Inspection on 08/05/08 for Woodcote Hall

This inspection was carried out on 8th May 2008.

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

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

Woodcote Hall 11/11/09

Woodcote Hall 27/01/09

Woodcote Hall 18/04/07

Woodcote Hall 16/08/06

Woodcote Hall 01/03/06

Woodcote Hall 04/10/05

Woodcote Hall 30/03/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Woodcote Hall Woodcote Newport Shropshire TF10 9BW Lead Inspector Joy Hoelzel Key Unannounced Inspection 8th May 2008 09:15 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 Woodcote Hall DS0000061781.V363929.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. Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodcote Hall Address Woodcote Newport Shropshire TF10 9BW 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) 01952 691383 01952 691635 woodcotehall@btconnect.com Select Healthcare Limited Vacant Care Home 56 Category(ies) of Dementia (1), Old age, not falling within any registration, with number other category (56) of places Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home may accommodate a maximum of 56 Older Persons and a maximum of 1 Younger Adult. The home may accommodate a maximum of 28 users requiring nursing care. The home must provide for 56 service users: 08.00-14.00 14.00-22.00 22.00-08.00 2 RGNs 2 RGNs 1 RGN 6 Care Assistants 6 Care Assistants 5 Care Assistants One named resident as per discussion of 13.09.05 4. Date of last inspection 18th April 2007 Brief Description of the Service: Woodcote Hall is a care home providing accommodation, personal and nursing care for up to fifty-six older people. It is privately owned by Select Healthcare Ltd. and is one of a number of care homes within the company. The Home is set within it’s own grounds and sited directly off the A41, south of the town of Newport. There is a selection of communal use rooms, most bedrooms are single occupancy and some have en suite facilities. There is a passenger lift to access the first floor. Information of the home and the provision of the service are available in the statement of purpose. Currently this document does not include information on the current level of fees for the service. The reader may wish to obtain more up to date information from the care service. Commission for Social Care Inspection reports for this service are available from the provider or can be obtained from www.csci.org.uk Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection took place over five and a half hours on Thursday 8th May 2008. Twenty three of the thirty eight National Minimum Standards for Care Homes for Older People were inspected as they are viewed as key standards for services. Forty four people are currently living at the home and during the inspection were observed to be accessing all areas of the home. A recently appointed Matron was in charge of the home, supported by two registered nurses, six care staff and ancillary personnel. The area manager arrived at the home during the afternoon. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of a number of people using the service were viewed including care plans, daily records and risk assessments. Other documents seen included medication records, service records, some policies and procedures and staffing records. Discussions were held with people living, visiting and working at the home. The service has had several unannounced random inspections since the last key inspection in April 2007 and these are summarised below. A random unannounced inspection was made 29 August 2007 following concerns we, the commission, received about staffing levels and a requirement was made to ensure that the home was sufficiently staffed at all times. A random unannounced inspection was made 9 February 2008 again following concerns regarding staffing levels. The inspection evidenced that staffing levels were not meeting the needs of the people using the service, with their health and welfare being adversely affected. The findings of this inspection resulted in the serving of a Code B notice, which is used whenever we are involved in an investigation which may result in a criminal prosecution-in this instance Woodcote Hall had breached Regulation 18 (1)(a) of the Care Homes Regulations 2001, which is an offence under the Care Standards Act 2000. A statutory requirement notice was issued, 13 March 2008, and sent to the company secretary informing of the action they must take to comply with the regulations within the given timeframe. Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 6 A random unannounced inspection was made 18 March 2008; the reason was in relation to two further anonymous complaints that we received expressing concern about the care that people were receiving, the home being dirty and that it was ‘understaffed for the amount of frail people in residence’. A random unannounced inspection was made 1 April 2008, to check compliance with the Statutory Notice that was issued for the breach of Regulation 18 (1)(a) of the Care Homes Regulations 2001, which is an offence under the Care Standards Act 2000. The findings of this inspection evidenced that outcomes for people living at the home were poor with people having to wait for unacceptable periods of time before being offered assistance and support from staff. This has the potential for people to be at risk of not having their health and personal care needs fully met with their dignity and choice being compromised. The home had not complied with the statutory requirement notice that was served in March 2008 and the home remained in breach of Regulation 18 (1)(a) of the Care Homes Regulations 2001, which is an offence under the Care Standards Act 2000. A meeting was arranged 22 April 2008, to discuss the breach of the regulations with representatives of Select Healthcare Ltd and an interview under the Police and Criminal Evidence Act 1984 under caution was conducted. This inspection has shown us that improvements are being made, staffing