Inspection on 07/07/07 for WCS - Woodside

This inspection was carried out on 7th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

WCS - Woodside 30/06/09

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

Similar services:

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE WCS - Woodside Spinney Hill Warwick Warwickshire CV34 5SP Lead Inspector Amanda Lyndon Unannounced Inspection 7th July 2007 09:15 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 WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service WCS - Woodside Address Spinney Hill Warwick Warwickshire CV34 5SP 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) 01926 492508 01926 498848 Warwickshire Care Services Limited Mrs Patricia Bernadette Ashwell Care Home 38 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (30) of places WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 12th September 2006 Brief Description of the Service: 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. Woodside is registered as a care home providing personal care to 38 older people; this includes a registration for the care of 8 older people with dementia. The dementia unit is situated on the ground floor. The first and second floors can accommodate 15 and 15 residents respectively. All bedrooms 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 a shower room is provided upon both the first and second floors. A passenger lift to each floor, and ramps leading to outside areas, ensure easy access to all areas of the Home. 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 5-10 minute bus journey. The bus stop is directly outside the home. Woodside is a non-smoking home. Residents and staff are permitted to smoke outside the building. Woodside has an attractive garden area to the rear and a secure garden leading off the dementia care unit. There is limited off road parking for staff and visitors to the rear of the Home. The fees are currently £385 per person per week. There are additional charges for hairdressing, newspapers, personal toiletries and clothing. A copy of the most recent CSCI report was available for residents and visitors to refer to should they choose to do so. WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 5 WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced key field work visit was undertaken over one day by one Inspector when there were thirty five residents living at the Home. Information was gathered by speaking with residents, the Registered Manager, staff members, and observing staff perform their duties. An additional method of obtaining information was “case tracking” three residents in order to discover their experiences of living at Woodside. This included examining the care, medication, staffing and health and safety records relevant to these people. A partial tour of the Home relevant for these people was also undertaken. Information obtained and used in the planning of this field work visit included Regulation 37 notification reports of any accidents or incidents involving people using the service. In addition, the Registered Manager had completed a self assessment document, giving some information about the Home, residents and staff which was also taken into consideration. Prior to the visit three completed questionnaires were returned to CSCI from residents and their families and these included positive comments about the service provided including: “ My Mother likes it very much here” A negative comment was received “It would be nice to have a menu so you could choose as we don’t all like the same food”. No immediate requirements were made on the day of the visit. What the service does well: Prior to coming to stay at the Home prospective residents are encouraged to make informed decisions about whether they would like to live there and are encouraged to sample what life would be like to live there. One resident said “I came to look around here before I came to live here”. Any information of interest to residents is available in a large print format and can be made available in other formats for example braille or in other languages so that everybody can access this information. Residents are involved in the planning of their care so that their preferred routines in respect of their daily lives and interests are maintained. Residents have access to a range of Health and Social Care Professionals and staff provide support to ensure that any instructions are carried out and this ensures that any health care needs are met. One resident said “I am well looked after here”. WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 7 Residents are cared for in a respectful manner by staff working at the Home and this ensures that their self- esteem and dignity are maintained. There are a variety of activities for residents to participate in should they choose, both “in house” and outside of the Home. Activities on offer meet the needs and interests of residents and these are on display so that residents can choose which activities they would like or would not like to participate in. Residents are supported to form friendships with each other so that they can share their experiences with each other. One resident said “I must say that I enjoy every minute of living here, it is much better than living on my own, I love the company”. Residents are able to exercise control over their daily lives and this promotes their independence and individuality. One resident said “We can get up at whatever time we want to here”. Another resident said “There are no rules here, I have a nap in the afternoons”. Residents are supported to continue to practice their chosen religions and this ensures that their beliefs and individuality are respected. Visitors are made to feel welcome and a good rapport had built up between people using the service, staff and their visitors. Residents can meet with their visitors in private should they choose to do so. There is a