Inspection on 30/06/09 for WCS - Woodside

This inspection was carried out on 30th June 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

WCS - Woodside 07/07/07

WCS - Woodside 12/09/06

WCS - Woodside 01/03/06

WCS - Woodside 11/07/05

WCS - Woodside 02/03/05

WCS - Woodside 18/06/04

WCS - Woodside 03/03/04

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Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: WCS - Woodside Spinney Hill Warwick Warwickshire CV34 5SP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sandra Wade     Date: 3 0 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: WCS - Woodside Spinney Hill Warwick Warwickshire CV34 5SP 01926492508 01926498848 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Warwickshire Home Care Services Limited care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 38 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 38, Old age, not falling within any other category (OP) 38 Date of last inspection Brief description of the care home Woodside care home is managed by Warwickshire Care Services Ltd who has managed the home since it transferred, along with a number of other homes providing care, from Warwickshire County Council in 1992. Warwickshire Care Services Ltd is a voluntary sector organisation. The home is situated on the outskirts of Warwick, within a housing estate. Close by is a small parade of shops, including a post office, newsagent and general store. There is also a local pub. Both Warwick and Leamington Spas main shopping centres are within a 5 to 10 minute bus journey. The bus stop is Care Homes for Older People Page 4 of 36 Over 65 0 38 38 0 Brief description of the care home directly outside the home. Woodside is registered as a care home providing personal care to 38 older people; this includes a registration to care for older people with dementia. The home has a dementia unit on the ground floor. The first and second floors can accommodate 15 people. All rooms are single; there are no en suite rooms. The home can offer one respite place and regularly looks after up to four additional residents for day care above its 38 place registration. Each floor has a lounge and dining area which have been fitted with kitchenettes. On each floor there is also one bathroom and there is a shower room provided on the first and second floors. A passenger lift is available so that people can access the upper floors, there are also ramps leading to outside areas to ensure people can easily access all areas of the home. Woodside is a non-smoking home and there is only provision to smoke outside the building. Woodside has a garden area to the rear and a secure garden leading off the dementia care unit. Parking spaces are available to the rear of the home but these are limited. The fees at the time of this inspection were not published and therefore the home would need to be approached directly to establish these. There are additional charges for hairdressing, newspapers, personal toiletries and clothing. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. We carried out this inspection between 8.15am and 6.45pm. The last key inspection to the home took place on 7 July 2007. Three people who were staying at the home were case tracked. The case tracking process involves establishing an individuals experience of staying at the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Due to surveys being requested from the service for their Annual Service Review, these Care Homes for Older People Page 6 of 36 were not requested again for this inspection. Records examined during this inspection, in addition to care records, included staff training records, staff duty rotas, kitchen records, accident records, financial receipts, complaint records, quality monitoring records and medication records. People who live in the home were observed in the lounge and dining areas to ascertain what daily life in the home is like. A brief tour of the home was undertaken to view specific areas and establish the layout and decor of the home. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? There are various systems in place to monitor the quality of care and services people receive. This includes a newly formed Committee called Friends of Woodside made up of volunteers who aim to help with fundraising to improve the social aspect of care that people receive such as increased and improved social activities. More staff have been employed and successfully retained reducing the need for agency staff so that people receive more consistent and effective care. More laundry staff have been employed to help improve this service. A review of social activities has been undertaken resulting in a more varied and increased number of social activities being undertaken. Improvements have been made to the environment including the creation of a more open environment in the dementia care unit. Some of the bedrooms have also been redecorated. Care Homes for Older People Page 8 of 36 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 36 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are provided with some information about the home to help them make a decision to stay and an assessment of their needs is undertaken to ensure the home can meet these needs. Evidence: A large print Statement of Purpose/Service User Guide is made available and contains information about the care and services provided. The manager confirmed that this is given out to prospective residents either before or when they come to stay. It was evident that some of the information needed to be updated and it also did not contain a statement of Terms and Conditions for the home or the summary of our inspection report. The manager agreed to review this document and update this as appropriate so that people have all the information they need to help them make a decision to stay. Prior to people living at the home the manager explained that