Inspection on 12/01/06 for Wood House

This inspection was carried out on 12th January 2006.

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

Wood House 26/07/06

Wood House 06/07/05

Wood House 21/02/05

Wood House 14/10/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Townley Road, 2-3

Orchard House Nursing Home

St Josephs Rest Home

Foxley Lane (121a)

Tudor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Wood House 7 Laurel Close London SW17 0HA Lead Inspector Louise Phillips Unannounced Inspection 12th January 2006 10:30a X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wood House DS0000010240.V277297.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wood House DS0000010240.V277297.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Wood House Address 7 Laurel Close London SW17 0HA 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) 020 8672 4332 020 8767 5966 juliuss@servitehouses.org.uk Servite Houses Mr Julius Wasiu Seid Care Home 34 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (6), Old age, of places not falling within any other category (34) Wood House DS0000010240.V277297.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th July 2006 Brief Description of the Service: Wood House is a care home managed by Servite Houses, registered to provide personal care and accommodation for up to 34 older people, including up to six people with a mental disorder, excluding dementia. The home is situated in a road behind Tooting High Street, within walking distance of Tooting Broadway shopping centre and the public transport links served by the area. The main accommodation at Wood House is on the first floor which is accessed by a lift and stairs. The home is divided into four units (A, B, C and D), each with their own dining room/ lounge area, kitchenette, bathroom and toilet facilities. Wood House DS0000010240.V277297.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day with time spent talking to residents, staff, the manager and viewing paperwork. A tour of the premises was carried out and care records were inspected. Five staff and seven residents were spoken during the inspection. What the service does well: What has improved since the last inspection? What they could do better: 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. Wood House DS0000010240.V277297.R01.S.doc Version 5.1 Page 6 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 Wood House DS0000010240.V277297.R01.S.doc Version 5.1 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4 Residents are supplied with good information about the home and local area. Assessment of residents is poor and does not ensure that their current needs are being met. EVIDENCE: The home has a recently updated Service Users Guide that is informative and clearly defines the service offered by Wood House. Copies of this are available in the entrance area of the home and a copy of the latest CSCI inspection report is also available in each unit. Since the last inspection the service has altered to enable a small number of older people with mental health needs to live at the home. During the inspection a Community Psychiatric Nurse (CPN) was visiting some of the residents, where she said that she works jointly with another CPN to visit approximately every two weeks to give one person their medication and also review the other residents under the care of the community mental health team. Wood House DS0000010240.V277297.R01.S.doc Version 5.1 Page 8 A new assessment format recently introduced at the home is being used to reassess the current residents, to coincide with the new care plan format that is also being implemented at the home. The file for one resident who has mental health needs indicated that their needs had been re-assessed towards the end of last year. However, speaking to the staff member who had carried this out, they stated they had simply copied the information already contained in the residents file, and they were unable to describe the meaning of phrases they had written (as highlighted later in the report). In relation to the assessment of this residents’ ‘psychological factors’ the following entries were found: “…(the resident) hates noise. Activities such as fire alarm irritate them. (the resident) will remain quiet until someone approaches …, when they will explode. Approach with caution…” “…(the resident) conversational interest falls to somewhat a posh life…” The staff member stated that they had recently received training in mental health from the organisation, yet these entries show a very limited understanding of people with mental health needs, and also a poor use of words to describe the history of the resident. The level of training received by the staff needs to be improved and it is required that only staff who have received appropriate training in mental health and assessing residents carry out this task in future. Wood House DS0000010240.V277297.