choice of wholesome meals which meet any dietary needs for reasons of health, taste, culture or religion. One resident said “The food is excellent. The chicken was lovely today”. Another resident said “I have a good variety of food here”. Complaints are investigated in an appropriate and timely manner so that people are confident that their views are listened to. One resident said “I would talk to my key worker if I had a problem but I have no grumbles here”. There are systems in place to protect residents from harm. Residents are provided with a clean and homely living environment in which they are safe and secure and their privacy is respected. Residents are encouraged to personalise their bedrooms to reflect their individual tastes, age, gender and culture so that they feel comfortable in their surroundings. Aids and adaptations are provided so that the independence, choice and dignity of residents are promoted whilst maintaining their safety. Regular maintenance checks of this equipment ensure that they are safe to use. Appropriate recruitment checks are undertaken on all prospective staff members so that they are deemed to be safe to work with vulnerable residents. Staff members have a good knowledge of residents’ individual care needs. One resident said “The staff are ever so nice to me”. Staff training is provided so WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 8 that staff had the appropriate skills and knowledge to work safely and effectively and provide a good standard of care to residents. Systems are in place to obtain residents’ views about the care and services provided are good. Residents’ meetings are held regularly and service satisfaction questionnaires are completed. This is in order to monitor the quality of care and services provided and make improvements as necessary. Quality monitoring visits are undertaken every month by External Senior Managers and there is evidence that any suggestions for improvements put forward by residents are acted upon. Residents have the option of using the Home’s facility for the safekeeping of small amounts of money. The arrangements for health and safety are good and this safeguards residents. What has improved since the last inspection? What they could do better: Improvements are required regarding the ordering and administration of medication so that residents receive their medication as prescribed. Menus should be produced in a format that residents have easy access to in order to assist them when choosing their menu options. Consideration should be given to the need for a loop system in the TV lounges for residents with hearing impairments so that all residents can enjoy the television. WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 9 The temperature within the internal environment of the Home was too warm in areas and this should be monitored and remedial action taken to reduce this as necessary in order to ensure residents’ health and comfort. Professional advice should be sought about the need for suitable mechanical disinfecting equipment to be provided for staff use in order to hygienically clean commode pots and minimise the risk of the spread of infection at the Home thus safeguarding both residents and staff. 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. WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admission processes are thorough so that prospective residents are able to make informed decisions about whether they would like to live at the Home. People know before admission that their care and support needs could be met at the Home. EVIDENCE: Statement of purpose and service user guides had been produced in large print formats for prospective residents to refer to and these were also available in different languages or braille on request so that residents had access to the information included within them. These contained good information about the services provided at the Home. The Registered Manager is in the process of producing booklets based on the key points identified within the service user guide for residents to refer to easily. Prior to trial visits being arranged, senior staff undertake comprehensive assessments of prospective residents’ individual care needs. In addition to this a copy of the assessment of care needs undertaken by the Social Worker is WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 12 also obtained. This is to ensure that residents’ care needs could be met at the Home and reduce the risk of unsuccessful trial visits. Prospective residents are then encouraged to visit the Home for a day in order to sample what life would be like to live there. One resident said “I came to have a look around here before I came to live here”. Residents come to live at the Home on a six-week trial period and following this time a care review is undertaken involving residents, their families, the Home’s staff and Social Worker (if the residents is funded by Social Services). This provides all present with the opportunity to put forward their views about whether the individual is happy to continue to live at the Home and discuss whether their care needs are being met. Intermediate care is not provided at Woodside. WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health provision and care delivery are good and person centred care ensures that residents’ individuality is maintained. Residents are supported in a respectful manner by staff and this ensures that their dignity and self-esteem are maintained. A lapse in medication procedures has resulted in a resident not receiving their medication as prescribed. EVIDENCE: On admission to the Home comprehensive assessments of residents’ individual care needs are undertaken and these included good information about individual residents’ interests and preferences regarding their daily lives so that these could be maintained whilst living at the Home. This included a “life history” in which interesting