she arranges to Care Homes for Older People Page 11 of 36 Evidence: undertake an assessment of their needs. Care files viewed for new people to the home contained a copy of the assessment carried out. A member of staff said that people who may like to live at the home can visit and have a look around and stay for a day or trial visit prior to making a decision to stay. Arrangements are also made for copies of assessments completed by the Social Worker to be obtained. This is to ensure that staff at the home are clear about the needs of people and that they can meet these needs before they agree to accept the placement. People spoken to during this inspection were not able to comment on the admission process due to not being able to recall the details of this. Care Homes for Older People Page 12 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are being further developed to ensure the care needs of people living in the home are identified and met. Some attention to medication management is required to ensure people receive their medication as prescribed to meet their health care needs. Evidence: The home provides care and support for both older people and people with a diagnosis of dementia. The Annual Quality Assurance Assessment completed by the home in April 2009 and forwarded to us states some details about how people with dementia are supported. This includes each person having a picture in their room of the carer who has key responsibility for their care known as the key worker to help people remember who this is. The manager has also stated that they routinely use Advocates who can act as representatives for those people who need or wish for this service. The Care Planning system includes life histories which can be used to establish peoples needs and help staff in maintaining some of the persons previous routines. Care Homes for Older People Page 13 of 36 Evidence: People living in the home also have access to a pictorial social activity plan to help them decide if they want to be involved in specific social activities being provided. The home has a specific dementia unit on the ground floor but people with dementia can also occupy other areas of the home. Three people who live at the home were case tracked. This process includes reviewing all records relating to the person as well as speaking to them, their carers and any visitors they may have where this is possible and viewing their living space to determine what it is like for the person to live in the home. People who come to live at the home receive a comprehensive assessment of their needs so that staff support required can be established to meet these needs. It was evident from care files viewed that information collected as part of the assessment had been transferred into the care plans. There was good information about individual interests and preferences and their daily lives so that these could be maintained whilst living at the home. Information also included a life history in so that staff could consider this when planning their care. Standardised records are used whereby staff indicate by ticking appropriate boxes what aspects of support each person requires. Where there are specific needs there is the option to record this separately. Should people develop short term problems such as a urinary infection there are appropriate forms in place for staff to record these and the staff actions required to address them. The care plan for one person identified they were at risk of developing pressure sores. A body chart had been developed showing the locations of the body where these were likely to develop and instructing staff to monitor these areas. Staff had been instructed to apply cream to one of the pressure areas on a daily basis to prevent damage to the skin. Medication charts showed that a cream had been prescribed to apply to pressure areas although it was not clear on this record how often this should be applied. The person concerned was noted to be thin and frail looking and was hard of hearing which made it difficult to communicate with them. Staff said that they did manage to understand the person though hand gestures but they did have pictures they could use if needed. Staff confirmed that the person was diabetic and that food and fluid charts were being completed to monitor their intake. Charts viewed had not been completed each day to show the person was receiving sufficient intake of food and fluids and it was also not always clear what amount of the food and fluid listed had Care Homes for Older People Page 14 of 36 Evidence: been taken. For example the chart indicated that the person had been given tea and orange drinks but it was not clear how much they had taken. Despite this, weight records seen showed the person had slightly increased in weight over the last three weeks. Following discussion with the manager, she advised that the food and fluid charts had been revised to ensure the exact amount of fluid taken can be recorded and also a more precise record can be kept of food taken. The new forms for fluid intake were seen which will help staff identify that the person has received sufficient fluid to maintain their health. Systems for monitoring weight had also been reviewed and the manager advised these were being kept in a file where staff could easily record and monitor these weekly. There was no specific care plan around the management of their diabetes although there were good records in the file explaining what diabetes is and the symptoms associated with this. It was not clear what staff should do if the person should display some of these symptoms or what the acceptable range of blood sugar readings were for this person. Staff explained that the district nurse came into the home to monitor the blood sugar levels and that tablets were being given to control the condition. They also explained that the nurse had records in regards to this. The manager