMarch 2006. She had attended at the CSCI offices in Horwich on 8th May 2006 for an interview that formed part of the registration process. Some references had been outstanding at the time of the interview, so the registration had not been finalised. Mrs. Brandon is a qualified nurse. She has considerable experience in caring for people living in nursing homes and in managing staff. During interview, the Manager spoke about her aims for the home. These focussed on the residents and what they needed, preferred or wanted. She spoke about helping residents to have a better quality of life, and about staff delivering care in a respectful way that allowed residents to maintain their independence, privacy and dignity. Since starting in post, the Manager has held two staff meetings, which staff said were about sharing information. Meetings with residents and their relatives have yet to be arranged, but the Manager said she was looking at ways to arrange for advocates (such as Age Concern) to join in with the meetings. She felt this was particularly important for those residents who were no longer able to speak for themselves and for those who had little support from their families. The Manager said she very much wanted to encourage an open culture at Dean Wood Manor, where people felt able to speak up, make suggestions, and share their opinion. She saw meetings and social events as a way of bringing this about. Mimosa sends someone to assess the home on a monthly basis (known as Regulation 26 visits) and a copy of the report is sent to CSCI for information. The reports have not always reflected the service as observed by CSCI or by social services and health professionals. For example, one reported that all equipment was in working order, when the weighing scales were broken. Another said that there were no significant events on-going that related to the home, when the quality of care being provided to two residents was being investigated by the local authority. The monies held on behalf of three residents were checked and found to match the written record. Monies are kept on behalf of a good number of residents. Cheques presented by families for residents are cashed through the Mimosa account and immediately placed in the resident’s folder. Two issues arose from discussions with the Administrator. Firstly, the Administrator has the key to the safe, so when she is off site, residents cannot get access their money. While, according to the Administrator, this is never an issue because “residents don’t need anything”, the fact is that if they could not get to their own money if they wanted to. In this case, the resident’s right to control his or her own money was being compromised. Secondly, several residents did not have any Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 29 money kept on their behalf. Families paid for expenses, usually hairdressing, as and when they were asked to by the Administrator. Therefore, several residents were not receiving the weekly allowance to which they were entitled, and the home could not demonstrate that efforts had been made to secure the money for them. In this case, the home was failing to ensure the residents’ financial interests were being safeguarded. Staff supervision is not yet up and running, as the Manager would wish. She is trying to arrange supervision on a monthly basis during the next few months, and then reducing to once every two months. The Cook and the Housekeeper have carried out formal supervision sessions with their staff but the records were not available to look at. Two members of the care staff said two Senior Carers had supervised them, but no records were available to look at. Regular supervision of staff is key if they are to understand the main aims and values of the home, and if gaps in knowledge and individual limitations are to be identified. Since coming into post, the Manager has been reviewing the practice of the nursing staff. One nurse has been dismissed; one has been counselled about the quality of her work. With the pre-inspection materials, the Manager provided a list of maintenance and associated records, a number of which were checked at the site visit on 11th May, including bath hoist and lift servicing. The records showed that some staff had received training in safe working practices, and further training is being planned for the coming year. As noted at Standard 18, however, even those staff who have been trained recently were still using out-dated moving and handling techniques. As noted at Standard 26, food hygiene training will be important for those members of staff serving food, so that the risk of spreading infection is minimised. The accident records were looked at for March, April and May. As noted at Standard 18, there were ten instances where a resident had hit another, or where a resident had hit a member of staff. These had not been notified properly. An incident on 27th April 2006 stated that a resident had been drinking body lotion in the West Lounge. This had not been notified properly. This incident raises two issues. Firstly, if bedroom doors are closed and/or locked, where did the resident get the body lotion? At this inspection, talcum powder was seen in the bathrooms. If the resident got the body lotion from a bathroom, this is evidence to show that staff are not being diligent about putting away toiletries after use, and are posing a risk to the health and safety of residents. The second issue is, if it belonged to the resident, why had it not been properly stored in her bedroom? Had the incident been recorded and notified appropriately, staff would have been able to answer these questions and been able to demonstrate that they had put in measures to prevent a reoccurrence. As it was, there was no evidence to confirm action had been taken. Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X 3 X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 2 X 2 Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 31 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement Thorough pre-admission assessments must be consistently conducted, and records properly maintained. Care plans must be developed with the resident and/or supporter. If this is not possible, the reason should be recorded. TIMESCALE 30/04/06 NOT MET. Care plans must be complete and contain up-to-date information. Residents must be offered opportunities to engage in community activities. The complaints book must be available for examination. The telephone number of CSCI local office recorded on the procedure must be corrected. Staff must receive further training to ensure that residents are kept safe in the home and protected from harm. A copy of the action plan for the remedial work on the ground floor unit must be provided to DS0000064122.V288654.R01.S.doc Timescale for action 30/06/06 2. OP7 15 30/06/06 3. 4. 5. OP8 OP13 OP16 12 16 22 30/06/06 30/06/06 31/05/06 6. OP18 13 30/06/06 7. OP19 23 31/05/06 Dean Wood Manor Version 5.1 Page 32 8. 9. OP27 OP30 18 18 CSCI. The management of nursing care provided in the morning must be reviewed. A training schedule must be produced, showing courses and workshops that are appropriate to the work that staff at the home are to perform. A copy of the schedule must be provided to CSCI. Safeguards to protect the financial interests of residents must be improved. Residents’ funds must be available to them, including outside of office hours. All staff must receive regular, formal supervision. Records must be kept. TIMESCALE 30/04/06 NOT MET. Accidents must be reported on properly. Records must be kept to show that audits have been done, and appropriate action taken. 31/05/06 31/05/06 10. OP35 13 31/05/06 11. OP36 12 30/06/06 12. OP38 37 31/05/06 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. 4. 5. Refer to Standard OP7 OP8 OP12 OP28 OP29 Good Practice Recommendations Consideration should be given to keeping residents’ progress records separately from the main care plan. Consideration should be given to enable carers to make entries in the care plans. The recruitment of an Activities Co-ordinator should be given priority. Ways to achieve the minimum 50 of care staff with NVQ level 2 should be explored. The home should consider ways to implement and monitor DS0000064122.V288654.R01.S.doc Version 5.1 Page 33 Dean Wood Manor 6. OP33 its equal opportunities policy. Care should be taken to ensure that Regulation 26 reports are accurately completed. Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 34 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 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 Dean Wood Manor DS0000064122.V288654.R01.S.doc Version 5.1 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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