information about residents’ lives was obtained and could be used in the planning of their care whilst living at the Home. Comprehensive care plans had been derived from this information and there was evidence that residents and their families were involved in this process. Care plans included good detail of the specific support required by staff so that residents’ care needs could be met in a way that they preferred thus ensuring that their individuality is maintained. Detailed care plans regarding residents WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 14 emotional and mental health needs were in place and these included information about any trigger factors for challenging behaviour and the management of this. Staff had undertaken recent training in this area so that they should have the necessary skills to provide support in this area in a sensitive and appropriate manner. Care plans are reviewed every month and more often should residents’ care needs change to ensure that they reflect current care needs. Each month residents are involved in completing service satisfaction questionnaires regarding all aspects of their lives at the Home, including care delivery, catering and housekeeping and this information forms part of their monthly care plan review. Formal care reviews involving residents, their families, the Home’s staff and social worker (if not privately funded) are undertaken annually (and six monthly if privately funded). This is important to give all present the opportunity to put forward their views about the care provided and suggestions, if any, for improvement. Personal risk assessments had been completed and these included detail about the specific support required by staff in order to minimise risks to residents whilst maintaining their independence and dignity. It is recommended that moving and handling risk assessments include detail of the action to be taken should a resident fall so that the correct hoisting equipment is used if necessary. Falls risk assessments had been completed and these clearly identified ways to minimise the risk of residents falling based on their individual care needs. Residents appeared to be well supported to maintain their personal hygiene and choose clothing that was appropriate for their age, gender, culture and the time of year. One resident said “I am well looked after here”. None of the residents have pressure sores (sore skin) and appropriate pressure relieving mattresses and cushions are obtained from the district nursing team following assessment. Residents are weighed each month so that any abnormalities regarding this can be detected and the appropriate action taken. English is the first language for all residents living at the Home, however it had been identified that a number of residents with dementia had limited communication skills. Picture aids had been introduced as a way for these people to express their needs and views and the Registered Manager stated that this was successful. In addition laminated photographs of keys workers was being introduced so that each resident had a photo reminder of who their key worker was. Residents have the option of retaining their own General Practitioner on admission to the Home (if the GP is in agreement), otherwise residents have the choice of registering with one of four local surgeries. Residents have access to a range of visiting health and social care professionals including social WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 15 workers, district nurses, community psychiatric nurses, opticians, dentists and chiropodists. Systems in place for the management of medication, including controlled medication were generally good and the majority of medication administration charts (MAR) were well maintained. All staff responsible for the administration of medication had received appropriate training so that they should have the necessary skills and knowledge to administer medication in a safe manner. This system was audited on a very regular basis in order to identify any shortfalls or errors so that residents should receive their medication in a safe manner. None of the residents had chosen to self- administer their own medication however this was an option if they should choose to do so. A useful written record of the uses and side effects of medication was available for staff to refer to. The “as required” medication protocol had been reviewed and this included detail of the reasons for the administration of this medication. There were a small number of “gaps” on MAR Charts as medication had not been signed for on administration and countersignatures had not always been obtained for hand written entries onto MAR charts (this had been identified by the Registered Manager during the audit process and action was being taken to address this). The actual dosage administered in respect of variable doses had not always been recorded and this will prevent an accurate audit trail from being undertaken and the effectiveness of the treatment from being monitored. Staff had failed to order enough of one type of medication for a resident and as a consequence of this, there was none in stock on the day of the visit, resulting in a resident not receiving the medication as prescribed. Staff must ensure that systems are in place to ensure adequate stock control of medication at all times so that residents receive treatments as prescribed. Stock balances of other medication sampled on the day of the visit were found to be correct. Staff were observed supporting residents in a respectful manner and residents confirmed that they received their post unopened so that their privacy was maintained. A number of residents had chosen to have a private telephone line in their bedrooms and there was a portable phone available for residents to make and receive calls in private. A number of residents had chosen to have the key for their bedroom doors and a lockable drawer was