agreed to develop their own care plan explaining how the diabetes was being managed to ensure staff were clear on their responsibilities in monitoring this. One person spoken to said they were able to do most things for themselves, their care records confirmed this. Staff spoken to about this person were able to advise where support was required such as bathing but they also explained a stomach problem and the symptoms associated with this. Staff were able to explain how they were managing these symptoms but records did not give clear instructions to staff on managing this to ensure a consistent approach by all staff. Records were available in each file to record any medical health care needs such as visits from GPs, community nurses or chiropodists although these had not always been completed for all professionals. Daily records had been completed by staff with any problems being identified although sometimes it was not evident that problems identified had been transferred to care plans. For example in one daily record it is reported that the GP had confirmed a urinary infection but there was no care plan stating this. This means that unless staff regularly read all of the information in the daily records they could miss this information which could result in an oversight in care. Care Homes for Older People Page 15 of 36 Evidence: People living in the home and their relatives were positive about the care provided. One person said staff are very good, a relative said I have a brilliant relationship with the home, relatives are part of the care package another said residents are well cared for and well looked after, nothing is too much trouble. A review of medication was undertaken. It was evident that the medication that had been provided in the monitored dosage system (where tablets are stored in individual pockets for dispensing each day) was being managed appropriately. Medication provided in separate boxes was not managed well. The amount of some medications such as Paracetamol had not been carried forward onto the current medication charts so it was not clear how many tablets or capsules there were to start with. This made it difficult to audit that the amount received, given and remaining for the person was correct. There were some gaps on the medication records so it was not clear if the medication had been given or not. This included an inhaler prescribed for breathing problems twice a day which records showed had not been given consistently. For some medications there were more tablets left than there should have been when counting the amount received, given and remaining. This suggests staff have signed records when the medication has not been given. Temazapam that had been prescribed had ran out on 7 June 09 and on 8 June 09 staff had recorded the code N which means offered but not required. Staff could not have offered this as there were none to give, the correct code had not been used to indicate none were available. Ibuprofen gel had been prescribed to be applied three times a day for one person, this was to relieve muscle pain. The medication chart showed that this was not being applied as prescribed. The same applied to Movicol satchets which had been prescribed One, twice a day, records showed they were not being given twice a day. Medication prescribed for Parkinson Disease had not been given as prescribed. In one box there were several tablets more than there should have been and in another box of the same medication with a different dosage there were several less than there should have been suggesting the correct dosages had not been given. If this medication is not given as prescribed it can impact on the health of the person as their symptoms will not be managed effectively. Care Homes for Older People Page 16 of 36 Evidence: Cavilon cream had been prescribed as required but there was no indication on the Medication Administration Record (MAR) how often it had been agreed that staff should apply this to ensure a consistent approach to care. Appropriate systems were in place for the storage of all medications including controlled drugs. There was also a register for staff to record any controlled drugs in use and this had been completed appropriately. Records contained instructions to give medications Morning, Noon, Evening and Bedtime as opposed to specific times. One person said that the morning medications can take up to 11am to administer. There needs to be a sufficient gap between medication rounds to ensure people receive dosages within appropriate timescales. The manager said that morning medications should be completed by 8.30am. This will need to be reviewed to ensure all staff are clear on the timings when medication is given. The privacy and dignity of people living in the home was seen to be respected with the exception of two incidents observed and issues identified regarding laundry management. Staff were observed to knock doors before entering a persons room and people spoken to confirmed this happened. People were in clean clothing and were appropriately dressed for the time of year. There were two incidents observed where people were in a state of undress, in one case a person was looking for the toilet late morning in their night clothes which they were lifting up to their waist. In another, the person was in a bathroom as they were going to have a shower but they were also awaiting the use of the toilet which was outside the door, the shower room door was open while they were waiting with a member of staff. The member of staff did however attempt to close the door when observed by the inspector. There were some concerns raised about items of clothing not being appropriately ironed and wrong clothing being in wardrobes. Care Homes for Older People Page 17 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have access to a range of social activities and have a choice of meals on a daily basis to meet their health