Inspection on 20/12/06 for Dean Wood Manor

This inspection was carried out on 20th December 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 11/05/06

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 HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Dean Wood Manor Spring Road Orrell Wigan Greater Manchester WN5 0JH Lead Inspector Kath Smethurst Unannounced Inspection 20th December 2006 08:30 X10029.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.V325092.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 and Care Homes for Adults 18 – 65*. 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.V325092.R01.S.doc Version 5.2 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 Healthcare Limited ** Post Vacant *** 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.V325092.R01.S.doc Version 5.2 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. 11th May 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. 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. Fees take account of the size of room the person occupies, as well as the extent of personal and/or nursing care they require. Fees range from £299.68 to £561.50 per week in the main part of the home and £650 to £675 per week in the Woodlands suite. Additional charges are made for hairdressing and transport. 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.V325092.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection at Dean Wood Manor took place over seven hours by two inspectors and included a site visit to the service. The home had not been told that the inspectors would visit. The inspectors looked at records the home holds on residents (care plans) and other records the home needs to keep to ensure the home is being run properly, for example activity records, menus, staff files and staff training records. The inspectors also looked around the building. To find out more information the inspectors spoke at length to a number of residents and a visitor. The operations manager, a nurse, three care staff, the housekeeper, maintenance person and administrator were spoken with. Staff were also watched as they went about their work. Comment cards, asking residents and relatives and other visitors to the home for example doctors and the district nurses what they thought about the home and the care provided were sent out prior to the inspection. Four relatives returned comment cards. All were satisfied with the care provided. What the service does well: From speaking to residents and visitors and the information relatives gave in the comment cards, it was clear that in the main they were happy with the care provided. One resident said, “It’s absolutely marvellous here I wouldn’t want to go anywhere else- the carers are very understanding, patient and caring- all the staff are excellent”, another resident described the home as a “Fantastic place”. One relative who returned a comment card wrote, “I have found the staff at Dean Wood Manor most kind and caring, there is a happy atmosphere in the home”. Staff appeared to enjoy being at work, one member of staff said, “I love working here” another, “I love the residents and there is a good staff team now”. Relatives said they could visit at any time and staff always made them feel welcome. The meals at the home are varied and well balanced. Residents who were able to comment said they liked the food. The home is clean and residents have a lot of space in which to move about. The home makes sure that before staff start work they are properly checked to make sure they are suitable to care for people living in the home. Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There were still some things needing to be put right in the home, which should have been done by June 2006. This in part is due to the home not having a Manager who was able to make plans for improvements. A new manager is due to start work in January 2007 and with clear leadership many of the things, which need to be improved, should be quickly sorted out. Assessments and care plans need to have more written information so that people reading them have a clear picture of what is important to them (likes, dislikes and hobbies). Staff need to make sure they weigh residents more often to make sure they have not lost weight. Plans need to be made to make sure there are more activities for residents both inside and outside the home. Staff need to have more training in order to better look after residents with mental health needs. Management need to look at the number of registered mental nurses working to make sure residents get the care they need. Staff need to make sure residents have some money to spend. One to one meetings with staff need to begin, to make sure staff are doing their jobs properly and to check if they have received the training they need. Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 7 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. Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Older People) & 2 (Adults 18-65). Standard 6 is not applicable to this home. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents were assessed prior to moving in, but in some instances social care needs had not been assessed resulting in there being insufficient information to guide staff. EVIDENCE: Since the last inspection the Woodlands Suite has opened and three residents have been admitted. The Woodlands suite accommodates adults less than 65 years of age with mental health needs. Qualified nurses undertake preadmission assessments. Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 10 The record for one of the residents was examined. A Social Services needs assessment was in place. The operations manager had also completed a full assessment of care needs. The assessment document was detailed and included information relating to physical and social care needs. Residents had contracts that made it clear what a persons responsibilities were when they were living in the Woodlands suite. One resident said that they were expected to keep their room tidy and help with their washing and cooking their meal. Records of the two most recently admitted residents over 65 were also examined. The assessment documents showed a full assessment of physical care needs had been completed. It was noted in one of the plans that the social profile section had not been completed. This information is important in order to ensure staff have the information they need to meet all needs. The percentage of the residents living in the home have specialised needs (dementia). Dean Wood Manor is not currently registered to provide dementia care. However some of the homes own literature states the home provides “Nursing and Residential Care for the Elderly Mentally Ill”. While some residents have lived in the home for a long time and have developed this condition, others with dementia have recently been admitted. Until the registration categories have been reviewed the home is advised not admit any further residents with dementia. This was discussed with the operations manager who agreed to provide further information in regard to the needs of people currently living at the home. Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 (Older People) & 6, 9, 16, 18, 19, 20 (Adults 18-65). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health and care needs were in the main met but care plans did not always provide clear guidance to staff in each area of need and did not cover all relevant areas. Residents were treated with dignity and respect and their right to privacy was upheld. Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 12 EVIDENCE: Four care plans were examined (1adult under 65 and 3 older people). The care plan for the resident under 65 had comprehensive information relating to personal, social and health care needs. Each area of risk had a separate record. Daily entries in care notes were completed and gave a good indication of the care provided and the residents well being. The plan was easy to read, had been regularly reviewed and set out clear guidance for staff to take when providing care. In regard to the plans for the residents over 65 staff said new care plans were in the process of being introduced Two plans in current use and one new style plan were examined. The care plans contained details of residents physical care needs. Risk assessments were in place in each of the files examined. They covered areas such as moving and handling and nutrition. All had been reviewed on a monthly basis. During previous inspections requirements have been made to ensure all aspects of health, personal and social care needs to be identified and planned for. This remains relevant. It was noted that some important and significant information had not been recorded. For example in one plan the social profile and activities record was blank while in another the section covering life history had not been completed. It was also noted there were some omissions in records of resident’s weights. In two of the plans there were no details of these residents being weighed. In one case it had been identified the resident was at high risk nutritionally. Whenever concerns are raised in respect of nutrition residents it is important to monitor weight regularly to ensure they don’t loose weight. Concerns were raised regarding the information contained in one of the new style care plans. An entry in the section relating to activities read, “X can’t take part in any activities in the home due to his mental status”. This is not appropriate as all individuals have the potential to take part in activities regardless of mental health needs. It was also noted in the same care plan the resident went to bed between 6.30pm and 9pm. This would seem early considering it was also identified the resident had problems with sleeping and had a disturbed sleeping pattern. These issues were discussed with the operations manager who offered assurances this would be addressed. Currently nursing staff are responsible for drawing up and maintaining the care plans. One of the nurses who completed training overseas said she had “problems with care plans” as “I have never had any training. We didn’t cover care plans. I would like to know more”. This is an area, which needs to be Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 13 addressed. Steps need to be taken to ensure all staff responsible for drawing up care plans are competent to do so. Care staff spoken with indicated they had no involvement in the care planning process with the exception of filling progress notes and weekly care sheet. This is unfortunate as the care staff spoken with were very knowledgeable about the residents needs and preferences. Discussion took place with the operations manager as to the possibility of care staff having more input in the care planning process so the knowledge they have is used more effectively. Residents able to comment said they were happy with the care provided. One resident said, “Its absolutely marvellous here I wouldn’t want to go anywhere else” a second, “Fantastic place. My health’s improving, it’s a fabulous place”. Relatives/visitors spoken with and those who returned comment cards were also satisfied with the care and support provided. One wrote, “X has been well looked after”, a second, “I am very pleased with the care and the service has been proficient”. In each of the care plans examined details of visits by health care professionals were recorded including doctor, chiropodist and dentist. Staff providing care and support in the Woodlands suite need to be mindful that residents should be offered an annual health check. Procedures are in place that described safe medication handling. Nursing staff are