available in each bedroom for the safe storage of private and valuable items. WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities arranged meet the needs and expectations of residents so that their social care needs are met. Residents exercise control over their daily lives and staff respect their personal preferences in respect of this so that their independence and individuality are maintained. Residents have a choice of healthy meals that meet any special dietary requirements for reasons of health, taste and cultural/religious preferences. EVIDENCE: There were a variety of “in house” activities for residents to participate in should they choose including “ladies pampering evenings”, film nights, bingo, gardening and word games. A hairdresser visits the Home twice a week and there is a hair salon on site so that residents can enjoy having their hair done. A summer fete is planned for the near future and a number of residents choose to have a daily newspaper delivered to the Home. One resident said “I have my newspaper every day, I couldn’t live without it”. Another resident said “ I really enjoy the bingo”. Activities are suitable for the needs of residents, for example, time is spent with residents who have dementia on a one to one basis and reminiscence sessions are held. The activities are considered to be age appropriate and include the interests of residents living at the Home. WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 17 It was evident that friendships had formed between residents and one resident said “ I enjoy having a good banter with other people”. Another resident said “I must say that I enjoy every minute of living here, it is much better than living on my own, I love the company”. There were also opportunities for residents to participate in activities and social events within the local community so that residents met with people living outside of the Home of a similar age, ensuring that their individuality and selfesteem are maintained. Two residents choose to attend a local community centre each week for lunch and a game of bingo, residents visit the local shops and pubs and school pupils regularly visit the Home. There had been a number of organised trips recently including a trip to Iron Bridge and a local market. A trip is planned to Bourton on the Water in the near future. Forthcoming activities are discussed during residents’ meetings and during this time residents are encouraged to put forward their ideas for future events. Activity boards located throughout the Home displayed forthcoming events so that residents could plan and choose which events they wished to participate in. Activity records are kept however these are if a “tick box” style and did not identify what the activity was or the success of each event to be used in the planning of forthcoming events. This information was not recorded within the daily notes. Opportunities for residents 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. A number of residents choose to watch the Sunday Service on the television. There were no residents of non Christian faiths currently living at the Home however the Registered Manager stated that staff would provide support for people in this area as required. A number of residents choose to go outside of the Home with their friends and families and this is important to ensure that residents maintain links with those people important to them. There is open visiting at the Home and residents have the opportunity to meet with their visitors in private if they should choose. Relatives are invited to regular group meetings so that they are involved in the running of the Home and visitors are encouraged to participate in social events held at the Home in order to promote a family atmosphere at Woodside. There are no rigid rules or routines at the Home and residents confirmed that they were able to go to bed and wake up at the times that they preferred. Residents had the choice of being served their meals where they chose. One resident said “We can get up at whatever time we want to here”. Another resident said “There are no rules here, I have a nap in the afternoons”. WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 18 Menus identified that there was a variety of meals provided at the Home, predominantly traditional English dishes as this was the preferred taste of residents living at the Home. Suggestions for menu choices were discussed during residents’ meetings and there was evidence that any suggestions put forward were added on to the menu. Themed evenings are held at the Home so that residents can sample dishes from around the world. Special diets could be arranged for reasons of health, taste or cultural/religious preferences. Extra calories are added to meals prepared for residents who are deemed to be in need of extra nourishment. Cooked breakfasts were available and a snack meal was available before bed and during the night so that residents were not hungry. Fresh fruit had been cut up and was available in the lounges for residents to have as a snack and this promotes healthy eating. A snack trolley was available in the lounge on the dementia care unit so that residents could have a snack whenever they wanted to. Residents had requested cake with their cup of tea during afternoons and this was now being provided. Residents confirmed that they are offered a choice of meals and there was a choice of chicken casserole or vegetable bake for lunch on the day of the visit. Residents are encouraged to serve their own vegetables from terrines and salt and pepper available on the dining tables so that they can exercise control over their portion sizes. Staff were assisting residents during lunch time in a sensitive manner and a number of residents were using plate guards thus promoting their dignity and independence at mealtimes. One resident said “The food is excellent. The chicken was lovely today”. Another resident said “I have a good variety of food here”. Menus were not on display at the Home however residents were shown the different choices on offer each mealtime. Prior to the field work visit a negative comment was received about menus not being on display and consideration should be given regarding this. “It would be nice to have a menu so you could choose as we don’t all like the same food”. It was noted, however that “pop” music was being played in one of the dining rooms during breakfast and this was not the radio channel of choice for the residents present. Afterwards this was brought to the attention of the Registered Manager who stated that she would address this so that residents enjoyed their meals in a relaxing atmosphere. WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their visitors are confident that their views are listened to and any issues raised are dealt with in an appropriate and timely manner. There are systems in place that should protect residents from harm. EVIDENCE: Since the last visit, CSCI have not received any complaints, concerns or allegations about the service provided at the Home. The complaints register identified a number of complaints made directly to the Home and issues raised included poor care delivery and a staff shortage on one occasion. There was evidence that these had been investigated in a comprehensive and timely manner to the satisfaction of the complainants and care practices had been reviewed in response to these. The Registered Manager undertakes a monthly audit of all complaints received into the Home in order to identify any trends and ensure that appropriate remedial action has been undertaken. The complaints procedure was on display in prominent positions throughout the Home so that it was easily accessible to residents and their visitors. In addition, “comments/complaints and suggestions” books were located in prominent positions throughout the Home. One resident said “I would talk to my key worker if I had a problem but I have no grumbles here”. Details about an independent advocacy service were on display for residents to refer to if needed. WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 20 There were systems in place to protect residents from harm and this included recent staff training about the protection of vulnerable adults so that staff should have knowledge about how to take the appropriate action for all incidents of alleged or actual abuse. A copy of the Department of Health’s “No Secrets” was available for staff to refer to if they had any concerns to raise of a sensitive or confidential nature, thus safeguarding residents. WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are provided with a homely living environment in which they feel safe and secure and their privacy is maintained. Aids and adaptations were fit for purpose and met the needs of residents. The absence of appropriate mechanical disinfecting equipment to clean commode pots may result in the spread of infection. EVIDENCE: The building was built in the 1960’s and externally is institutional in appearance. The internal environment of the Home was generally well maintained and there was a rolling programme of redecoration and refurbishment in place. Some lounge and bedroom furniture was found to be old and worn however new commodes had been purchased recently and there was a rolling programme of replacing other furniture in place. Residents had recently been involved in choosing the colour schemes for their bedrooms that were due to be redecorated and new bed linen and towels that were to be WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 22 purchased. The dementia care unit is located on the ground floor and the door to this unit is alarmed so that residents’ safety is maintained. Residents had a choice of communal lounge areas and these were decorated in a homely style so that residents could relax in these areas. A number of residents stated that they were enjoying watching Wimbledon on the television in the lounge. There was a kitchenette on each floor so that residents can make their own hot beverages and snacks if deemed to be safe to do so. There is no “loop” system for residents with impaired hearing in the main communal areas, however an amplifier is available when using the telephone. There are three assisted bathing and two “walk- in” shower facilities and these were found to be clean and ready for residents to use (with the exception of one shower that was temporarily out of action due to a flood). The Registered Manager stated that residents could use these areas in private so that their privacy is maintained. Other aids and adaptations are provided for residents use in order to promote their independence including hand rails in corridors, raised toilet seats (where needed), grab rails around toilets, made to measure wheelchairs (following occupational therapy assessment), walking aids and there were four mechanical hoists for the safe moving and handling of residents. Pressure mats were provided in all bedrooms on the dementia care unit in order to alert staff when residents were leaving their bedrooms. This ensures that residents are able to walk freely around the unit whilst their safety is maintained. Bedrooms were of varying sizes and these were allocated to residents based on their care needs. For example, larger rooms were allocated to residents that required mechanical transfer aids in order to ensure that the health and safety of residents and staff were promoted. Some of the bedrooms were small and would not meet the standard size requirements for new rooms. Residents are encouraged to personalise their bedrooms to reflect their personal tastes, interests, age, gender and culture so that they are comfortable in their surroundings. A nurse call facility was provided in each bedroom so that residents could summon assistance as required. A number of new divan type beds had been purchased recently for