and social care needs. Evidence: The care plans of each person living at the home were found to contain information on their interests and hobbies. The home employs two Activity Organisers so that people living in the home have access to a range of social activities on a regular basis. Activity schedules are put on display each week so that people know what activities are to take place. Resident meetings are held on a monthly basis where social activities are discussed so that these can be arranged in accordance with their wishes. Schedules seen showed that activities included coffee mornings, motivation, bingo, raffles, knitting, puzzles, potting plants, sensory (activities that involve the use of smell, touch, sight) and making Easter Bonnets. The Care Manager explained that people pay a small fee to play bingo but everybody gets a prize and they therefore enjoy playing. Care Homes for Older People Page 18 of 36 Evidence: Outside entertainers also come into the home and outside visits are arranged when possible. A visitor spoken to about their relative said there seems to be lots of activities for them, they take her to the pub for half a pint, they are ever so good. Another visitor whose relative was limited in what they could do explained that staff would take them to the lounge to listen to music or play quizzes and watch picture shows. A person living the home said they had played bingo a few times and said that the activities are not my cup of tea really. They said they would like to go on an outside visit although they could not confirm what type of visit. Opportunities for people to continue to practice their chosen religions were provided including Holy Communion that was held at the Home each fortnight and a monthly church service. Visitors were observed to freely come and go throughout the inspection and they were made to feel welcome by staff. There are no set routines at the home such as all people having to be up for a specific time for breakfast. People were seen to get up at various different times throughout the morning. Care plans seen confirmed the preferred times for people to get up and go to bed and staff spoken to were able to confirm these times. On arrival to the home care staff were observed to ask those people who had just got up what they would like for breakfast. A cooked breakfast was offered. Staff confirmed menus are printed each week and those viewed showed two choices of main meal as well as a hot choice and sandwiches at tea time. It was not clear from menus seen what drinks and snacks are available each day so that people living in home know what is available to them. At lunch time the main meal was leek and potato soup followed by turkey with mashed potato or boiled potatoes, green beans and cabbage. The desert was a sponge pudding with custard which looked hot and appetising. Meals are taken to each unit in a hot trolley and are served by staff, good sized portions were seen. Those people spoken to about the food said it was good. A visitor said of their relative she does not eat a lot but the food is good, you can have as much as you want. Another visitor explained that their relative was now unable to eat meals due to a medical condition but the meals were very good. At lunch time the mealtime was observed in the dining room where people have a diagnosis of dementia. Staff were seen to assist one person to eat and prompted and encouraged others to eat when necessary. Care Homes for Older People Page 19 of 36 Evidence: The dining room had been arranged so that some people could sit at tables alone if they wished. It was clear the seating arrangements had been done to suit the needs of each individual. Staff spoken to confirmed this. Care Homes for Older People Page 20 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate procedures are in place to manage any complaints or allegations of abuse to help protect people living in the home. Evidence: Since the last visit we have not received any complaints, concerns or allegations about the service provided at the home. Several complaints had been received by the home and copies of letters and replies were available in a complaints folder. Issues raised included poor hygiene, laundry not being managed well with there being missing items and wrong items returned and insufficient choices of food. There was evidence that those responded to had been investigated in a comprehensive and timely manner and that actions had been taken to address the issues raised. There were some instances where responses were not evident. The manager said that all complaints had been responded to except two and she would be taking action to address these. The manager also said that she would be developing a complaints register so that it would be easier to see the number and type of complaints received and responded to. A complaints procedure was in place although the copy in the Service User Guide and on the back of a bedroom door was out of date. The manager agreed to ensure the updated procedure was made available. A visitor to the home said that if they had any concerns they would go directly to the member of staff on duty and if this was not resolved to their satisfaction they would Care Homes for Older People Page 21 of 36 Evidence: speak to the manager. Another visitor said that when they had raised an issue they were not happy about it was dealt with straight away. Systems are in place to manage any allegations of abuse and these include a policy and procedure for staff to follow should this be observed or identified. Staff spoken to were aware of their reponsibilities for reporting this and for ensuring the safety of any person in the home who may be affected. Care Homes for Older People Page 22 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely environment which is generally well maintained and is subject to ongoing refurbishment to ensure this remains safe and comfortable