responsible for the administration of medication. One of the nursing staff spoken with said nursing staff had recently undertaken additional medication training. Currently none of the residents administer their medication. Discussion with residents indicated residents preferred to hand over responsibility to staff. The home uses a monitored dosage system supplied by a local pharmacy. The supplying pharmacist has recently undertaken an audit. A report had not been returned but staff advised no major areas of concern were highlighted. Accurate records were in place for the receipt of medication. It was noted that the home did not have a waste medication destruction system. Staff were aware of the legislation regarding the removal of waste medication and advised that arrangements had now been made with an authorised waste disposal company. Confirmation that this has been addressed must be forwarded to the CSCI (Commission for Social Care Inspection). A separate facility is provided for the storage of medication (on each unit). A lockable drug trolley is provided which when not in use are secured to the wall. A separate system for recording the administration of controlled drugs is in place and separate storage is provided. Medication storage was orderly with no evidence of overstocking. Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 14 The home uses a monitored dosage system supplied by a local pharmacist. Medication Administration Records (MAR) are supplied by the pharmacy except for example when additional medication is provided mid month. A sample of MAR sheets was examined and were found to be clear and up to date. During the last inspection it was noted the morning medication round (in the main part of the home) took some time to complete (3 hours). During this inspection this situation had improved somewhat in that the morning medication round was completed in half the time. Those residents who were able to comment and feedback in returned relative comment cards, indicated staff respected their privacy and dignity. During the inspection, staff were observed to treat residents with respect and consideration. Residents were observed to be dressed in clean well maintained clothing. Staff were observed knocking on doors before entering rooms and toilets. One resident said, “They always knock on my door and pop in to see if I want anything”, a second, “They always knock on my door”. Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 (Older People) & 12, 13, 15, 17 (Adults 18-65). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Provision of social activities and integration into community life needs to be improved to fully satisfy each resident’s social and recreational interests. Residents enjoyed the meals and food is nourishing and presented in a way that meets their needs. Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 16 EVIDENCE: The activity life skills co-ordinator (Woodlands suite) and activity co-ordinator (main part of the home) posts were vacant. The operations manager indicated that action was being taken to recruit staff for these vacancies. A programme of activities was seen on a notice board (main part of the home) and included crafts, board games, bingo and a knitting circle. There was no evidence that these activities were currently being organised for the residents. A carer said that staff sometimes organise a game when they have time. Some Christmas events had been arranged and a video, that one of the residents had taken, of the Christmas party was viewed. This showed residents enjoying an entertainer and dancing with staff support. A Christmas carol concert by the local church had also been arranged for the evening of the day of the inspection. One resident said that she sometimes ordered a taxi and went out to the shops. Other than a few residents going for a walk (weather permitting), there was no evidence of any community-based activities. A member of staff said that the residents with dementia did not go out. In regard to the residents living in the Woodlands suite activities varied depending on individual need. Currently there is no designated member of staff responsible for organising activities, but as previously mentioned the unit planned to employ a life skills organiser. Currently all three residents can go out into the community independently, although one resident said that they didn’t go out very often and usually sits in the lounge and watched TV. One resident was planning to start a college course in the New Year. A computer for residents use was in the lounge, this currently did not have internet access, this was being considered. On the day of the inspection residents living at the Woodlands suite went for a Christmas meal with staff to a local pub. A member of staff said that they would like to organise more community activities but funding could be a problem. Taxis had to be used and entrance fees to gyms and leisure centres restricted them using them. The operations manager advised issues surrounding transport were being considered and the provision of a car (for the Woodlands suite) was being considered. The range and frequency of activities in the home need to be improved upon. Steps need to be taken to ensure the programme of activities for both adults under and over 65 years of age is introduced in order to meet the needs of the residents both individually and as a group. During the visit staff were observed to be busy however but when their duties allowed they did spend some time socialising with residents. A friendly but respectful banter was seen between residents and staff. Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 17 It was evident from speaking with staff that they know a great deal about residents’ preferences. 