residents’ comfort and “hospital beds” could be obtained via the district nursing team as required following assessment. The temperature within the Home on the first and second floor was too warm on the day of the visit and the fans recently purchased for this reason were not in use. The temperature should be monitored and remedial action should be taken to reduce this as necessary in order to ensure residents’ comfort. The secure external gardens are well maintained and suitable for wheelchair users and residents with physical impairments. There is a sensory garden accessible to residents living within the dementia care unit so that they can experience the sight and smells within this area. Garden furniture is available WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 23 for residents’ use and there was an abundance of flowers for residents to enjoy. A number of residents were involved with the raised plant/flower beds and the vegetable patch and are currently growing a variety of vegetables. Plans are in place for a themed “beach” area to be developed for residents’ use. Residents had requested an awning as it was too hot to enjoy the garden on hot days and this had been purchased. Since the last visit alternative access to the garden has been created so that residents living elsewhere in the Home do not have to go through the dementia care unit to access the garden thus enhancing the privacy of residents living in this area of the Home. Since the last visit the storage area for clinical waste awaiting collection had been fenced off so that they were screened from view. There is hygienic system in place for the laundry of residents’ personal clothing and bed linen and the Home was found to be clean and fresh on the day of the visit. A sluice room was provided on each floor however suitable mechanical equipment for the hygienic cleaning of used commode pots was not available. An infection control procedure had been written about the manual cleaning of these in order to minimise the spread of infection throughout the Home. This is of particular importance as all of the residents use a commode during night time hours and professional advice should be sought and consideration given to obtaining suitable mechanical disinfecting equipment in order to safeguard both residents and staff. During the visit one carer was observed to be wearing protective gloves whilst walking around the Home and this may result in the spread of infection. This was brought to the attention of the Registered Manager who stated that she would address this. An environmental inspection of the main kitchen had been undertaken recently and a “Gold Award” had been awarded as a result of this identifying that food is prepared in a hygienic manner. WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive support from an adequate number of appropriately recruited and trained staff so that they receive a good standard of care. EVIDENCE: Residents expressed their satisfaction about the staff team and the Registered Manager stated that the current staffing levels were adequate to provide a good standard of care for residents. One resident said “The staff are ever so nice to me”. Staff turnover is very low and this ensures continuity of care for residents. Staffing rotas identified that there are six care staff on duty during day- time hours and three care staff on duty during the night. The Managers and Receptionist work in addition to this. House keeping, catering and maintenance staff provide ancillary support to the care staff team so that residents are supported in all aspects of their daily lives. Agency staff are used on occasions to ensure that staffing levels do not fall below acceptable numbers, so that residents are supported by an adequate number of staff at all times. The Registered Manager and Care Manager provide “on call” support to the person in charge of the shift so that they are available to answer any questions and provide support as required. The gender mix of staff reflected the gender mix of residents so that care and support could be provided in an understanding manner. Care plans included detail of whether individual residents had any preferences regarding this. WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 25 Staff recruitment files included all information required by regulations in order to safeguard residents and all staff were deemed to be safe to work with vulnerable adults prior to commencing employment at the Home. Residents are involved in the interview process so that they have the opportunity to put forward their views about prospective staff members before working at the Home. All new workers undertake comprehensive induction training so that they should have the appropriate skills and knowledge to work in a competent manner. This ensures that they are aware of their roles and responsibilities regarding their job roles. Staff had undertaken recent training relevant to their job roles including fire safety, infection control, food hygiene, emergency first aid and challenging behaviour. 