for people to live in. Evidence: The environment is generally well maintained with each floor having a communal lounge and dining room area with a kitchenette to prepare snacks and drinks. Communal toilets are close by. The lounge areas had comfortable sofas and easy chairs as well as high backed chairs for comfort. Each had a television and music system and small tables for drinks. Some of the dining/lounge areas have wood panelled flooring but others have carpet. Some of the carpeted areas looked in need of a deep clean or replacement. The manager said that new flooring and carpets were on order as it had been recognised these needed to be changed. Since the last inspection the dementia care unit has been opened up more so that people have more freedom and can enjoy the environment better. Aids and adaptations were available for people living in the home in order to promote their independence including hand rails in corridors, raised toilet seats, grab rails Care Homes for Older People Page 23 of 36 Evidence: around toilets, wheelchairs, walking aids and four mechanical hoists for the safe moving and handling of people. Pressure mats were also noted to be in place in some bedrooms in order to alert staff when people get out of bed and possibly leave their rooms. Staff felt the use of these mats helped in preventing people from falling. It was not evident the use of these mats had been agreed with the people using them or with members of their family as appropriate. The use of these mats can be seen as an evasion of the persons privacy. It was evident that people are given the opportunity to have their own key to their room. One person was observed to have their own key and chose to keep their room locked. This demonstrates their independence was being considered and supported where appropriate. Bedrooms were noted to be of varying sizes and a nurse call facility is provided in each bedroom so that people can summon assistance if required. There are no rooms within the home with an ensuite facility but commodes were seen to be provided in rooms where these have been requested. Bedrooms were tidy and had been made homely to suit each individual with personal possessions on display. Since the last inspection some of the rooms have been redecorated. It was evident that the person occupying one of these rooms had been involved in choosing the decor which included part stencilling on the walls. There was one bedroom noted to have an unpleasant odour. There were also areas of the home where there was an underlying odour as well as areas that were odour free. One person commented that there had been two occasions when they had raised issues about the cleanliness of the room but since these issues had been raised there had been no further problems. The Housekeeper confirmed that they have a carpet cleaner to ensure carpets are regularly cleaned but this had recently broken and a new one was on order. They were also managing with one less cleaner due to sickness although they were covering shifts with other staff where possible. There are pleasant gardens which are secure and suitable for wheelchair users. The manager said that people living in the home had been potting plants and had grown some of their own plants for the garden. The home was also in the process of fundraising for a Summer house. Facilities available for the management of the laundry include two washing machines and one drier. There is a handwash sink for staff to wash their hands and system in Care Homes for Older People Page 24 of 36 Evidence: place for managing any heavily soiled items to help prevent any spread of infection. New laundry assistants had recently been employed to help provide an improved laundry service to people living in the home. Care Homes for Older People Page 25 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive support from adequate numbers of staff who are subject to ongoing training to ensure they provide safe and suitable care to people living in the home. Evidence: Since the last inspection the management arrangements for the home have changed on more than one occasion. A new manager is now in post and has been working at the home since January 2009. She advised that she is being supported by a care manager and both work in a supernumerary capacity. They share the responsibility of working at weekends and tend to work alternate weekends to ensure the home is appropriately covered. The manager advised that the usual complement of staff consists of six care assistants during the day and three at night. Duty rotas seen confirmed these numbers are being achieved. During the inspection staff were observed to be busy throughout the day attending to people. Staff interacted with people in a friendly and approachable manner and also made visitors to the home feel welcome. People spoken to were positive about the staff working in the home. One person said staff are very good a relative said I have a brilliant relationship with the home......nothing is too much trouble, another stated staff are wonderful they are so kind. Care Homes for Older People Page 26 of 36 Evidence: People spoken to felt there were enough staff on duty to meet their needs if all staff rostered to work were on duty but if the home were short staffed due to sickness or absence this did make a difference. The manager acknowledged this but advised staffing arrangements had been more stable over recent weeks and they were hoping to maintain this. If the Registered Manager or Care Manager are absent from the home they provide on-call support as required to the person left in charge home. Staff spoken to said that they felt the staffing numbers were sufficient to care for the people living in the home but they do get occasions when people are off sick. They stated that the manager in these instances makes sure there are enough staff on duty. A new member of staff explained the induction training