levels have been revised, and outcomes for people using the service have improved. However, further enforcement action is being considered. The service must now sustain and further develop these improvements to ensure the effectiveness and continuity of good outcomes for the people residing at the home. What the service does well: A full assessment of a person’s care needs are obtained prior to offering a placement at the home, this ensures that staff have the information to meet those needs. Three visitors spoken with during the day stated • • • ‘ Things have greatly improved over the last 3-4 weeks, ‘ Very satisfied with the care provided’ ‘The staff are brilliant, very caring and cannot do enough’ Three people living at the home stated – • • ‘The food is good’ ‘Staff are very good but nothing is like your own home and I am hoping to return home shortly’ DS0000061781.V363929.R01.S.doc Version 5.2 Page 7 Woodcote Hall What has improved since the last inspection? What they could do better: The current statement of purpose is not user friendly; the service is developing an improved statement of purpose which will set out the aims and objectives of the home and include a service user guide, which provides information about the service that the care home offers. When ever possible care plans should be developed, agreed and reviewed with the individual person and/or representative. More attention should be given to increasing the variety, frequency and range of social and leisure activities to meet the needs and personal preferences of all the people living at the home. The input of the recent recruitment of the social activities coordinator will be determined in due course. Repairs to the main drive would reduce the risk of accidents to all people living, working and visiting the home. The wardrobes provided by the home should be securely fixed to ensure the safety of people living, working and visiting the home. Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 8 Staffing levels and skill mix should continue to be determined by the assessed needs of the people living at the home, to ensure that care needs are fully met and that outcomes for people are improved. 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. Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 9 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 Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 10 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): OP 1,3,6 Quality in this outcome area is good The home understands the importance of having sufficient information when choosing a care home. People can now be confident that the care home can support them. This is because there is a new accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service is currently developing an improved statement of purpose, which will set out the aims and objectives of the home and include a service user guide, which provides information about the service that the care home offers. Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 11 The new Matron confirmed that the information document would be available shortly. The case file of the person who recently moved into the home was looked at to see if information had been sought regarding this persons needs prior to moving into the home. A letter is on file from a previous social care placement giving details of individual requirements, in addition a member of staff at the home completed an assessment. The assessment identified specific religious, dietary and cultural needs ensuring that staff were prepared and able to meet the care needs. Other case files looked at included information from social worker reviews; assessments from Primary Care Trusts and community care services. The new Matron discussed the admission procedures and acknowledged the need to maintain a robust system to ensure that prospective residents are not offered a placement unless the home can be certain that care needs can be fully met. One visitor commented of how she felt that it was a huge responsibility when she had to find a care home for her father but felt that she ‘couldn’t have found a better place for him’. The home does not provide an intermediate care service. Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 12 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): OP 7,8,9,10 Quality in this outcome area is adequate. Each individual has a care plan but the current practice of involving residents and/or their representative in the development and review of the plan is variable. The plan includes basic information necessary to deliver the person’s care but is not detailed or person centred. Implementation of the revised care planning documentation should focus on an individual’s particular needs in a person centred way. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All people living at the home have a case file that includes risk assessments and care plans for any identified care needs. Five case files were selected for inspection and were for people who had been at the home for varying lengths of time. The files contain documents for a Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 13 variety of care needs but not all had been fully completed or offered staff the full information to ensure that care needs are fully met. There was little evidence in the case files selected to suggest that people or their representatives are being fully involved with the care planning process. A visitor confirmed that they were aware that their relative had a care plan but had not been invited or offered the opportunity to contribute to the process but stated that was ok and was ‘happy to leave it to the staff’ but went on to say they would like to be informed of any changes to his relative’s condition. It is acknowledged that some people may not wish to or are unable to contribute to the process but efforts should be made to ensure that the plan of care is discussed and agreed with the individual and/or representative. The new matron confirmed