64 of care staff had achieved NVQ level 2 so that they should have the appropriate skills and knowledge to provide a good standard of care for residents. In addition five staff are currently working towards this qualification. WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home is run in the best interests of the residents living there. Systems in place for quality monitoring and resident consultation are good and residents are confident that their views are acted upon. The arrangements for health and safety are good and this safeguards residents. EVIDENCE: It was evident that the Registered Manager had an excellent knowledge of her job role and strived to provide a good standard of service for residents. She had recently undertaken a management course during which different management styles and staff team development were discussed so that she could utilise these skills whilst leading the team at Woodside. Positive comments were made about her management style and this ensured that staff moral was good thus promoting a friendly atmosphere for residents. One resident said “The Manager is really good and very approachable”. The WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 27 Registered Manager is supported by a Care Manager and there were clear lines of accountability within this management team. Quality monitoring visits are undertaken by External Senior Managers every month and written records of these visits were available. There was evidence that any action needed arising from these visits was undertaken for the benefit of the residents living there, for example regarding the environment and food provided. Residents’ meetings were held every two months and this provided residents with the opportunity to put forward their suggestions for the running of the Home. Residents met during the visit confirmed that they felt that these meetings were interesting and beneficial. Written minutes of residents’ meetings are distributed to each resident so that they are aware of the content of these. Topics discussed included social events, menus, environmental issues, new residents (and the cat) were welcomed. Staff meetings are held regularly so that staff are aware of their roles and responsibilities regarding their job roles, training opportunities and resident care. A comprehensive quality assurance system is in place to ensure that the service is continually monitored for quality and residents are involved in this process. There was evidence that remedial action is taken in response to any shortfalls identified and a report based on the findings of this system is produced. There is a robust system in place for the safe storage of small amounts of residents’ money should they choose to use this facility and written records regarding this were well maintained. Cleaning products and other substances considered to be harmful were stored safely so that they were not accessible to vulnerable residents. Health and safety checks of equipment are undertaken regularly so that they are safe to use. All accidents involving residents are investigated by the Registered Manager and written records regarding this are well maintained. There was evidence that the appropriate actions are taken following accidents thus safeguarding residents. Accidents are audited in order to identify any trends and reduce the risk of further accidents of a similar nature. Bedroom and office doors were not fitted with automatic closures however the Registered Manager stated that the Fire Officer was satisfied with this as all corridor doors would close automatically in the event of an emergency thus allowing time for residents to be in a place of safety in the event of a fire. WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 28 Consideration to fitting automatic closures to bedroom doors should be given in order to improve the safety measures already in place. WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 2 X 3 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 2 WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 30 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 OP9 Regulation 13(2) Requirement The actual dosage of medication administered in respect of variable doses must be recorded on the medication administration chart so that the effectiveness of treatments can be monitored and so that an accurate audit trail can be followed. (timescale of 20/10/06 not met). Staff must ensure that systems are in place to ensure adequate stock control of medication at all times so that residents receive treatments as prescribed. Medication administration charts must identify all medication that has been administered to residents in order to determine whether medication has been administered as prescribed by the Doctor. Timescale for action 07/08/07 2 OP9 13(2) 07/08/07 WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 31 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 OP7 Good Practice Recommendations It is recommended that moving and handling risk assessments include detail of the action to be taken should a resident fall so that the correct hoisting equipment is used in the event of an emergency thus prevent further injury to residents. Countersignatures should be obtained for all entries onto medication administration charts so that any prescribing and administration instruction errors can be detected. A written record of the activities that individual residents have participated in should be kept and the success of each activity should be recorded. This will assist in the planning of future events and ensure that the social care needs of residents are being met. Consideration should be given to producing menus in a format that residents have easy access to as this will assist them when choosing their menu options. Consideration should be given to the need for a loop system in the TV lounges for residents with hearing impairments so that all residents can enjoy the television. The temperature within the internal environment of the Home should be monitored and remedial action should be taken to reduce this as necessary in order to ensure residents’ health and comfort. Professional advice should be sought about the need for suitable mechanical disinfecting equipment to be provided for staff use in order to hygienically clean commode pots and minimise the risk of the spread of infection at the Home thus safeguarding both residents and staff. Consideration to fitting automatic closures to bedroom and office doors should be given in order to improve the safety measures already in place in order to safeguard residents in the event of a fire. 2 3 OP9 OP12 4 5 6 OP15 OP22 OP25 7 OP26 8 OP38 WCS - Woodside DS0000004271.V338189.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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