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 The care files for all residents need to be improved greatly to reflect the actual needs of each resident and any risks they might pose. The ageing, illness and death of a resident whilst at the home is not currently dealt with or planned for. EVIDENCE: “…once you get going, they’re not too bad…” “…the good bit is the am, pm and night summary, as it lets you know a bit about what each person likes during the day…” These are two staff responses to the new care plan format that staff are in the process of implementing. Because of this some residents care plans are still in the older format. The new care plan for one resident provides good information about their mobilising, personal care and communication needs. In a number of care plans some of the information written is irrelevant and unnecessary, where it tended to be the assessment and not the plan of care. Examples of this are in relation to particular areas such as the residents ‘diet and weight’ where it states they “…eat well…”, or their ‘religious observance’ Wood House DS0000010240.V277297.R01.S.doc Version 5.1 Page 10 where one care plan stated“…non-practicing member of C of E…”. These are clearly assessments and not care plans based on an identified need of the resident. Also, the care plan for the mental health needs of one resident stated that: “…(the residents) mood can fluctuate between comparative and cooperative…” It is unclear what this means. The inspector was informed by the staff member who wrote this that they had copied this entry from previous care plan. They said that this means the resident “…can be verbally abusive and aggressive…threatening…” however there was no risk assessment or plan on how staff are to manage this. The poor use of recording how areas of risk are managed was found on another unit at the home. However, this was not just in relation to poor risk management planning, but the overall care of a particular resident, as described below. The medicine chart indicates that the resident is prescribed a number of painkillers, to be given at different times throughout the day. On asking a member of staff (and later the manager) neither could explain the reason why the resident was taking all these painkillers. The care file also did not indicate when the medication was last reviewed. A member of staff also commented that the resident “…suffers from constipation…”. During the inspection the same resident was seen being verbally abusive to other residents. When staff intervened and took the resident to their room the other residents said that “…the other day (the resident) tried to bite a member of staff…(the resident) is always shouting and rude and tries to hit out…”. The care file for the resident did not correspond at all with the inspectors’ findings, and the care documentation seemed to relate to a different resident altogether. There was nothing in the care plan relating to why they were taking the painkillers, when they had last had their medication reviewed, the action being taken to address their constipation, when they first became aggressive, or the possible relationship between all these factors. In addition, the risk assessment did not detail anything about the residents’ aggressive behaviour. This example clearly details that the care records and the level of care given is not adequate. One area that has improved is the quality of information in daily notes. This has improved greatly to provide a good account of what the resident has done throughout the morning, afternoon and night periods. However, the level of record keeping in the care files, eg. assessment forms, care plans and risk assessments is of a generally poor standard, inaccurate and not updated to the actual current needs of the residents, and requirements have been made to address these. Wood House DS0000010240.V277297.R01.S.doc Version 5.1 Page 11 Servite Houses has a comprehensive policy on death and the care of the dying that details the procedures for staff to take in the event of this occurring at the home. Records in the residents’ files did not demonstrate that the event of their death or serious illness had been appropriately planned for, and the home should ensure that this is dealt with. This is a sensitive area and should be handled with respect and as the resident would wish. Wood House DS0000010240.V277297.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15 The home is working towards offering a more culturally-balanced menu to cater for the wishes of the residents. EVIDENCE: It was good to see that on one unit the staff member was sat at the table playing a game of dominos with a resident, whilst other residents sat chatting, with relaxing music playing in the background. Walking around the home the inspector observed that on all the other units residents were sat in the lounge areas watching television, with staff in the kitchen areas. Since last inspection the home has worked positively with the catering provider to include a greater variety of meals for ethnic minority residents. The current four-weekly rolling menu details that one ethnic meal is included per week, and the manager stated that it is planned for this to increase to a minimum of two such meals to be included weekly. Wood House DS0000010240.V277297.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed on this occasion. EVIDENCE: Wood House DS0000010240.V277297.