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. Residents wishing to maintain their religious links were encouraged and enabled to do so. Resident’s religious beliefs are noted in care plans. The home has an open visiting policy. There are no restrictions on the time people visit and this was evident, with a visitor observed during the inspection. Further evidence was highlighted in the visitor’s book where entries showed residents friends and relatives visiting at different times during the day and the evening. The only time restrictions would be imposed is when requested by residents. Feedback from a relative spoken with and those who returned surveys indicated staff made them welcome when they visited. Residents who were able to comment expressed satisfaction with the care provided. Residents said they had choices where they wished to sit, when they got up, when they went to bed and what clothes they wore. A high percentage of residents (in the main part of the home) have memory and communication difficulties so were unable to confirm they were able to exercise choice. However observation of care practice indicated residents could make some choices in regard to the meals and where they spent their day. Resident’s rooms are personalised and residents are able to bring personal items in the home. As previously noted care records would benefit from having more personal detail (particularly due to residents’ communication difficulties). This would recognise the knowledge existing staff have and provide a guide for staff, regarding how each resident likes their care to be delivered. Four-week menus are in place. The menus were inspected and were found to be well balanced and varied. A choice is offered at every meal. The lunchtime meal in the West Dining Room (main part of the home) 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 pleasant atmosphere. Menus were displayed. On the day the meal consisted of chicken soup, liver and onions or homemade chicken pie, potatoes and cabbage. Staff were sensitive and discreet when providing assistance and no one was rushed. Second helpings were offered. Staff asked residents which option they preferred. Residents who commented expressed their satisfaction with the quality, quantity and choice of food provided. Tea, coffee or juice was available to drink. Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 18 In the East Dining Room, residents were more dependent upon staff for assistance. The soft/liquidised lunch was liver, peas and mash. All the elements of the meal were pureed separately in line with recommended practice. It was not however clear if these residents had been offered a choice. Residents not able to manage their own lunch were supported appropriately and given time, staff spoke to them explaining what the food was and checking if they were ready for some more. One area to consider is in regard to the way staff are deployed during mealtimes. It was noted that some residents had to wait for assistance with some asking when they were having their lunch. With this in mind a review of the number of staff providing support in this dining area should be undertaken. Residents living in the Woodlands suite prepare their own breakfast, tea and snacks. Currently lunch is provided from the main kitchen. However it is hoped the residents will soon begin to prepare all their meals. Residents shopped individually for their food. One resident said he was encouraged to prepare most of his meals. As previously mentioned on the day of the visit residents went out for lunch. Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 (Older People) & 22, 23 (Adults 18-65). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives knew who to go to with concerns and complaints and appropriate systems were in place to protect residents from abuse. 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. A copy was not displayed in the Woodlands suite. Steps need to be taken to address this. 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 (Commission for Social Care Inspection) since the last inspection. A system is in place to record any concerns or complaints. The three residents whose care was looked at (in the main part of the home) were unable to indicate if whether they could speak to staff about any problems. However other residents spoken with and relatives who returned Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 20 comment cards confirmed they knew whom to approach if they had a concern or complaint. One resident said, “If I wasn’t happy I would talk to the staff but I know how to complain I would put a complaint form in to the nurses stationit would get sorted out”. Discussion took place with staff regarding what they would do if a concern or complaint were made to them. One member of staff said, “If someone made a complaint I would try to deal with it, but if not talk to the senior” a second, “I would take the complaint to the sister in charge” a third, “Try to deal with it if not take to manager”. An investigation, under the Local Authority’s “Protection of Vulnerable Adults” procedure concerning three residents had been undertaken since the last inspection. The results of the investigation found no conclusive evidence to substantiate the allegations. Adult Protection and Prevention of Abuse policy are in place. The home ensures all staff completes a POVA and CRB (Protection of Vulnerable Adults Register/Criminal Records Bureau) before they commence work. Training in the signs and recognition of abuse is covered during induction and in NVQ (National Vocational Qualification) training. Mimosa have also organised 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. When staff were asked if they were aware of abuse procedures and what they would do if they suspected abuse, one member of staff said, “ The policy is in the office. I would report immediately” a second, “Policy in office I would always report”. 