Inspection on 18/11/05 for Woodcote House

This inspection was carried out on 18th November 2005.

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

Woodcote House 23/02/07

Woodcote House 02/02/06

Woodcote House 14/03/05

Woodcote House 28/10/04

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

CARE HOMES FOR OLDER PEOPLE Woodcote House 167 Sandy Lane South Wallington Surrey SM6 9NP Lead Inspector David Pennells Unannounced Inspection 18th November 2005 12:00 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 Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 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 House DS0000007206.V254390.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Woodcote House Address 167 Sandy Lane South Wallington Surrey SM6 9NP Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8395 4010 020 8395 5668 Brook Care Homes Elizabeth McNally Care Home 11 Category(ies) of Dementia - over 65 years of age (11) registration, with number of places Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. One service user is under the age of 65. Date of last inspection 14th March 2005 Brief Description of the Service: Woodcote House is an extensive family style house set on a busy road to the south of Wallington. Though a distance away from local ‘town’ facilities, the home is close to bus connections and a few local amenities such as a newsagent, etc. The house provides social care with nursing - predominantly for older service users with dementia or related conditions - though some of the current service user group are under other excepted categories. This specific service has been provided here at Woodcote House - for the current user group - since the end of July 2004, when almost the whole community moved en masse to this new location from another home, Beeches House in Carshalton Beeches. Service users and their carers have indicated that they are happy with the location of the house and the facilities they now have. The house has seven single bedrooms and two double-occupancy rooms. Toilets and bathrooms are provided around the building. The house has a pleasant lounge, an adjoining dining room and a smoking lounge. Outside there is a patio area and a large lawned garden at the rear - both of which have a potential for development. Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was conducted over a period of about half a day, the inspector arriving at lunchtime, and staying until after supper. During this time, the inspector was able to meet staff, service users and the manager of the home –who was most cooperative in helping the inspector assess progress in meeting the requirements and recommendations from the last inspection visit - as well as providing information about the present operation of the home, reflected through the Pre-inspection Questionnaire which had been completed and returned to the Commission. The inspector is grateful to the service users, staff and the manager for their welcome, cooperation and hospitality shown throughout the inspection. The inspector had received four very positive responses to the service user comment card questionnaire, and six from service user’s relatives or friends. The advocate’s responses were universal in general approval of the service, though three did make the point that they felt that more direct stimulation – not the TV – was needed to encourage mental stimulation rather than sedentary passivity. What the service does well: What has improved since the last inspection? Following an OT assessment of the premises, a fixed shower chair has been provided in the shower room and new flooring and a smaller washbasin installed in the down stairs communal-use toilet. The kitchen – and some bedrooms have been repainted. Outside, a ramp grab rails and a gate have been provided to enable flat access to the rear patio – a much-used area in the summer. Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 Page 6 Since the last inspection visit, all service users have been given ‘local’ contracts; the Complaints procedure has been revised, staff supervision has been restored to the necessary frequency and medication profiles have now been devised and provided in the service users medication records. 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. Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 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 Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6. Prospective service users can be confident that the information that is necessary for making an informed choice as to whether the home could meet their needs will be provided, with full detail included. Service users at the home will be clear about terms and conditions set by the home through the provision of a written document served on each individual. Service users can be assured that their needs and aspirations will be fully assessed and recorded prior to a placement and on an ongoing basis, once they are resident at the home. EVIDENCE: The home’s Statement of Purpose is in place in writing and clearly states the home’s physical dimensions - as required by revised Standard 1.1 - this appears also in the Service User’s Guide. The manager confirmed that all service users or their relatives have now all been given - by the Company’s General Manager - a copy of home’s Statement of Purpose, the home’s Service User Guide and also a copy of the ‘local’ home contract – to lodge alongside Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 Page 9 the tri-partite contract or the private contract, where appropriate. There is also a summary of the local contract within the Service User guide itself. The suitability of two ‘out-of-category’ service users at the home (who both moved to Woodcote House from the proprietors’ closing ‘Cladagh’ Nursing Home –and having functional mental health - rather than dementia - care needs) is still to be formally confirmed with individual placement officers (in writing) and these supporting statements submitted with an application form to the Commission for agreement of a Variation against the home’s registration. Specific care plans are now agreed and put in place to address any specifically identified needs of these ‘out-of-category’ service users. The registered manager stated that care managers were still involved with these two service users (though at a distance) and would approach them, to ‘regularise’ the situation with the Commission, once and for all. It is recommended that an in-house assessment format should be evolved to enable the senior staff to ensure that all necessary information is accumulated to inform a full and focused assessment of need – over and beyond the full comprehensive assessment a care manager may provide and in case of direct referral on a private basis, instead of referral through the care management system. Woodcote House does not provide intermediate care; therefore standard 6 does not apply. Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11. Service users can expect that their care will be arranged through a thorough care planning and risk assessment process and the regular reviewing of goals and achievements. Service users can be assured that their health care, in all dimensions, will be attended to - through appropriate contact with health care professionals as appropriate. Service users can be assured that the management of medication in regard to their individual needs will be managed and administered well, within a clear policy and procedure framework. Service users and their supporters can be assured that they will be treated with respect and dignity during their stay at the home and at the point of serious illness and death. Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 Page 11 EVIDENCE: Care plans examined for new service users evidenced that full attention was paid to both ‘needs’ and ‘risks’ – the provision of ‘cot sides’ for one service user had been fully explored and assessed, with the service user’s partner signing their concurrence with this provision, thus indicating their presence at the multi-disciplinary meeting where this issue was discussed. Every service user file seen had a variety of risk assessments associated with their specific condition(s). Pressure area (‘Waterlow’), Liability to Falls, Manual Handling, General Dependency, and a generic Risk-taking form were all in place to address any identified areas of concern. Seven service users have a GP located at the main Shotfield Practice in Wallington, another two service users had a different GP at the same practice. Two service users had their own preferred GPs located elsewhere. District nursing and other paramedical services are accessed either at the home or out in the community, dependent on the service user. As the home is registered to provide care with nursing, there is always a registered nurse on every shift, and they have the sole responsibility for ensuring that medication and any treatment is appropriately given. Current intervention to a service user with a leg ulcer problem was being addressed with additional support from the Tissue Viability Nurse from the Wilson Hospital. Accredited Training in all aspects of medication had been undertaken in February 2005. Medication profiles have been introduced to the recording system at the home; a profile was noted in place and on file for each service user; each was current and had been updated where appropriate. Storage and recording (ordering, receipt, administration, disposal) of medication all presented to be in order. Visits for inspection and advice from the pharmacist have been restored following the move; two satisfactory visit reports were noted at the home. The needs for one service user – who now is having difficulty weight-bearing – may well become an increasingly significant issue and call for reassessment and greater provision of manual handling equipment as time moves on. The manager is monitoring this situation. Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 Page 12 All service users were well dressed and presented in a neat and tidy way, with many a character ‘shining through’ - with obvious personal choices of favourite clothing, and grooming. Ten of the eleven service users have some level of direct or ongoing contact with a relative - be it partners, or offspring / relatives. One service user does not have contact with any relatives; the staff and service user’s social worker are actively aware of this issue, and access to advocacy has been considered. Two service users had passed away in the past year; one was ‘expected’ and the other a surprise sudden medical incident followed by hospitalisation prior to death. A relatively recent process of palliative care had been successfully provided at the home in conjunction with staff from St Raphael’s Hospice. More recently, a service user had quite suddenly died - the ‘outfall’ from this sad event again being handled with sensitivity and attention by the management and staff members; care for the deceased service user’s ‘best friend’ was sensitive, supportive and appropriate. The most recent departure of a service user at the home has been well managed, with the service user’s partner present at the home at the crucial moment – and they and service users and staff being supported throughout this sad time. Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Service users can expect to lead a comfortable and pleasant lifestyle, based on individual assessment and the service user’s expressed likes and dislikes, and respecting the individual’s own decision-making. Contact with families and friends and the local community is positively encouraged, and service users can be assured that such links will be upheld through the home’s practices, support and encouragement. Service users can expect a pleasant and nutritious diet to be provided, with the emphasis on personal preferences - and mealtimes being a calm & pleasurable experience. EVIDENCE: An activities therapist visits the home and appropriate simple Arts & Crafts activities are encouraged. Music & gentle exercise and Sing-alongs are popular. A Newspaper Group is enjoyed, tying in with low-key Reality Orientation, as is the Reminiscence Group. The excellent ‘Memory book’ work in place for a number of service users is an excellent source of discussion. Some relatives did comment that they thought the TV (sometimes children’s TV) was ‘on’ too much and that more direct 1;1 activities could be encouraged. Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 Page 14 Photographs were seen of service users sitting out on the new refurbished patio area during the hot summer afternoons. Apparently, on a number of occasions, the evening meal was served outside and there was difficulty in persuading service users back into the house! One service user is now accessing an art therapy session held at Wallington Resource centre on a Monday afternoon – and thoroughly enjoying it. A few service users continue enjoy ‘popping across the road’ to the shops; the local bus service enables an opportunity to visit shops in Wallington; an important opportunity for some, when they feel up to it. Trips across to the nearby Garden Centre for a visit and coffee - and pub lunches for small groups of service users accompanied by staff are the most popular expeditions from the home. Service users are also encouraged to go out shopping or to visit the library and other local coffee shops / venues. An excellent example of the home’s encouraging engagement with a service user’s family and friends, is the support being given recently to the partner and child of a service user who had previously become estranged. The home seemed as excited as the service user on this re-engagement, and the home has clearly supported and sensitively ‘enabled’ this revival of an all-important relationship. The Commission’s questionnaire clearly evidenced that service users’ friends and relatives feel positively