Inspection on 17/01/07 for Woodbury Court

This inspection was carried out on 17th January 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Woodbury Court 14/01/08

Woodbury Court 12/01/06

Woodbury Court 04/08/05

Woodbury Court 15/10/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Woodbury Court Tavistock Road Laindon Basildon Essex SS15 5QQ Lead Inspector Vicky Dutton Unannounced Inspection 17th January 2007 09:00 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 Woodbury Court DS0000061614.V327531.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. Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodbury Court Address Tavistock Road Laindon Basildon Essex SS15 5QQ 01268 564230 01268 564231 woodlands@runwoodhomes.co.uk runwoodhomes.co.uk Runwood Homes Plc 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) Ms Karen Allen Care Home 93 Category(ies) of Dementia - over 65 years of age (66), Old age, registration, with number not falling within any other category (27) of places Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th October 2006 Brief Description of the Service: Woodbury Court is a purpose built two storey establishment which accommodates 93 older people. The home has surrounding grassed areas, a secure patio area and a large car park. The 1st floor and part of the ground floor accommodates residents with dementia. Another unit on the ground floor accommodates residents over the age of 65 years, whose difficulties may be more physical. All bedrooms are single and have en suite facilities. Laindon town centre is situated near to the home. Woodbury Court has a statement of purpose and service users guide available. Information about the home and most recent inspection report are available to residents/visitors in the homes lobby area and in the visitor’s area of the home. It was confirmed that the current fees at the home are £520.00 to £570.00 (dementia care). There are additional charges for chiropody, hairdressing, personal items and newspapers/magazines. The email address shown on the previous page is incorrect and should read; woodbury.court@runwoodhomes.co.uk. This will be corrected on the next inspection report. Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced ‘key’ site visit. Due to the size of the home the inspection was undertaken over two site visits. The first visit took place over a nine and a half hour period, the second over a four and a half hour period. As two inspectors were present this equated to twenty eight hours of input. At this inspection all the key standards, and the homes progress against their previous agenda for action were assessed. Prior to the site visit the home had submitted a pre-inspection questionnaire, and provided additional information that assisted with the inspection process. At the site visit a partial tour of the premises took place, care, staff, and other records and documentation were selected at random and various elements of these assessed. A notice was displayed in the home advising all visitors that an inspection site visit was taking place with an open invitation to speak with an inspector. During the site visits residents, visitors and some of the homes staff were spoken with. As part of this key inspection questionnaires were sent out in the post to health and social care professionals. Staff, residents and relatives/visitors surveys were given out during the inspection. The views expressed at the site visit and survey responses have been incorporated into this report. The inspectors were assisted at the site visits by the registered manager, deputy manager and other members of the staff team. An operations manager also attended for some of the first site visit. Feedback on findings was given throughout the visits, and summarised at the end of each visit. The opportunity for discussion or clarification was given. A feedback card on the inspection process was sent to the home after the site visits. The inspectors would like to thank the staff team, residents, relatives and visiting professionals for their help throughout the inspection process. What the service does well: Feedback from residents, relatives and visiting professionals about the home was variable but some was positive. Comments such as ‘Staff are very cheerful and welcoming’ and ‘my relative is very content at the home. I am happy with all the services and the lovely cheerful staff, who are all friendly and helpful at all times’ were made. Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 6 Woodbury Court provides residents with a pleasant environment that is well decorated and has items on display to provide interest for residents. The registered manager at the home is experienced, forward looking in their approach and has many ideas for the future development of the home. Staff at the home were caring towards residents. 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. The summary of this inspection report can be made available in other formats on request. Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 7 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 Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 8 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, & 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their families are not always given sufficient information before they decide to move into the home. Prospective residents have their needs assessed before moving in. Development is needed to ensure that staff at Woodbury Court receive adequate training to help them to meet resident’s needs. EVIDENCE: The home has a statement of purpose and service users guide in place. These documents were not viewed in detail at this inspection. The registered manager said that the homes Service Users Guide and Statement of Purpose were in the process of being reviewed and updated. The manager was advised of recent changes to The Care Homes Regulations stipulating areas to be included in the homes Service Users Guide. Work was in hand to incorporate this information. Feedback from resident’s/relatives showed that they are not given written information about the home before they move in. It was also Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 9 confirmed