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 24 and 26 Good improvements have been made to the décor in the home. Residents are happy with their bedrooms and bathing facilities. EVIDENCE: Since the last inspection the repairs have been made to the kitchen tiles and staff toilet facilities to make these areas more hygienic. Wood House has a warm and inviting atmosphere that is enhanced by the modern furnishings, bright décor and good standard of cleanliness throughout. An area still outstanding form the previous inspection is the development of an increased seating area outside for the residents to use in the warmer weather. In addition, the television on unit B was seen to have a poor level of reception and in need of repair or replacing. Three residents bedrooms were looked at and were individually personalised, warm and nicely decorated. Residents spoken to commented that “…I like my Wood House DS0000010240.V277297.R01.S.doc Version 5.1 Page 15 room…” and that “…I have a shower and toilet near my room, it is very nice…hand rails…can be in and out of shower in twenty minutes…”. Wood House DS0000010240.V277297.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 Training for staff needs to greatly improve to enable the mental health needs of residents to be adequately met. EVIDENCE: As stated earlier in the report, there has been a recent change in the registration of Wood House to enable up to six people with mental health needs to live at the home. The manager stated that as a result of this all staff had received two hours of training in mental health from the organisation, and that a ‘refresher’ course was due in February 2006. Two members of staff were spoken to about the training and their understanding of mental health issues. The comments received were: “…good because I learnt that people say things that are not true…” “…cannot change mental health – need to help them lead a comfortable life…” These comments, along with the findings of the assessment records and care planning (as detailed earlier in the report) does not demonstrate that staff have an adequate understanding of people with mental health needs. The current level of training needs to be greatly improved to ensure that it incorporates all aspects of mental health, symptoms, causes, assessment, care planning, risk assessment, etc. Due to the complex nature of mental health, the amount of training needed for the staff and the need to provide up-to-date Wood House DS0000010240.V277297.R01.S.doc Version 5.1 Page 17 care it is required that Servite Houses access external training organisations to deliver this training. Wood House DS0000010240.V277297.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 Record keeping at the home needs to significantly improve to protect the residents and ensure that they are getting the right care. EVIDENCE: As highlighted earlier in the report, the standards of record keeping in the care assessment forms, care plans and risk assessments is of a generally inadequate standard, inaccurate and not at all up-to-date with the actual current needs of the residents. A number of requirements in relation to record-keeping and staff training have been made to address these particular areas of concern. Wood House DS0000010240.V277297.R01.S.doc Version 5.1 Page 19 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 2 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 X 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 2 X X 3 3 X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X 2 X Wood House DS0000010240.V277297.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 12(1), 14(1)(a) Requirement The Registered Persons must ensure that the assessment of residents are only carried out by staff who have received appropriate training in mental health and the assessment of residents. The Registered Persons must ensure that each resident has an up-to-date care plan that details the actual, current needs of the resident. The Registered Persons must ensure that the risk assessments are regularly reviewed and upto-date (previous requirement not met) The Registered Persons must ensure that the health and medication needs of each resident are reviewed at least annually. The Registered Persons must ensure that accredited medication training is provided to all staff to ensure that they understand what medication they are administering to residents and the reason for this. DS0000010240.V277297.R01.S.doc Timescale for action 28/02/06 2 OP7 15 28/02/06 3 OP8 13(4) 28/02/06 4 OP8OP9 14(2) 31/03/06 5 OP9 13(2) 31/03/06 Wood House Version 5.1 Page 21 6 7 OP20 OP30 23(2)(c) 13(6), 18(1) 8 OP37 17 The Registered Persons must ensure that the television in unit B is repaired or replaced. The Registered Persons must ensure that staff at the home receive appropriate training from an external provider to enable the mental health needs of residents to be adequately met. The Registered Persons must ensure that all records, care plans and risk assessments are accurate and detail the up-todate needs of each resident. 28/02/06 28/02/06 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP11 Good Practice Recommendations The Registered Persons should ensure that a plan is in place for each resident regarding their wishes in the event of their becoming terminally ill, and the event of their death. The Registered Persons should ensure that an enclosed outdoor space with seating be provided for residents. 2 OP19 Wood House DS0000010240.V277297.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wood House DS0000010240.V277297.R01.S.doc Version 5.1 Page 23 - 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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