process they had completed and confirmed that they felt the training they had received was sufficient before working as part of the caring team. The induction training records showed that the training provided is comprehensive and includes the Skills for Care common induction standards. This training requires staff to complete training to set standards over a period of weeks so that they can build up their competencies to care for people safely. Staff training records are kept on individual files so it was not possible to check that all staff were fully up-to-date with their training. The manager did however state that out of 42 staff there were 28 with a National Vocational Qualification (NVQ) in Care and further staff were completing this. This exceeds our standard for 50 of staff to achieve this. She also stated that all staff had completed moving and handling training in the last 12 months and some staff were doing their food hygiene training now and emergency procedure training was still to be done. A member of staff spoken to said they had completed moving and handling training, fire training and had been given a date of the week following the inspection to complete food hygiene training. Staff records were viewed to confirm recruitment practices carried out. It was evident that criminal record checks had been carried out before the staff commenced working at the home as required. Action had also been taken to obtain two written references for each person although one person had only one reference on their file. The Care Homes for Older People Page 27 of 36 Evidence: manager said that this had been requested and received but it had not been put on the file and was locked away in the administrators office. Care Homes for Older People Page 28 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to monitor the quality of the service to help ensure the home is run in the best interests of the people living there. Health and safety checks are undertaken to reduce any risks of harm to people living in the home. Evidence: The new manager in post has worked at the home since January 2009. She has worked in residential care for 23 years and has worked in a management role since 1996. She has attained numerous qualifications including the Registered Managers Award, a Diploma in Welfare Studies, is a Manual Handling Assessor and Trainer and also a qualified First Aider. The manager also is working towards achieving a masters degree in Clinical Neuropsychiatry after having attained a Diploma for this. It was clear that since the manager has been in post she has made changes to the way care and services are provided to help raise the standards within the home. The manager had completed an Annual Review of the service which had identified areas where she would like to make improvements. These included more activities for Care Homes for Older People Page 29 of 36 Evidence: people, better laundry systems, a cleaner and brighter environment. It was evident from this inspection that some of these changes had already been completed and that further changes were planned. The manager had helped to instigate a Friends of Woodside Committee. This is basically a group of volunteers all of which have relatives or friends residing at the home. They aim to raise funds for extra social activities such as day trips, in house activities and entertainment. Meeting notes seen confirmed that fundraising ideas included a car boot sale and Summer Fete. Representatives had been identified from each floor in the home so that people living in the home could contribute their ideas and opinions for discussion and consideration by the Committee. Meetings had been held in May and June 09 and a further one had been planned for July 09. Residents are involved in the meetings that are held on a monthly basis and there are also relative meetings that are held 3 monthly and staff meetings. Notes of meetings are kept so that it is clear what was discussed although action points were not always clear. Quality monitoring of the care and services provided includes staff discussing specific issues with people on a monthly basis . Staff ask people in the home a question each month about an aspect of the care or service they receive. They are asked to give a one to ten scoring in relation to what they are being asked. For example one of the questions asked was about the times they liked to get up and whether this was being respected. Other questions were around the management of medication and social activities. Staff had then recorded the answers so that the manager could view these and take any appropriate actions. It was not evident that people receive a report showing outcomes of any quality monitoring surveys undertaken so that they know what people feel about the care and services they receive. This also allows people to see any proposed actions to be taken by the home in response to issues raised. Both the people living in the home and visitors were complimentary of the care and services provided. One person said that staff would knock the door each morning and bring them a cup of tea, they commented they were happy in the home but would like to go out more. A visitor said that staff kept them informed on what was going on in the home in relation to the care of their relative and said they do look after them they are very good. Another visitor explained the medical conditions of their relative and described how supportive and sensitive staff were in regards to how they provided care to their relative. This person also described how they felt at ease to raise any Care Homes for Older People Page 30 of 36 Evidence: concern or issue with staff without fear of any reprisals. The home can accommodate the safe storage of small amounts of money belonging to people. The Administrator manages any monies received and the records relating to any transactions undertaken but on the day of inspection