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. Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 (Older People) & 24, 30 (Adults 18-65). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the décor, fabric and furnishings within the home continues to improve providing residents with a clean, safe and well-maintained environment to live in. Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 22 EVIDENCE: The premises comprising Dean Wood Manor are based around an original grade II listed building that has been extended. People under and over 65 years of age live in the home in separate accommodation. The gardens surrounding the home are extensive and well presented. Since the last inspection the Woodlands Suite has opened providing accommodation for 7 adults (under 65) with mental health needs. A separate entrance is provided. Entry from the main part of the home is by keypad. Communal areas included a lounge with dining area and a kitchen. These areas are nicely decorated and are furnished with good quality furniture. There are seven bedrooms (one had en-suite facilities). Bedrooms varied in size, were well decorated and furnished adequately. It was noted that one of the resident’s bedroom doors was propped open with towels. When spoken with the resident said he did this as he didn’t have a key but would like one. Staff advised that keys had been ordered and were due to arrive shortly. Responsibility for cleaning/housework was shared between residents and staff. This appeared to be working well, as the unit was clean and tidy. In the main part of the home, work has continued on improving the environment. A programme of decoration was in place. Five bedrooms were completely redecorated and flooring, curtains and bedding replaced. The housekeeper said that residents were able to choose the colour scheme if the wished. All the bathrooms had been decorated since the last inspection and painted in warm colours to make the rooms less institutional. Pictures and mirrors had also been added. Some shortfalls were noted. The “link” area was very cold. Steps need to be taken to rectify this. The green vinyl flooring in the corridors in the main part of the home gives a somewhat institutional appearance and as such plans should be made to replace it. Some of the doors on the corridors had been painted in different colours in order to assist those residents with memory difficulties to find their bedrooms. Other signage would be useful to residents would include personalised plaques, or memory boxes, which would help with identification of bedrooms. While doors to bathrooms and toilets have signs to show what the function is, these signs need to be clearer and brighter for residents that are very confused in order to assist them in identifying the use of rooms. On the day of the visit the home was clean and odour control was good. The laundry was sited away from food preparation areas and was seen to be clean Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 23 and orderly. Sufficient and suitable equipment was provided. An OTEX system was used on the washing machines, which disinfected the laundry. Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 (Older People) & 32, 34, 35 (Adults 18-65). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall, the staffing numbers are sufficient, but the skill mix of staff needs to be reviewed to ensure care needs are not compromised. A staff development programme is in place but more specialist training is needed to ensure staff are equipped to meet the needs of all residents. Staff recruitment procedures are robust which ensures people living in the home are protected. EVIDENCE: On the day of the visit staffing in the main part of the home comprised of the nurse in charge, 2 senior care assistants, 3 care assistants, the cook, domestic staff, a laundry assistant and a maintenance person. In the main this appeared sufficient to meet the residents needs. As previously noted the number of staff supporting the more dependent residents at lunch should be reviewed. Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 25 During the visit staff were observed to respond speedily to requests made for assistance made by residents. They were also observed socialising with residents. It was also evident from staff comments they enjoyed working at the home. The Woodlands suite is staffed separately. Normally during the day there is one RMN (Registered Mental Nurse) and one care worker supporting three residents. On the day of the visit the RMN had reported sick, which left one carer on duty when the night carer finished work. This was not an issue on the day as all the residents were going out for a Christmas meal. However following the inspection the CSCI (Commission for Social Care Inspection) was contacted by a visiting community nurse. The nurse was concerned that there was only one carer on duty and no RMN cover in the home, particularly as one of the residents was displaying some challenging behaviour. The operations manager was contacted regarding this. He agreed to forward a contingency plan in the event of such incidents occurring again. Nevertheless a review is needed regarding the provision of RMN cover to ensure the skill mix of the staff on duty in the home meets the needs of residents. The files of three staff employed looked at showed all necessary recruitment checks had been undertaken. All contained: written application forms, 2 references, Criminal Records Bureau (CRB) check and verification of identification. Interview notes were on each individual file. Each member of staff had completed an equal opportunities monitoring form. The operations manager advised that Mimosa had employed a company (Medex Training) to provide all mandatory training in the coming year. Mimosa is also in the process of introducing on line training courses for staff to