that a review and revision for all case files and care plans is currently receiving attention and demonstrated this by offering a case file that had recently been reviewed. Staff have been instructed on the required standard of documentation and recording of care needs. The new plans, if used, will show that long term and short-term health needs are monitored and appropriate action and intervention taken. Staff were able to provide a verbal update of the care of people who use the service and described the individual and diverse care needs. However observation of staff working practice did not consistently evidence that a person’s privacy and dignity are being upheld. For example not all staff were knocking on bedrooms doors before entering, continence aids were openly on show in bedrooms and staff were overheard to be chatting together whilst assisting with personal care. This was discussed with the new Matron at the time and again she offered an assurance that this is on the agenda for training and discussion with staff. The home operates a twenty eight day prescribing regime for the administration of medication using a monitored dosage system with the additional use of boxes and bottles of medicines. The registered nurses administer the medications from the two medication trolleys. The Medication Administration Record charts appeared to be completed as no gaps in the recording were noticed in the selection of charts seen. One chart looked at did not indicate the route of the administration of the medication, the nurse confirmed that all medications to this person are dispersible and demonstrated knowledge of the clinical guidelines for this. The pharmacist undertook an audit for the medication in May 2008 and a follow up visit is planned for June 2008. Concerns were identified at the Random inspection 1 April 2008 regarding the length of time the nurses were taking to complete the 08:00 medication round. They were observed to be dispensing the medication at 10:45 the nurse Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 14 confirming that these were the early morning tablets. The concern related to the possibility of a person receiving medications without the required length of time required in between repeat doses. During this inspection the medication round was observed to be complete at 09:30. The registered nurse commented that amendments to the working practice had been made since the random inspection in April 2008. Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 15 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): OP 12,13,14,15. Quality in this outcome area is adequate. Generally staff are aware of the need to support residents with the activities of daily living but this process could be improved. Improvements have been made to meals and mealtimes; further improvements are needed to ensure people enjoy the social aspect of dining. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A monthly newsletter is being produced by the new matron and includes a programme of activities planned for during the month. The new matron explained that recruitment for a social activities coordinator has been successful with an anticipated start date the beginning of June. It is then expected that there will be an increase in the variety and frequency of activities. Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 16 During the day there appeared to be very little structured social or leisure activity as staff were extremely busy with attending to the personal care needs of people and assisting with their preparations for the day. Twenty one people were in the day lounge, thirteen were sitting in wheelchairs, the television was on, some people were asleep in the armchairs, and other people were watching the happenings of the day. Currently staff facilitate leisure and recreational activities as and when time and work constraints allow. Visitors are welcome to the home and can visit at times suitable for the person living at the home. Visitors stated that they were satisfied with the visiting arrangements and appeared to be comfortable and relaxed whilst visiting. The main front door is kept locked at all times for security reasons; a controlled circuit television camera is sited at the front door enabling staff to see the identity of the caller. Entry is gained by staff releasing the lock. Exit from the home is by push button control by the front door. During the tour of the premises most bedrooms had been personalised and contained the photographs, pictures and personal items belonging to the person. People are encouraged to have their meals in the dining room but are able to have meals in other areas of the home if they wish. The new matron explained the revision of availability of breakfast ensuring that each person has breakfast at a suitable time. Lunch is now served at 12:30 following suggestions from staff and residents that previously it was available too early and too soon after breakfast. The new matron confirmed that an order had been placed for table linen, cutlery and condiments and were expected to be available at the home shortly. This will then ensure that the dining room can be fully prepared prior to serving meals and enhance the social aspect of dining for people living at the home. A daily menu is available and displayed at the entrance of the dining room indicating the choice of the day. The care staff serve the meals and were observed to be assisting discreetly when people needed help. One person stated that ‘ the meal was lovely and couldn’t be better in a hotel’ other people said the meal ‘was poor’. The new matron explained the amendments and changes recently made to meals and mealtimes and offered an assurance that snacks and drinks are available through out the twenty four hour period. Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 17 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): OP 16,18 Quality in this outcome area is adequate. The service has a complaints procedure that meets the national minimum standards and regulations and is displayed on a notice board in the home. There have been a number of complaints about the same issues that have not been addressed in a timely way. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Details of how to complain are displayed at the entrance to the home and have been included in the statement of purpose. Three people stated they would speak with the new Matron if they had any concerns and also speak with their relative. One person stated that they generally don’t like to complain but has spoken with the new Matron about a few issues and received a satisfactory explanation. An unannounced random inspection was carried out on 29 August 2007 to look at the staffing levels following three complaints of insufficient numbers of staff at the home. A further eleven concerns were received from August 2007 to March 2008 regarding staffing issues. Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 18 The previous registered manager and area manager were contacted and involved with investigating the complaints. An assurance was given that a recruitment drive for care staff was ongoing and that staffing levels were adequate for the numbers of people living at the home. Unannounced random inspections were carried out in February, March and April 2008 to check the staffing levels and the care that people living in the home were receiving. It was evidenced that people had to wait for considerable periods of time to have their care needs fully met. Inspection reports for these visits are available upon request. As the home was in breach of Regulation 18 of the Care Homes Regulations 2001, a statutory requirement notice was issued to • Ensure that the staffing numbers are appropriate to the assessed needs of the service users, the size and layout and purpose of the home, at all times. Consideration is being given to further enforcement action. We have received no further concerns since March 2008, but the new Matron informed that concerns have been raised to her of laundry items ‘going missing’. Following investigation into this, a satisfactory explanation was offered; the missing clothing has been found and returned to the original owners. Two referrals were made to the safeguarding adults team in November and December 2007 following allegations regarding issues of care, the previous registered manager was fully involved with the investigations and offered her full support. One of the referrals is now closed with the other still to reach a satisfactory conclusion. As part of the specialist inspections taking place throughout the region this week, and as part of this inspection people living in care homes were asked if they knew who to speak with if they felt unsafe or uncomfortable – three people living at Woodcote Hall responded that they ‘would tell the new matron or the staff’. Staff stated that they have seen the policies and procedures for safeguarding and discussed the action they would take if they had any suspicions and demonstrated an understanding of the whistle blowing procedures. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this have been maintained and fully receipted. Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 19 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): OP 19,24, 26 Quality in this outcome area is adequate. The home provides a physical environment that generally meets the specific needs of the people who live there. The home is comfortable and has a programme to improve the decoration, fixtures and fittings. Occasionally there is slippage of timescales and maintenance tends to be reactive rather than proactive. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Woodcote Hall is situated in a rural locality set in open countryside. The property is a large manor house, which has been extended and has had alterations throughout the years to provide the accommodation for a social Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 20 care home. The gardens to the side of the property are accessible to people living at the home and people state that they enjoy sitting in the garden whenever the weather permits. The main drive is in need of attention as there are many potholes in the road. Different areas around the home are in need of attention with the routine maintenance, redecoration and the renewal of fabric and fittings continuing. The CCTV camera is sited at the main entrance of the home and is used for security purposes only. Some of the magnetic door closures fitted to private and communal area doors were not working, with some doors being propped open with pieces of furniture. The new Matron took immediate action to ensure that they were in working order. The Environmental Health Officer visited recently advising of the re-location of the pantry and for a replacement floor in the main kitchen area. Work has been completed in both areas. During the tour of the premises a selection of bedrooms were looked at, there was variety of bedroom furniture that has been provided by the home, some of which is in a poor state and in need of replacement. The decor of the bedrooms also varies greatly with some rooms in need of redecoration and refurbishment. The new Matron confirms that new bedroom furniture is on order and that plans are in hand for decorating. The communal areas appeared clean and comfortable but in need of improvement and attention, many items, wheelchair footrests, condiments, books, dead flowers, gave the home a messy look and uncared for in places. Some of the wardrobes provided by the home had not been secured to the wall to prevent them from toppling over and causing injury. Not all bedrooms doors have been fitted with an appropriate locking facility and not all toilet and bathroom doors have a lock or ‘in use’ indicator. The lack of these has the potential of not preserving a person’s privacy and dignity. The new matron informed that the central heating and hot water boilers have been serviced by outside contractors, there had been previous concerns that the some areas of the home were not being maintained at an ambient temperature and hot water temperatures were not at a suitable level. Infection control within the home is being compromised by staff working practice, during the tour of the building items of soiled and dirty laundry and continence aids were placed directly on the floor in some bedrooms and not being placed directly into wheeled skips. This was discussed at the time of the Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 21 inspection with the new Matron who offered an assurance that staff would be instructed to amend working practice. Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 22 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): OP 27,28,29,30 Quality in this outcome area is adequate. People are generally satisfied with the care they receive to meet their needs, but there are times when they may need to wait for staff support and attention. There is currently a limited understanding of the person centred way of delivering care and support, the planned changes should give staff the opportunity to deliver the individual care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The new Matron confirmed that forty four people are currently living at the home, with a staff complement on the morning of the inspection of two registered nurses and six care staff. Catering and domestic staff are additional. A duty rota is maintained on a weekly basis to identify the members of staff in the home at any one time. Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 23 The new Matron is currently developing a team of bank staff and the use of agencies to provide staff is now minimal. A key worker system is in place with staff having the responsibility of the extra care of a group of residents. A meeting has been held with the staff to explain the additional responsibilities and it is anticipated that the provision of care will improve. Staff meetings have also been held with all staff and revised systems of working have been implemented. Three care staff and one registered nurse discussed the recent changes and the improvements made. One staff member stated ‘The home has much improved since the new matron took over. Lots of changes taking place, the increase in the staffing levels is beneficial, not so rushed and worn out. Morale is now better’ Visitors spoken with also commented on the improvement in the staffing levels and of the use of permanent staff and not the previous reliance on agency staff. ‘There have been improvements during the last three to four weeks; my relative appears more content and settled. Staff seem much happier’ General observations of daily activity and discussions with people suggested that staffing levels have improved, however, the service must ensure that there is a continuity and sustainability of the improvements. The majority of the complaints made between August 2007 and March 2008, were in relation to insufficient staffing levels and that people had to wait for long periods of time for care interventions. This was evidenced during the inspections in February and April 2008. During this inspection improvements were noted in that people were receiving assistance at a more reasonable time, however, one person described their particular morning routine and felt that the practice suited the staff and not them personally. This was discussed with the new matron who offered an assurance that with the revision of the care plans, person centred care would be discussed, documented and implemented. It was not possible on this occasion to access the complete training records or training matrix due to problems with the home’s computer system. The new Matron discussed the many training opportunities that have recently been arranged for staff. Training opportunities were displayed in the staff office and the selection of personnel files looked at contained some certificates and accreditations of training. On the day of the inspection, staff were attending fire safety training. Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 24 Four staff personnel files were selected for inspection and indicated that suitable recruitment procedures are in place. Each file contained references, criminal record bureau disclosures and confirmation of identity. Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 25 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): OP 31,33,35,38 Quality in this outcome area is adequate. The new Matron is qualified and has the necessary experience to run the home, and is improving and developing systems that monitor practice and compliance with the plans, policies and procedures of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last key inspection in April 2007 the registered manager has taken retirement and another person has been recruited. Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 26 Ms Kay Davis is a registered nurse and has had sixteen years experience of managing a social care home. Ms Davis has yet to make a formal application for the position of registered manager, but has made several changes, amendments and improvements since her arrival at the home. Ms Davis offered a clear understanding of the key principles and focus of the service and discussed the plans for improvement. These, when implemented, will improve the quality of life for residents with a focus on equality and diversity issues and promoting human rights, especially in the areas of dignity, respect and fairness. People living, working and visiting the home spoke of the improvements made since her arrival at the home and were confident of more changes and improvements to come. Time will determine the effectiveness of the changes to the management of the home and providing good quality outcomes for the people in residence. The monthly newsletter distributed within the home includes a satisfaction survey. Six have recently been completed either by the resident or the relatives and returned to the matron. Comments included – • A bit shabby, • Clothes go missing, • Commode not emptied till 7pm, • Sometimes have to wait ½ hr for care • Bed not made till late. • Staff are polite, courteous and caring • Satisfied with bedroom, dining room and lounge • Suitable menu The new Matron plans to discuss the findings with staff during the regular meetings that are held. Other quality assurance and monitoring systems, including the provider’s monthly reports of the premises have not highlighted any concerns in these areas. But many of the concerns raised during August 2007 and March 2008 were of similar issues as those raised in the recently completed satisfaction surveys. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this were seen and have been maintained and fully receipted. Records are maintained for the weekly, monthly and annual health and safety checks. The new matron informed that the suppliers of wheelchairs have been contacted and a full audit of the wheelchairs has been requested. Staff have had recent training for the safe use of bedrails, with the new Matron stating that bedrail safety and checks will now be responsibility of the key workers. During the tour of the building some bedrails on the beds appeared to Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 27 be not fitted correctly with a potential for causing injury to the person in the bed. The new matron confirmed that a full audit of the beds would be completed to ensure that all bedrails in use will be suitable and compatible with the type of bed and safe. The records for checking the temperature of the hot water indicated that at most outlets the water had a reading of around 37 degrees Celsius. For the comfort and safety of people the water temperature should be maintained at around 43 degrees Celsius. Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 28 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 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X 2 X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 29 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 OP8 Regulation 12(1)(a) Requirement Timescale for action 08/05/08 2 OP10 12(2)(3) (4)(a)(b) 3 OP38 13(4) The service must make proper provision for the health and welfare of people who live at Woodcote Hall to ensure that they receive the nursing, personal care and monitoring that their conditions require. Previous timescale for compliance being 01/04/08 – not met. Suitable arrangements must be 08/05/08 made to ensure that people living at the home are treated in a way that respects their privacy, dignity, wishes and feelings. Previous timescale for compliance being 01/04/08 – not met. Bed rails must be assessed, 08/05/08 fitted and maintained in accordance with MHRA/HSE guidance. This is to protect the person from the risk of harm and promote their safety Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 30 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 The statement of purpose and service user guide should be updated to contain current and accurate information of the service provision, so people can make informed choices about the home’s service and understand what is offered. The service user guide should include information on the current level of fees. Information in the care plan should accurately reflect the care that is being offered and provided. When ever possible care plans should be developed, agreed and reviewed with the individual person and/or representative All people should be offered opportunities to engage in leisure and recreational activities to suit their personal preferences People should be supported and helped to exercise choice in daily living to ensure that whenever possible they are in control of their own lives. People should receive wholesome, balanced diets in pleasing surroundings at times convenient to them. Concerns and complaints should be dealt with in a timely way to ensure that people will be confident that they are being listened to and their concerns taken seriously. Repairs to the main drive would reduce the risk of accidents to all people living, working and visiting the home. The magnetic door closures fitted to private and communal area doors should be in working order to ensure the safety of people living in and working at the home. Doors to service users private accommodation should be fitted with locks suited to individuals capabilities to ensure that privacy and dignity is upheld. Toilet and bathrooms doors should be fitted with a suitable locking facility/’in use’ indicator to ensure that privacy and dignity are upheld. Amendments should be made to staff working practice to ensure effective infection control is achieved and maintained. Staffing numbers should continue to be reviewed and increased in line with the dependency needs of the people DS0000061781.V363929.R01.S.doc Version 5.2 Page 31 2 3 4 5 6 7 8 9 10 11 12 13 OP7 OP7 OP12 OP14 OP15 OP16 OP19 OP19 OP24 OP24 OP26 OP27 Woodcote Hall 14 OP28 15 16 OP30 OP31 17 18 OP33 OP38 and taking into account the lay out and purpose of the home. The home should achieve a ratio of 50 of trained care staff to ensure that suitably qualified, competent and experienced staff are working at the care home at all times All staff should receive the training and development requirements relevant to their job description to ensure that staff are competent and trained to do their job. A formal application for the position of registered manager of the service should be made as soon as possible. This will ensure that a competent and experienced person is managing the home on a daily basis. Quality assurance and monitoring systems should be further developed to ensure that the home is run in the best interests of the people living at the home. For the comfort and safety of people the hot water temperature should be maintained at around 43 degrees Celsius. Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Woodcote Hall DS0000061781.V363929.R01.S.doc Version 5.2 Page 33 - 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!