the Administrator was not available. Receipts were seen to confirm money transactions undertaken but as a full audit of the records and monies available could not be completed, it was not possible to confirm this aspect of the service was being managed as required. It was evident that appropriate health and safety checks are being carried out at the home. Records were seen to confirm gas, electrical checks and hoist servicing and all were within appropriate timescales. Hot water temperatures were being monitored and recorded to ensure these were not too high to scald people. A fire risk assessment had been completed to help ensure any fire risks are managed safely within the home. A legionella water check had been carried out in 2007 and it was not clear when this was next due. The manager agreed to follow this up to ensure water services continue to be well managed within the home. The kitchen was viewed and was clean and organised. Temperature records were viewed for the fridges and freezers and these showed they were within the recommended temperatures for the safe storage of food. Some dried produce had not been appropriately sealed after using such as oats, sugar and cakes to make sure they remained fresh and there was no risk of insect contamination. This was brought to the attention of staff to address. All accidents involving people living in the home are investigated by the manager and written records regarding these are kept detailing any actions taken. It was not evident that some of the accidents involving medical intervention had been reported to us as required. The manager agreed to review this practice to make sure this happens. Accidents audits had been carried out to identify any trends and reduce the risk of further accidents of a similar nature. Care Homes for Older People Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Clear care plans need to be in place for each care need identified. This includes diabetes and short term health problems. This is to ensure staff provide a consistent approach to meeting care needs of people living in the home. 17/08/2009 2 9 13 The quantity of all medicines 31/07/2009 received and any balances carried over from previous cycles must be recorded on medication records. This is to enable audits to take place to demonstrate the medicines are administered as prescribed. 3 9 13 Records need to clearly 31/07/2009 show how medication has been managed. This includes the use of correct codes. This is so it is clear Care Homes for Older People Page 33 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action medication has been given as prescribed to maintain the health of people in the home. 4 9 13 Medication must be given as 31/07/2009 prescribed. This is to ensure the health of people living in the home is maintained. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 A clearly defined Service User Guide needs to be available which contains all of the required information. This includes a Statement of the Terms and Conditions for the home and the summary of our inspection report. Actions must be taken to ensure the privacy and dignity of people living at the home is maintained at all times. It is advised that the menus for the home include all drinks, snacks and meals provided so that people living in the home know what is available to them each day. Information relating to the procedure for making a complaint needs to be up-to-date in all areas of the home so that any concerns raised by people living in the home or their representative can be referred on to the appropriate person or organisation if required. Written records regarding any concerns or complaints need to be maintained consistently so that it is clear these have been managed effectively and appropriate actions have been taken to safeguard people living in the home. The programme for carpet replacement should be undertaken as soon as possible. This is so those areas of carpet that are stained and marked are removed to improve the environment for people living at the home. Page 34 of 36 2 3 10 15 4 16 5 16 6 19 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 7 26 Any unpleasant odours need to be effectively removed to ensure the environment remains fresh and clean for the people who live in the home. It is advised that all employment checks are maintained on files promptly to ensure it can be demonstrated that all appropriate employment checks have been completed prior to new staff starting at the home. It is recommended that a training schedule is devised which clearly shows all staff training completed and planned. This is to demonstrate that all staff have completed training within the required timescales to maintain their competency to care for people safely. Quality monitoring involving surveys should result in an outcome report showing any areas where any improvements may be required and any proposed actions. This should be published to enable people living in the home and their representatives to see the outcomes and any changes planned. The home must be able to demonstrate there are robust systems in place for the management of money belonging to people in the home. This is so we can be sure peoples money is being kept safe and is being managed appropriately. All accidents that impact on the wellbeing of people living in the home, including those where medical intervention is sought, should be reported to us. This is so we know these are being identified and acted upon accordingly. All dried food produce needs to be kept appropriately sealed to ensure this remains pest proof and fresh so it is suitable for people to eat. It is advised that records make it clear when the next legionella check is due so that this can be followed up accordingly to ensure water services remain safe. 8 29 9 30 10 33 11 35 12 37 13 38 14 38 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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