that staff would not normally take information with them when visiting potential residents to carry out a pre- admission assessment. At the second site visit the registered manager said that this should happen, and that a supply would be made available for this purpose. Many admissions to the home are initially admitted as part of the homes interim placement scheme (see below.) Due to the nature of these admissions it was not felt appropriate to give these resident’s a service users guide that is geared towards permanent residence. It was advised that relevant information be put together to offer these residents a proper picture of the home and the interim placement scheme. The files of two recently admitted residents were viewed. These showed that pre-admission assessments were carried out by the home, to confirm that the home can meet their needs. One of these assessments had been completed on admission, as it was an emergency situation. Staff training at the home is ongoing. A training matrix provided by the home showed that 12 care staff have yet to receive any training in dementia care for which the home is registered. In some instances this is planned. Evidence of staff induction (for new staff) into the needs of residents was poor (see standard 30). One relative said that ‘Staff do not seem to have the experience of coping with residents.’ The registered manager confirmed that staff have not received any awareness training in conditions such as epilepsy and Parkinson’s disease which some residents at the home suffer from. It was stated that a resource file is available to provide information, and, that it is hoped to provide training in relevant areas during the coming year. Intermediate care is not offered at Woodbury Court. However 17 beds are provided as part of an interim placement scheme. These beds offer residents a temporary placement (usually up to six weeks) as an extended recovery period following illness or crises. Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In general residents health and care needs are well identified and planed for. Medication practices at the home are generally well managed and ensure that residents are kept safe. However best practice needs to be reinforced in some areas, and the timing of the morning medication round needs to be reviewed. EVIDENCE: As part of this inspection several care plans were viewed. In general they provided a good basis for care to be delivered to residents. Identified shortfalls were discussed with the registered manager. These included risk assessments being in place for behavioural issues, but this information not included in care planning. A care plan should have been in place to provide staff with guidance in managing these behaviours. One resident had returned from hospital three months ago with significantly changed care needs. Although the changed needs had been mentioned in the review sections, the care plans had not been updated. This provided misleading information to staff and had the potential Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 11 to put the resident at risk. At the second site visit the registered manager confirmed that this care plan had been revised. Sometimes information held in different areas of the care file was not ‘joined up’ or followed through. This could lead to important information being missed by staff. For example one resident just diagnosed with a medical condition. There was no record of the GPs visit in the relevant section, and no follow through/comment in ‘daily observations.’ The registered manager pointed out strategies for improving care planning at the home. A ‘Care Plan Support Pack’ had been prepared for staff to use. To address the issue of some care plans being over complex and muddled a schedule is in place to complete a full review/re-write of all care plans in the home. It was agreed that this work needs to be prioritised by the needs of individual residents in order to prevent out of date care plans, that do not reflect resident’s current needs remaining in place. Feedback from residents/relatives showed that they had not been/do not feel involved with the care planning process. This also needs to be addressed by the home. From records and observations it was indicated that the home monitor and meet residents health care needs. Residents can access professional services such as chiropody, optician and local and hospital based health services. Nutrition records are maintained at the home. But in order to gain an adequate picture of an individual residents dietary intake, it is necessary to cross reference the individual nutrition record with the menu records, or choice sheets used. The registered manager undertook to look into how this situation can be improved. It was seen that where pressure relieving equipment is required this is provided through the health authority. In a lounge on the high dependency unit many of the armchairs were missing their normal cushions. Some had specialised pressure relieving cushions in place of these. It was not clear if these had been specifically assessed for individual residents or just placed there to replace the missing cushions. Residents falls are monitored and referrals made to doctors or other professionals as necessary. The falls prevention team have been approached, but they feel that their clinic will not be of help to residents who have dementia. Feedback from visiting professionals about the home was generally positive. One said that ‘I have seen the care and organisation in the home slowly improve.’ They said that regular meetings are held with management of the home to aid communication. One did however also note (on the survey form) that there was not always a senior member of staff available to consult with. Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 12 Medication at the home is mainly managed via a monitored dosage system (blister packs). At the first site visit the medication for Tulip unit was viewed. Records sampled were well maintained, and no anomalies were noted in the sample undertaken. Policies and procedures were available to inform staff practice. A care team manager (CTM) spoken with confirmed that they had undertaken appropriate training, and had their practice monitored by the registered manager. Woodbury Court is a very large home. Three medication trolleys are housed and used on each floor. As there is only one member of staff on each floor on each shift (the CTM) that administers medication, a large percentage of their time is spent on this task, with morning rounds in particular taking two hours or more to complete. This needs to be reviewed to make sure that residents receive their medication in a timely manner, and, that there is sufficient time between doses of medication. At the second site visit on the high dependency unit it was difficult for the CTM on duty to give full time and attention to the task of medication, as the needs/behaviours of the residents provided a constant distraction. Also at the second site visit a resident on another unit, with at that time no CTM presence was very distressed and in pain because they felt they should have received their pain relief before having to get up and be moved around by staff. The registered manager agreed to look into this incident. At lunchtime on the day of the first site visit one resident was not adequately supervised in taking their medication. As a result of this the tablet was lost. A carer said that they would alert the CTM to provide another tablet, but this was not observed to happen. The registered manager was also advised of the need to reinforce best practice/ensure staff are trained in relation to the administration of eye drops. During the inspection residents were generally treated with respect and their privacy and dignity upheld by staff. However staffing levels at the home sometimes make this difficult for staff. At the first site visit one resident could not be taken to the toilet when they wished to go. Another resident did not/could not ask, but became agitated and was then incontinent. One residents named wheelchair was observed to be used for another resident. A number of residents were not wearing any leg coverings, one said that they would like to but that they ‘had not got any.’ Rooms facing the main road are not supplied with any net curtains/blinds to provide them with privacy should they wish it. The registered manager is keen to promote this area of care and work with a programme called ‘Dignity Challenge,’ which is part of the Dignity in Care scheme devised by Social Care Institute for Excellence (SCIE) and promoted by CSCI. Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 13 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 adequate. This judgement has been made using available evidence including a visit to this service. Activities are available at the home, but development is needed to make sure that these meet the needs of all residents accommodated at the home. A review of staffing levels/deployment is needed to make sure that routines at the home meet resident’s needs and expectations. Visitors are always made welcome at the home. Residents generally spoke well of catering services at Woodbury Court. EVIDENCE: A tour of the premises indicated that activities at the home are plentiful and varied. There was lots of information on display, and corridors were bright and cheerful. A poetry group and a bible study group were identified as two of many activities, and there was evidence of art and craftwork on display. It was also clear that community groups are involved in the home. Volunteers from the community are also used in the home with such services as PAT dogs. The home employs two full time activity co-ordinators. Both co-ordinators work the same hours on a Monday to Friday basis. It was reported that care staff also are involved with the provision of activity. In spite of this the inspectors did not observe any activity going on in any area of the home during the first site visit. (Although it was stated that some did take place on the ground Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 14 floor.) The activities co-ordinators also later reported that they had carried out a slide show in several areas of the home, but that this had not been observed by inspectors. At the second site visit both activity co-ordinators were working with six residents on the ground floor of the home. Some residents identified that they did bingo or played cards, and that ‘there was not enough to do.’ Another visitor upstairs said that activities had decreased and that, ‘you very rarely see any activity going on,’ and that activities were concentrated downstairs. Activities records are kept separately from residents individual care files. The activity co-ordinators said that these records took two hours a day to maintain. The registered manager undertook to review this process. The records showed a varied picture, with more activities perhaps provided for the more able residents. At the second site visit the activity co-ordinators were spoken with. It was clear that they have many future plans for developing the service that they offer. The registered manager also identified that development work is planned or underway to provide better and more appropriate activity/occupation for those residents who have dementia. Innovations such as a textured sensory panel, and a sensory room are planned. A new assessment tool in relation to activity/occupation has just started to be used, but adequate training is needed so that staff understand how to use this. It is hoped that this tool will provide a better focus for providing activities relevant to the individual needs of those with dementia. Opportunities are available to residents to meet their spiritual needs. Some residents felt that they were not offered choice in daily routines. One said that they got called and had to get up then, as they had to have breakfast at 08.30. Another resident regularly missed the end of a TV programme as they were taken to the dining room for tea at that time. At the second site visit it was confirmed that night staff get many residents up each morning. One resident spoke of being ‘woken up.’ Once residents are up they sometimes have a long wait for breakfast. Observations at the second site visit revealed issues regarding morning routines and the provision of breakfast. According to staff it is practice for all residents to be got up before care staff then begin the task of serving residents with breakfast. In the case of Residents on Rose unit this meant that residents were left sitting at tables waiting for some time until breakfast was eventually served at 09.30. Some residents confirmed that they had been up since 06.00/06.30. It was said that they might be offered a cup of tea earlier by night staff, and that breakfast was sometimes earlier, but that it depended very much ‘who was on.’ Residents on Ivy (high dependency unit) had not had the benefit of an early cup of tea. Many were already up and dressed on the inspector’s arrival at 08.00, but no breakfast was served until about 08.50. At 08.00 one resident was asking for a cup of tea, another for lemonade. One said ‘Wish they would hurry up with breakfast.’ The registered manager thought that there was flexibility in the system, and that breakfast would be provided as needed, but this was not observed at inspection or Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 15 confirmed by residents. The issue of the timing and flexibility of breakfast has been raised at previous inspections but not yet addressed by the home. Visiting at the home is very open. And visitors are welcome at any time. The home has a pleasant visitors room on the ground floor of the home. This has a lot of information available for visitors. An issue raised in feedback on surveys was the difficulty of gaining access to the home at weekends. (See also standard 27.) One said ‘Someone should man the front desk at weekends. On two occasions we could not gain entry for half an hour. By then half a dozen visitors were waiting.’ Information on advocacy services was available on notice boards around the home. Residents are able to bring in personal possessions. Resident’s views about the food provided by the home were varied. Many felt that the food provided was good and plentiful. Others raised issues such as the vegetables being too hard, the food being too cold and the frequency of sandwiches at teatime. One relative said ‘the food is rarely hot and sometimes they cannot eat it because it is not cooked properly. Staff are sometimes not very helpful about this.’ Although in a large home it will probably not be possible to please everyone, some comments such as food not being hot were common and this needs to be addressed. Menus and ‘choice sheets’ viewed showed that a varied diet is offered, and that residents are offered choice. Lunch on the day of the first site visit was very well presented. The dining environment in some areas would benefit from improvement by the replacement/adequate cleaning of place mats. There are issues with the amount of crockery available. Residents on Rose Unit had no cups available at breakfast time. Also the bowls provided for cereal on this unit were too small causing frustration for one resident. The inspectors were told that new crockery was on order. The home currently employs one chef, who works on their own (with a kitchen assistant) and is covered by an agency member staff when off. The registered manager said that the chef is happy working on their own. Given the size of home and number of meals to be prepared, this needs to be kept under review. Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. The home has a clear complaints process in place. Development is needed to make sure that complaints are concluded properly. Actions need to be taken to prevent repeat complaints on similar themes. Residents are generally protected by staff having a good awareness of adult protection. Development is needed however to make sure that senior staff are confident and react appropriately in the event of an incident. EVIDENCE: The home has a clear complaints procedure in place, which is on display for residents and visitors. Verbal and survey responses showed that residents and visitors are aware of the homes complaints procedure. People spoken with said that they would feel confident in raising any concerns with somebody, generally the CTM on duty. The homes complaints file was viewed. Five complaints had been recorded for November 2006 and one in December. Complaints all focused on similar issues: Laundry issues, such as missing clothing. Care issues, such as residents being wet, through incontinence, and having dirty fingernails. Staffing issues, shortages of staff, call bells not being answered. Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 17 Actions had been taken in response to all complaints, but in some instances the outcome and conclusion of the complaint was not clear. Since the previous inspection four protection of vulnerable adults (POVA) alerts have been made. These issues were managed appropriately by the management of the home. During the first site visit a potential POVA issue raised by a resident was brought to the attention of the registered manger. A resident said that they had reported an incident of inappropriate staff behaviour to the CTM on duty during the previous week. The registered manager was unaware of this and agreed to look into it. At the second site visit the registered manager confirmed that this situation had been looked into and resolved. Care staff spoken with at the home had a good awareness of abuse issues and the protection of vulnerable adults (POVA). The homes training matrix showed that a number of staff, including senior staff, have yet to complete training in this important area. One senior member of staff spoken with was not fully aware of appropriate actions/reporting procedures to be taken should an incident occur. They spoke of filling out a concerns form and leaving it for the manager. The above incident confirms the need for senior staff to have a better awareness of appropriate actions to take when an allegation is made. The home incorporates a ‘high needs’ dementia unit. The registered manager agreed that although the current dementia training undertaken by staff might touch on challenging behaviour, this was not adequate. It was hoped to access training in managing challenging behaviour in the near future. Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 18 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, 21, 22, 24, & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Woodbury Court provides a generally clean and comfortable environment for residents. Development is needed to ensure that residents are cared for properly by staff that have a clear awareness of infection control and universal precautions. EVIDENCE: Woodbury Court is a fairly new and purpose built home that provides a spacious and comfortable environment for residents. The home is on two floors and divided into six units. The units are interconnected and staff work across different areas. A general hand is employed for 33 hours per week to undertake maintenance, equipment testing and decorating tasks. The registered manager spoke of plans to complete an assessment programme ‘How dementia friendly is Your Building’ and make any changes necessary/possible. There are also plans to develop a sensory garden area for the benefit of residents. Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 19 On Jasmine unit there is only one shower room to serve 11 rooms, so bathrooms on another unit, Lavender, are used. All rooms have an en suite facility and overall sufficient and varied bathing facilities are provided at the home. Time and trouble had been taken with the homes bathroom areas to make them colourful and homely. The home has one hairdresser’s room to serve 93 beds. This is situated on the first floor on the high needs dementia unit. Equipment at the home needs to be monitored and managed more effectively for the safety and benefit of residents. At the first site visit a hoist and some wheelchairs were noted to be in a poor condition. The registered manager had addressed this at the time of the second site visit. At the second sit visit a resident was noted to be being pushed around in a wheelchair with flat tyres. Another was using a Zimmer frame with ferrules that were worn through to the metal. The use of poorly maintained equipment could present a hazard to residents. Residents spoken with were happy with the accommodation provided at the home. It was noted that some residents are still sleeping with a sheet on top of a plastic mattress without the benefit of a suitable mattress cover. Since the previous inspection heating controls in residents bedrooms have been made accessible enabling residents to control the heat in their rooms if they wish to do so. At the time of the inspection (both site visits) visit the home was dealing with an outbreak of infectious disease. The home was managing the situation effectively, had consulted with relevant professionals and had an action plan in place. Although some staff spoken with had a good knowledge of infection control procedures, they could not identify that they had received training in this area. This was confirmed by the training matrix provided by the home that did not identify infection control as a core area of training for staff. Neither was appropriate training evident in staffs’ induction programme. This needs to be developed so that residents are cared for safely. Many en suite areas did not have towels available to encourage hand washing. This was an area raised by several residents/relatives: ‘Would like a towel in the bathroom (en suite.)’ And, ‘Dirty hand towels removed, but clean ones are replaced as and when, sometimes many hours later.’ The home has a large laundry area, which was clean and well organised at the time of the first site visit. Residents and visitors raised a number of issues in relation to the laundry service at the home with missing or damaged clothing being the focus of their concerns. Again many residents felt that it ‘depended who was on,’ as to the level of service they received. Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 20 Apart from isolated pockets, odour control at the home was satisfactory. Feedback from relatives however indicated that this might not always be the case. One said ‘carpets and furnishings smell strongly of urine.’ Domestic staffing hours at the home need to be reviewed. The registered manager identified that the home has no vacancies for domestic staff. The home is very large, yet a weeks rota viewed showed that only three domestic staff were rostered to work, providing cover for the whole building during the day. (four on one day.) An additional afternoon/evening domestic is provided on three days. Separate laundry staff are provided during the daytime only. A relative said, and it was observed by inspectors, that chairs at the home are not always cleaned properly. The housekeeper at the home later told inspectors that staff had tried hard to clean chairs properly but that they were now stained and needed to be replaced. At a recent relatives meeting the cleaning of rooms was raised. In particular this related to the inadequacy of deep cleaning, such as under beds. One relative said that when their relative had moved into the home, the room had not been properly cleaned or prepared ready for a new resident. At the second site visit the home, although a carpet cleaning programme was in place, the home was not able to produce any ‘deep cleaning’ schedules to show how cleaning in the home is managed effectively. The registered manager undertook to address this. It was stated that the home have obtained a copy of tool produced by the Health Protection Agency and are keen to work through this learning lessons for the home. Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 21 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 poor. This judgement has been made using available evidence including a visit to this service. Staffing at the home is not adequate to consistently meet the needs of residents. Although staff are recruited safely to protect residents, they do not receive an adequate induction to assist them in understanding the home and caring for residents. EVIDENCE: To gain an adequate picture of staffing at Woodbury Court it is necessary to access the many different rotas that are in use, identifying different grades and designations of staff working on different floors of the home. The rotas need some attention, for example no hours recorded for the chef, three staff names not properly identified. The registered manager had addressed these issues at the time of the second site visit. The registered manager said that they were happy with the current staffing levels at the home and felt that they were adequate to meet resident’s needs. However observations of staffing levels and comments from resident’s/visitors during the site visits raise issues about the ability of the home to consistently meet the holistic needs of residents. The manager confirmed that current levels provided are seven care staff upstairs. Upstairs comprises of 48 beds over four units. One unit of 12 beds is Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 22 designated as a high dependency dementia unit. A member of staff identified that approximately seven residents on the first floor require the assistance of two staff, and that currently all but two other residents required the assistance of one carer. As well as caring tasks, the morning routine requires care staff to serve and assist residents with breakfast. Downstairs there are five care staff for 45 beds over two units. Staff identified that on the ground floor approximately six residents required the assistance of two carers. It was stated that on the ground floor night staff would assist 10 to 20 residents to get up each morning. One CTM covers each floor. As previously identified much of their time is taken up with medication and office based tasks. There is therefore limited time for staff supervision, observation of practice and guidance. As identified throughout this report, findings indicate that day staffing levels at Woodbury Court are not adequate to meet the holistic needs of residents and need to be urgently reviewed. Residents/relatives generally spoke well of the staff at Woodbury Court and made some positive comments such as ‘People are so nice,’ and ‘they always talk to them (resident’s) nicely, never a raised voice or cross word.’ However, a common theme in talking to, and feedback from, residents and relatives was staffing shortages, not enough staff, of long waits for call bells to be answered, to go to the toilet and so on. Survey responses also showed that most people did not feel that there were always sufficient staff on duty at the home. When inspectors tested a call bell the response time was very long. Staff were observed to be pleasant with residents but very busy and task orientated. Staff identified themselves that ‘there is no time for one to one.’ One member of staff said that they came in on their day off to give a resident that they were a keyworker to a bath, as there was no other time to do this. While this dedication is admirable it should not be necessary in a home that is adequately staffed. The registered manager said that the home currently has 209 vacant care assistant hours. To cover this many staff are working long hours and up to four double shifts a week in addition to their single shifts. This is not good practice and creates a further issue relating to staffing. When working a double shift staff have two twenty minute breaks and an hour long break in the middle of the day. This further decreases the staffing levels in the home. One member of staff said that this situation effected staffing between 12.00 and 16.00 on most days. It was stated that this could leave one person covering a unit at times. This was also observed by the inspector, and confirmed by a relative who said ‘We are concerned with the decline of Woodbury Court and it’s staffing levels over the last six to eight months……staff numbers seem to be much lower of late, especially in the afternoons when usually there is only one care worker on duty.’ Currently at weekends both the manager and deputy manager are off duty, there are no reception, administrative staff or activity co-ordinators on duty. Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 23 This means that the two CTM’s on duty have an additional workload to manage, in dealing with the homes many visitors and answering telephones. A relative said ‘it can be difficult to find someone to speak to, especially at weekends when no office staff or management are working.’ (See also standard 13.) The registered manager said that approximately six staff have NVQ at level 2. This is a low percentage of the overall staff group at Woodbury Court. The registered manager said that a new group of enrolments would take place soon. The files of three recently recruited members of staff were viewed. These showed that safe recruitment processes are maintained to protect residents. The registered manager was however reminded of the need to maintain the required records such as evidence of relevant qualifications and training, and a recent photograph of the staff member in all cases. Staff induction at the home was inadequate, and is not producing good outcomes for residents. The home has yet to commence the Skills For Care core skills programme with staff that has been introduced by the registered provider. Of the files of three new staff viewed a four week induction programme was in place. Only some parts of ‘day one’ had been completed. Subsequent weeks had no entries. It was stated that new staff ‘shadow’ other staff for a minimum of three days, and are monitored on an ongoing basis. It was confirmed by staff that the ‘shadowing’ is normally with another carer rather than with a senior member of staff, who can promote agreed and best practice. There was no evidence of on staff files that new staff are monitored and have their progress appraised. Residents spoken with gave an example of the poor practice of a new member of staff who had not been adequately inducted, and was not adequately supervised. Two relatively new members of staff were spoken with both confirmed that their induction had consisted of ‘shadowing’. One had only received moving and handling training so far. The other had received other core training recently. Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 24 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, 36, & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have the opportunity to express their views about the home. The home is generally managed safely and the welfare of residents and staff protected by safe procedures being in place. However safety, and the smooth running of the home is compromised by shortfalls in the management structure of the home. This particularly relates to the day to day management of the units and staff where there is insufficient senior staff cover. EVIDENCE: The home has an experienced and proactive registered manager in post. In a scheme run by the registered provider they were voted ‘Manager of the Year’ for 2006. The registered manager has completed relevant qualifications. Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 25 Management of the home has been enhanced by the recent appointment of a full time deputy manager. However, as evidenced in this report, the local management structure at the home, particularly at weekends, remains weak. This does not relate to the competence of individuals but reflects shortfalls in the level of senior and administrative staff available. Those residents/visitors, who were aware of who the manager was, said that they found them approachable. Some residents said that they were able to freely express their views and had them listened to by management at the home. They were not clear however if any actions took place as a result of their feedback. Issues such as problems with the laundry service (again dependent on who was on, some were good) and staffing shortfalls remained. Staff also felt that both the manager and deputy manager were approachable and would listen to them. Opportunities are available for residents and stakeholders to express their views. Regular meetings are held for residents and relatives. Meetings are also held for all designations of staff. The registered provider has strategies in place to monitor the quality of the service provided at Woodbury Court. An annual audit is undertaken. This last took place at Woodbury Court in March 2006. The audits include the use of questionnaires to seek residents and others views on the service. When next undertaken the report produced must be made available to stakeholders, and provide for an annual development plan for the home. The placing Local Authority conduct monitoring of the home. In response to this, CSCI inspection and the audit undertaken by the registered provider, the home has produced an action plan to continue the development of the home. The home have some internal procedures that contribute to overall quality monitoring of the home. These include medication and floor audits. Monthly visits are undertaken by a senior manager in the organisation as required by regulations. Other quality assurance mechanisms, such as a monthly managers audit are undertaken internally at the home. Given some of the findings of this report, it is not clear that quality assurance tools in use at the home have been effective in ensuring a quality service that meets residents needs. Resident’s monies were sampled and were satisfactory. Staff supervision is not being carried out with the recommended frequency. Two members of care staff, one been at the home since last May, and one for about a year both said that they had received two formal supervisions so far. The homes pre-inspection questionnaire identified that systems and services are monitored and maintained. Fire records viewed were satisfactory. A local fire plan was in place. The registered manager was advised to check with the fire service and make sure that this constitutes a fire risk assessment and complies with current requirements. Records to show that other aspects of Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 26 health and safety in the home are monitored were viewed and were satisfactory. The kitchen area of the home was visited on the first site visit to the home. The area appeared to be in need of cleaning, and the floor in particular was in need of attention. Many dishes in use were chipped and coffee/tea jugs were very stained. In relation to cleanliness in the kitchen, the registered manager said that they were aware of this, and it was due to the regular kitchen assistant being on leave. Appropriate records were maintained. Training details provided by the home showed shortfalls in core training at the home. This included kitchen staff who do not appear to have been trained in food hygiene, and senior and other staff who have not received training in health and safety. Most staff are up to date with moving and handling training with only five care staff currently requiring update training. Accident records are maintained and audited. The registered manager was advised to review the safety of the bathroom cupboards. These are not secured and contain items such as disposable gloves that may be a potential hazard in a home that is registered for dementia care. Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 27 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 2 X 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X 3 2 X 3 X 1 STAFFING Standard No Score 27 1 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 2 X 2 Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 28 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 OP4 Regulation 18 Requirement The registered person(s) must ensure that staff receive training appropriate to the work they are to perform. This refers to the need for staff to be trained in dementia care for which the home is registered, and to have awareness training in other conditions of old age as appropriate to the assessed needs of residents at the home. 2. OP7 14 The registered person(s) must ensure that all residents have a comprehensive plan of care that contains all relevant information and detail and is reviewed on a regular basis. All other associated care documentation must be maintained in an appropriate manner and in accordance with regulatory and NMS requirements. The previous timescale of 4/9/05, 02/02/06 and 19/06/06 to meet this requirement has not been achieved. Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 29 Timescale for action 01/05/07 01/03/07 3. OP9 13 The registered person(s) must 01/03/07 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into a care home. This refers to the issues raised in the body of the report about the administration, timing and handling of medications. 