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Inspection on 19/08/08 for Woodbury House

Also see our care home review for Woodbury House for more information

This inspection was carried out on 19th August 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Provides opportunities and support to service users to make choices about their daily lives. Provides consistency of care for service users by an established staff team.

What has improved since the last inspection?

The dining room and various areas of the home have been redecorated and refurbished. There is now stable management that has provided a more clearly defined structure to the home. The home was described as cleaner and fresher. The standard of overall care has improved. Service users are encouraged to participate more in the daily running of the home and interacting with other service users. A written record of handover meetings has been introduced that provides up to date information about service users. The service has reduced the number of service users having liquefied diets.

What the care home could do better:

Provide more frequent one to one supervision for staff. The management team want to continue to improve standards of care. To continue the refurbishment programme to enhance the environment for service users. Provide staff with additional training to enhance the range and quality of daily recording of service users well being and activities. Implement information about the staff on duty to kept in a prominent position.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Woodbury House Joulding Lane Farley Hill Swallowfield Berkshire RG7 1UR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sally Newman     Date: 1 9 0 8 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Woodbury House Joulding Lane Farley Hill Swallowfield Berkshire RG7 1UR 0118 9733885 Telephone number: Fax number: Email address: Provider web address: woodburyhouse@sxhealthcare.co.uk Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Exceler Healthcare Services Limited vacant care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 12 0 Over 65 0 33 Date of last inspection Brief description of the care home The property is a large converted country house that has rural views across the Berkshire countryside on the outskirts of Farley Hill near Reading. There is no public transport to the area; ample car parking spaces are available on the site and the service has its own transport vehicle. Woodbury House was part of the Ashbourne Healthcare Group; since the previous inspection in October 2005 the service has been sold; the operating company is Southern Cross Healthcare Group. A change to the registration of Woodbury House has been made; the service continues to provide personal care with nursing for up to 33 Older people and also residential Care Homes for Older People Page 4 of 26 care in a segregated unit on the first floor for up to 12 persons over the age of 50 years who have special needs including early dementia. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection that was conducted over the course of 3 days and included a visit to the service of 6 and a half hours duration. Information provided by the previous manager prior to the visit and records held by the Commission were referred to. A tour of the premises was undertaken and a range of records were seen. Three members of staff were spoken to in private and discussion was undertaken with the manager. The chef and a visiting relative were spoken to. Observation of care practise and interactions between staff and service users was conducted throughout the visit. There were a number of requirements arising from the last inspection that had been met. The home as improved since the last inspection with all outcomes areas now Care Homes for Older People Page 6 of 26 being judged as good. The manager demonstrated that he was well aware of the areas still requiring work and development. Overall the home is an improving service and no requirements or recommendations have been made on this occasion. The provider has a range of polices and procedures relating to equality and diversity. From the evidence seen the inspector considers that this service would be able to provide a service that meets the needs of individuals of various religious, racial or cultural needs. No complaints have been received about this service by the Commission since the last inspection. The current fees range from £550 to £850 per week. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All prospective service users have their needs assessed prior to a place being offered. Evidence: It was evident from the 6 care plans seen that the service completes pre-admission assessment documentation and obtains information from a range of appropriate sources. The manager confirmed that either he or the senior nurse visit the prospective service user for a face to face meeting. Local Authority Social Services care management assessments were on individual service user files where the Local Authority was funding the placement. Where prospective service users were selffunding the service uses a pre-admission assessment document that records all the relevant information required in order that appropriate care can be given once the service user moves into the service. Care Homes for Older People Page 10 of 26 This initial information is then expanded upon as the needs of the service user are fully understood. From the documentation see the information obtained prior to admission was sufficient to guide staff in meeting the needs of these service users. This service does not provide intermediate care. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal and social care needs of service users are met and are recorded in a plan of care. The arrangements for medication are robust and protect service users. Evidence: Care plans contained appropriate information that was easily accessible. The needs of service users was clearly indicated and guidance for staff on how these needs were to be met was provided in plain English. A designated section within care plans provided extremely useful information about individuals’ preferences and likes and dislikes in a range of areas including personal care, interests, mobility and religious beliefs. A list of medication taken and all hospital and health professional contacts was maintained. There was evidence that regular reviews of care plans take place. The relative spoken to confirmed that she had been involved in reviews of her mothers Care Homes for Older People Page 12 of 26 care, which had been very useful and informative. Risk assessments were in evidence and were individually focussed. Daily contact sheets are maintained for each service user. The senior nurse indicated that she was trying to guide staff in expanding the information in the daily contacts possibly by using prompts so that a fuller picture of the daily activities undertaken by each service user was recorded. The service uses a monitored dosage system for medication and only staff who are appropriately trained administer medication to service users. It was stated by the manager that the service may transfer its medication supply needs to Boots so that a periodic pharmacist visit to assess the medication arrangements within the home can be secured. In addition, a transfer would enable easier access to medication training for staff. A report was seen dated 4.2.08 that was completed by a Pharmacist from the Primary Care Trust and concluded that the service meets the national minimum standard in relation to medication. Information provided by the senior nurse confirmed that there had been no medication errors in the previous 12 months. The service does have a policy relating to the rights and dignity of service users. Staff were observed to address service users appropriately and with respect. The relative of a service user spoken to confirmed that staff are always polite and respect their right to privacy. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are provided with opportunities to participate in activities both outside and within the home according to their individual needs and preferences. The food provided is healthy and balanced and mealtimes are unhurried. Evidence: The home benefits from an activities organiser who was on annual leave at the time of the visit to the home. The activities timetable indicated that daily activities are arranged within the home on most days including light exercise, crafts music and discussion groups. Birthdays, anniversaries and special occasions are celebrated. One staff member advised that an American Independence day celebration had been particularly successful and a recent fête had raised much needed funds for the home. There was also evidence that outings outside the home periodically take place including pub visits, a Christmas concert and country parks. One staff member felt that the opportunities for outside activities had reduced in the last few years. Care Homes for Older People Page 14 of 26 Care plans indicated the particular preferences of individual service users as to the time they like to go to bed and the time that they get up in the morning. There was evidence from documentation seen that some service users like to have their breakfast in bed and this is accommodated. An inventory of personal possessions is maintained within care plans. Service users are encouraged and supported to make decisions for themselves. At the mid-day meal service users were observed being asked what they would prefer to eat and it was clear that some service users had changed their minds from the original choice they had provided. It was evident from records maintained on each unit that some service users like to have a cooked breakfast but as confirmed by the manager this can change from day to day. All service users are given a choice of what they would like to eat and their preferences are clearly recorded in care plans. Time was spent talking with the chef. The home uses a four weekly menu that is provided by the organisation and has been nutritionally assessed by a dietitian. The chef confirmed that fresh ingredients including fruit and vegetables are used every day. Records confirmed that fridge and freezer temperature checks are undertaken regularly. A food safety inspection was conducted by the Environmental Health Dept recently and a good 3 star rating was given. The senior nurse confirmed that she had arranged an assessment by a Speech Therapist for service users who were on on liquidised meals. As a result of these assessments only three service users remain on fully liquidised diets. Service users were observed being assisted with eating their meals appropriately by staff. Overall the meal time was calm and unhurried. It was noted that the dishwasher had not been working for several months. The manager confirmed that finance had now been agreed to purchase a replacement, which should be operational in one months time. The manager confirmed that there are no restrictions on visiting times. The visitors book provided evidence that there are regular visitors to the home. The relative spoken to advised that she never visits her mother announced and arrives on different days and at different times. She has always felt welcomed and find staff helpful and courteous. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users and their relatives can be confident that their complaints and concerns will be listened to and acted upon without delay. Service users are protected from abuse and neglect. Evidence: The organisation has a clear complaints policy and procedure that is made available to service users and their relatives. The complaints record was seen. It contained entries that had been appropriately addressed and with the outcome clearly recorded. Consideration should be given to filing complaint correspondence relating to particular service users within their individual file to ensure confidentiality. In discussion with the relative it was apparent that they knew who to speak to if they were not satisfied. They gave an example of a concern they had raised, which had been dealt with appropriately and efficiently. The manager confirmed that all staff receive training in the protection of vulnerable adults and he provided documentary evidence in the form of a training profile. This information indicated that the manager needed to undertake protection of vulnerable adults training. He confirmed that he would access appropriate training as a matter of urgency. It was clear from discussion with staff in private that they provided a sound Care Homes for Older People Page 16 of 26 understanding of the principles and potential for abuse and were clear about what action they needed to take should a suspicion of abuse arise or an allegation be made directly to them. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a safe and well maintained environment that is clean and hygienic. Evidence: A tour of the premises was undertaken. The home was clean throughout. A refurbishment programme has commenced that has seen redecoration and replacement of furniture in the dining room and redecoration of other parts of the building and new floor coverings in some areas. This refurbishment is ongoing and the manager was well aware of the outstanding work to be undertaken. The relative commented that the home was now cleaner and fresher than it had been some time ago. It was noted that one of the lifts was out of order. The manager confirmed that the finance for a major repair had now been agreed and he was awaiting dates from the relevant company. It was not his view that service users had been inconvenienced by the lift not working because they had made alternative arrangements for those service users effected. The laundry is sited conveniently and there are policies and procedures in place for Care Homes for Older People Page 18 of 26 the control of infection. The relative spoken to confirmed that she had noticed improvements in the laundry service in that all clothing is now correctly and clearly labelled. She also stated that she always found her mother to be wearing her own clothes which were freshly laundered. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are cared for by a well trained and dedicated staff team. Evidence: It was the view of the majority of staff spoken to that the deployment of staffing throughout the home was adequate to meet the needs of the current service users. The management of the unit supporting elderly people who were mentally infirm was being reviewed following the departure of the unit manager approximately three weeks ago. Other than this vacancy the home is currently fully staffed. Agency staff are rarely used and many of the exisiting staff have been working at the home for several years. There are dedicated domestic staff who do not undertake any personal care tasks. There is a national vocational training programme within the home and all staff are encouraged to undertake this professional training. The departure of the unit manager has meant that the home has also lost their in house trainer and assessor. The manager has already made links with a local college that provides NVQ courses and it is hoped that the services of an alternative assessor can be secured without too much delay. Care Homes for Older People Page 20 of 26 There was evidence from staff files that new recruits undergo induction training. A rolling training programme is provided for staff that covers all core training such as moving and handling, first aid, medication, and fire awareness. One staff member spoken with had attended dementia training which they had found very useful in their day to day work at the home. The manager advised that a review of personnel files had been undertaken to address missing documentation. Of the four staff files seen one did not have the required documentation in respect of two written references. However, this particular member of staff had been employed at the home for in excess of 10 years. The manager confirmed that the process of updating these files was ongoing. Staff meetings are held approximately 6 monthly. The minutes for the lastest were not available. It was noted that one to one supervision was being provided approximately twice per year. This does not meet the required standard or the expectation of the organisation. However, it was generally reported that communication between staff was good and that individual staff members felt well supported. Staff handovers that occur twice per day are now recorded. The manager wants to implement an information board in the reception area that will show photographs of all the staff on duty. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a well run home that takes account of their views and wishes. The health and safety procedures protect service users and staff. Evidence: The manager is qualified and experienced. He has not completed the registration process but is hopeful that this will be concluded in the not too distant future. The manager advised that he operates an open door policy where staff can come to him directly if they have a problem. This was confirmed by one member of staff who advised that he had approached the manager shortly after his appointment and he had found him to be fair and understanding. The manager was described as Care Homes for Older People Page 22 of 26 competent, calm and approachable. It was apparent through discussions with the manager that he is well aware of his responsibilities and obligations and that he is well supported by the operations manager who visits the service at least monthly. The manager confirmed that service user and relative questionnaires were circulated earlier in the year but to date none had been returned. He was not aware of an expectation on the part of the organisation for him to complete an annual service review however, he undertook to see what the expectation was in this regard. All policies and procedures are reviewed regularly by the organisation. The manager undertakes a thorough monthly audit of the operation of the service covering a wide range of areas. This includes auditing the medication arrangements and accidents in order to identify any patterns or trends. An audit of the arrangements for service users monies was not undertaken. The manager confirmed that there is a robust system overseen by the administrator who was not on duty at the time of the visit. The organisation also conducts periodic financial audits and the operations manager undertakes, as part of their responsibilities under regulation 26, reviews of the arrangements for service user finances. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!