complete. The staff training schedule is kept on computer and was made available for the inspectors to look at. In addition three individual staff training records were examined. There was evidence that new staff undertake induction training that meets the National Training Organisation (NTO) specifications following which foundation training is undertaken. Staff had undertaken a range of training. Courses completed by staff including health and safety, food hygiene, moving and handling, fire safety, life support and dementia care. Staff spoken with were in the main satisfied with the training provided. They also confirmed they had completed a lot of courses in the past year. It was also pleasing to note that training was also open to domestic staff. The housekeeper said, “The domestics and I can go on all training”. While the range and frequency of training has improved staff spoken with identified training courses they felt would be beneficial. This included care of the dying, challenging behaviour and additional dementia care training. Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 26 Another area, which needs to be considered, relates to the provision of service specific training for support staff working on the Woodlands suite. One of the support staff confirmed she had completed a two day mental health course but so far had not undertaken any further training. This is an area for future development. For example training covering specific mental health conditions and challenging behaviour. Since the last inspection progress has been made in regard to the provision of NVQ (National Vocational Training) for staff. The percentage of staff in receipt on NVQ (National Vocational Qualification) level 2 now exceeds 50 with 65 of staff in receipt of the award. Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36,38 (Older People) & 37, 39, 42 (Adults 18-65). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 28 The absence of a permanent manager has impacted on some aspects of service provision, particularly with regard to record keeping and quality assurance. EVIDENCE: Since the last inspection the registered manager has resigned. The company have had some difficulties in finding a suitable person to fill the position. In the absence of a manager the operations manager has been providing support at the home. A new manager has now been recruited and is due commence employment in January 2007. There are still a number of requirements, which need to be addressed. However the operations manager is confident the new manager has the experience to ensure standards are improved. Senior managers in the organisation need to ensure that the new manager submits a registration application with the CSCI quickly. Internal and external quality systems are in place such as staff meetings. Monthly meetings take place and are minuted. Formal meetings with residents are not yet held. Staff working on the Woodlands suite advised resident meetings were in the process of being arranged. Company representatives visit the home on a monthly basis to audit records and speak to residents and staff. A written report is then produced of the findings, which is then forwarded to the CSCI. In addition external audits are also completed by another area manager and include all areas of the running of the home e.g. grounds and health and safety. Full policy and procedures for the Mimosa group were seen in three files in the office these were comprehensive and included pro-formas for managers to complete for example response letters. Dean Wood Manor also takes part in an external audit arranged by Wigan Social Services. The Contracts Section of Wigan Social Services Department, in conjunction with a company called RDB Limited, has undertaken a voluntary star rating of homes in Wigan. As part of the rating process an annual audit of quality is undertaken. This includes consultation with service users and staff. The financial records for three residents were requested. Two of the residents did not have any money kept on their behalf. The administrator advised that the majority of families paid for expenses when requested. This arrangement meant some residents were not receiving the weekly allowance to which they were entitled. This issue was also highlighted in the last inspection. Steps need should be taken to address this issue to ensure resident’s financial interests are safeguarded and they have access to funds. The money for the one resident checked was seen to correspond to the amount recorded. Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 29 As identified in the last inspection the administrator had a key for the safe. As a consequence when she was off site residents could not have access to their money. The administrator said that some petty cash is kept in the treatment room if residents need any money over weekends and that this is put right on a Monday morning. It is fully recognised the policy of only designated staff having keys to the safe is to ensure financial interests are safeguarded, nevertheless this could lead to residents not having access to their monies. Therefore some consideration needs to be given to making alternative arrangements when these staff are not working. Staff are supervised by the trained nurses and senior care staff on a day-today basis. There is no written evidence of staff having received any formalised supervision or of any appraisals having taken place. Staff spoken with also confirmed supervision did not take place. One member of staff said, “I’ve never had supervision”, a second “Not had any”. Discussion with the area manager indicated this is in the process of being addressed. A supervision matrix has been compiled with details of the supervisee, supervisor and the date to be undertaken. While this is a positive initiative supervision sessions need to be carried out