4. OP10 12 The registered person(s) must ensure that the home is conducted in a manner that respects the privacy and dignity of residents. This refers to the issues raised in the body of the report including preserving residents dignity in relation to continence issues. 01/03/07 5. OP12 12 The registered person(s) must ensure that residents have appropriate choice and control over daily routines within the home. This refers to the issues raised in the body of the report and includes that residents should be able to have breakfast at a time that is suitable for them. In relation to this previous timescales of 28/02/06 and 19/06/06 have not been met. 01/03/07 6. OP16 22 The registered person(s) must 01/03/07 ensure that adequate records are maintained concerning complaints received by the home. This refers to the need to make sure that the Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 30 outcomes/conclusions of complaints are fully recorded. 7. OP18 18, 13 The registered person(s) must ensure that staff receive training appropriate to the work they are to perform. This refers to the need for, particularly senior staff, to receive adequate training in POVA procedures. And for all staff to receive training in managing challenging behaviour. 8. OP22 23 The registered person(s) must have regard for the number and needs of residents at the home and ensure that equipment provided for their use is maintained in good working order. This refers to the issues relating to equipment identified in the body of the report including wheelchairs and Zimmer frames. 9. OP26 18, 13, The registered person(s) must ensure that staff receive training appropriate to the work they are to perform. This refers to the need for staff to receive adequate induction/training in infection control procedures. 10. OP26 16 The registered person(s) must make suitable arrangements for maintaining satisfactory standards of hygiene in the home. This refers to the issues raised in the body of the report including the need to develop suitable deep cleaning Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 31 01/04/07 01/03/07 01/03/07 01/03/07 schedules/procedures. 11. OP27 OP31 18 The registered person(s) must, having regard to the size of the home and the number and needs of residents, ensure that all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate to meet the health and welfare needs of residents. This refers to the need for the registered person(s) to urgently review management, care and ancillary staffing levels and deployment at the home. Details of this review and outcomes to be sent to CSCI. 12. OP29 19 The registered person(s) must maintain statutory records in relation to staff recruitment. This refers to the need to ensure that a recent photograph and documentary evidence of relevant qualifications and training are obtained and available. 13. OP30 18 The registered person(s) must ensure that staff receive training appropriate to the work they are to perform. This refers to the need for staff to receive an adequate and robust induction into the home and needs of residents. 14. OP38 18 The registered person(s) must ensure that staff receive training appropriate to the work they are to perform. This refers to the need for staff Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 32 14/03/07 01/03/07 01/03/07 01/03/07 to receive adequate training in core areas appropriate to their role such as food hygiene and health and safety. 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 OP1 Good Practice Recommendations Prospective residents/their relatives should be given copies of the homes Service Users Guide or other information before moving into the home to help inform their decision. People using the homes interim care beds should be given information about the home, and the interim placement scheme. They should have information and be able to exercise choice about their admission to the home. The registered person(s) should ensure that nutrition records maintained at the home are clear and provide a full and accurate record of resident’s dietary intake. The registered person(s) should ensure that Activities/occupation at the home continue to be developed, so that all individual residents have their needs assessed and an appropriate plan of activity in place. The registered person(s) should review the record keeping processes in relation to activity/occupational provision. The registered person(s) should review the arrangements for managing the admittance of visitors at weekends. The registered person(s) should consider comments made in relation to the food provided by the home and consult with residents about these matters. The registered person(s) should ensure that sufficient and appropriate crockery is available for residents at all times. 2. OP1 3. OP8 4. OP12 5. 6. 7. OP12 OP13 OP15 8. OP15 Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 33 9. OP24 The registered person(s) should consider the provision of mattress covers where appropriate for the comfort of residents. The registered person(s) should make sure that there is an adequate supply of towels at the home that are available to residents at all times. The registered person(s) should ensure that all care staff are facilitated to obtain a National Vocational Qualification. 50 of the homes care staff should be trained to NVQ level two or above. Where residents provide feedback on the running of the home the registered person(s) should ensure that they are aware of what actions are taken as a result of this. Given the findings of this inspection the registered person(s) Should review the effectiveness’ of quality assurance processes used at the home. This to make sure that they are effective in picking up issues that are relevant to residents lives. The registered person(s) should ensure that care staff receive formal supervision at least six times a year. A risk assessment should be undertaken in relation to the risk posed by items stored in bathroom cupboards. 10. OP26 11. OP28 12. OP32 13. OP33 14. 15. OP36 OP38 Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Woodbury Court DS0000061614.V327531.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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