at the required frequency to ensure staff receive the support they need to do their jobs properly. The pre-inspection questionnaire provided details of maintenance checks undertaken by external contractors. A number were checked on site and were found to be satisfactory. A file is kept that staff record any faults or areas needing repair. The maintenance person marks these off as they are completed or if he can’t do them he reports this to the office. All the records were well kept and easily read. The maintenance person completed PAT testing on a twelve-month cycle. He had received training and now went to another home to test their portable appliances. The water had been tested for legionella in April 2006 and all water outlets tested by zone on a bi-monthly basis (baths monthly). All fire equipment is externally serviced. The maintenance person records the testing of the fire alarms weekly, he said that he is going to start recording who is on duty when the tests take place, as he does not know if everyone knows what to do or what it sounds like. Fire training is part of induction and the maintenance person is involved with all staffs induction. He said that fire training is now part of a rolling programme of training that staff are recalled to attend 12 monthly. A fire risk assessment is in place. Accident records between October 2006 and December 2006 were examined. It was noted that the majority of accidents occurred in the early morning. For example on the 23/11/06, 24/11/06, 25/11/06 and 27/11/06 an accident report was completed which recorded all the incidents occurred at 7am. Additionally all accidents concerned residents being found on the floor. This Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 30 pattern had not been identified or investigated. This was discussed with the operations manager who offered assurances this would be looked into. Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 31 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 X 2 X 3 2 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 2 34 X 35 2 36 1 37 X 38 3 Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes 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 (1) (a) Requirement To ensure all care needs are identified and they receive the care they need thorough assessments must be completed and cover all care needs identified in Standard 3. Timescale 30/06/07 not met. To ensure residents receive the care they need care plans must include clear guidance to staff as to the action they should take to meet needs in each area of their care. Timescale 30/06/06 not met. To ensure resident’s health and wellbeing is not compromised staff must ensure their weight is regularly monitored. A system for managing waste medication must be introduced. To ensure resident’s lead a stimulating life and their social care needs are met a programme of activities must be formulated and implemented. DS0000064122.V325092.R01.S.doc Timescale for action 15/02/07 2 OP7 15 (1) 01/03/07 3 OP8 14 (2) (a) 31/01/07 4 5 OP9 OP12 13 16 (n) 15/02/07 01/03/07 Dean Wood Manor Version 5.2 Page 33 6 YA14 16 (n) To ensure residents lead a stimulating life and their social care needs are met a programme of activities must be formulated and implemented which meets the needs of all residents including young adults. 01/03/07 7 OP19 23 (2) (p) The temperature in the “link” 15/02/07 area must be improved to ensure it is maintained at 21 degrees centigrade so the area is comfortable for residents to use. To ensure the staff on duty have the skills and knowledge to care for residents with mental health needs a review of RMN (Registered Mental Nurse) cover must be undertaken. To ensure staff receive the support and guidance they need to provide a good standard of care for residents all staff must receive regular, formal supervision. Timescale 30/04/06 and 30/06/06 not met. 01/03/07 8 YA32 18 (1) (a) 9. OP36 18 (2) (a) 01/03/07 Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 34 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP8 Good Practice Recommendations To ensure the knowledge care staff have about residents care needs and preferences is documented consideration should be given to increasing their involvement in the formulation and maintenance of care plans. The recruitment of an Activities Co-ordinator should be given priority in order to ensure the provision of social activities for residents is increased. The recruitment of a life skills co-ordinator should be given priority in order to ensure the provision of social activities for residents is increased. Work should continue to improve signage (in the main part of the home) to assist residents with memory difficulties find their way around the home. In order to make the home more homely for residents plans should be made to replace the vinyl flooring in the corridors (main part of the home). The deployment of staff at meal times in the east dining room should be reviewed to ensure residents are assisted in a timely manner. In order to equip staff with the skills and knowledge they need to care for residents with mental health needs, more training in mental health conditions and challenging DS0000064122.V325092.R01.S.doc Version 5.2 Page 35 2. OP12 3 YA14 4 OP19 5 OP19 7 OP27 8 YA33 Dean Wood Manor behaviour should be provided for care staff working on the Woodlands suite. 9 YA39 To ensure there is evidence residents have been consulted about the running of the home, as planned resident’s meetings should be introduced. Staff should take action to ensure they have their funds available to them, including outside of office hours. 10 OP35 Dean Wood Manor DS0000064122.V325092.R01.S.doc Version 5.2 Page 36 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: 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. 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