welcomed at the home. The concept of autonomy with regard to people with significant degrees of dementia is difficult to assess, however the standard is met with regard to promoting choice, access to advocates and concerning personal possessions. A written statement concerning Access to Personal Records continues to be required - to clearly state the home’s policy concerning the holding of records, levels of access, and the processes involved (see standard 37). The home is fortunate to have a qualified and competent chef - who was the principal catering officer for the larger nursing home setting that closed. The smaller number of service users he has to cater for now enables him to ensure that a focused and person-specific service is provided. Food provided to service users - and also generously provided for the inspector and staff - was most enjoyable; well presented, nutritious - and freshly prepared. The kitchen is well set up and stocked; the chef confirmed that he had all necessary equipment he required. The premises were generally clean and well ordered. Dried / packeted foodstuffs (custard / pastry / crumble mix, flour, rice and semolina) both in the basement and kitchen cupboards were noted to be have the packets ‘turned down’ on themselves once opened; they must be kept in sealed containers once the packets have been opened – to keep the contents fresh and to protect the contents from infiltration or contamination. Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 & 18. Service users and their advocates can be assured that any complaints will be processed and dealt with swiftly and effectively. Service users can be assured that their human and legal rights will be protected and that they will be protected from abuse of any kind - through the policies, procedures and practices of the home. EVIDENCE: A copy of the new complaints procedure confirms that all complaints will be responded to with a written response being given within 28 days of the expressing of the complaint / concern. The procedure also encourages service users to consider contacting the commission where necessary and reassures service users that their quality of care will not be jeopardised. No complaints had been received by or processed by the manager over the past twelve months. The manager is conversant with routes to access independent representation for a service user if the need arises. Service users without direct contact with relatives have had contact with advocates or social / care managers more recently and they are assessed as not in immediate need of such input currently. The manager assured the inspector that all service users have had their ‘voting rights’ moved to their new address, and some service users have voted in the most recent round of elections. Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 Page 16 The home holds a policy concerning adult abuse and also has a separate ‘Whistleblowing ‘ policy. The Abuse Policy clearly states that the Community Services Care Management Team must be contacted - and that they will take the lead in - and provide guidance and support to the home - if subject to any allegations relating to vulnerable adults. Monies handled on behalf of service users are kept centrally at the proprietor’s Head Office and brought to the home when sums are requested. Only one service user has such an arrangement with the home, Mr Brook (senior) being the named appointee for this person. The proprietor’s accountants monitor and audit the books. Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 - 26. Service users can be assured that they will live in a well-maintained and generally safe environment, which is clean and hygienic and odour-free. Service users can have access to a variety of well-furnished comfortable facilities in the house suited to their assessed needs. The house is suitably assessed with regard to specialist service needs, in line with current professional advice - and to the benefit of service users. Once certain outstanding premises issues have been resolved, the home will be a well-ordered environment to provide sensitive nursing and personal care to the service user population. EVIDENCE: The house is generally a very warm, comfortable, homely and pleasant family size house, which provides a reassuring environment for people with dementia to feel they are cared for in a ‘cosy’ atmosphere. Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 Page 18 Since the last inspection, the patio area has been enhanced with a safe ramp and a gate at the top of the brick stairs leading down to the large lawned back garden. Outstanding work from this requirement relates to the opposite side of the house: the side entrance / exit from the house near the laundry - and associated steps down to the lower lawn level – which must be made safe and provided with such ramping and grab rails as make it safe and secure for all service users – with, especially, a protective gate at the top of the flight of stairs for safety’s sake. Flooring in a toilet close to the lounge on the ground floor has now been provided with new (non-slip) vinyl flooring, and the over-large basin has been replaced with a smaller one, making access into this important area very much easier. The flooring outside this toilet, at the base of the stairs / chairlift leading to the smoking area must be stripped and resealed, or an alternative flooring surface provided; at present the wood is worn back to the bare wood and will in time become a hazard if it is not treated and made ‘good’. Another flooring issue noted is the deteriorating carpet surface from the front door to the rear patio doors – a popular route and one where the carpet must be replaced soon to ensure the décor of the home remains at a high standard in the entrance hall - and to avoid any health & safety risk developing. The Dining Room and the smoking Lounge are clearly now in need of being ‘freshened up’ / redecorated to remove the evidence of ‘wear & tear’ / nicotine on the fabric of the room - and to enhance the environment for service users. The home has now had an Occupational Therapist’s assessment of the premises with regard to the home and issues raised are being addressed – such as the installation of a fixed pull-down seat in the shower cubicle. It is good to know that such recommendations have been ‘taken on board’ and implemented. During the tour of the house, it was agreed that the bathrooms throughout the home would benefit from refurbishment / ‘warming up’; they are currently very bleak and sterile in appearance. Net curtaining and some colourful (appropriate) decoration will aid orientation when service users are in these areas. Call bell points are still to must be provided in the lounge and dining room. Such facilities are as much an aid to staff as service users – and, of course, visitors would find a call bell’s presence useful if they felt assistance was needed when staff members were not present in the room. The home - as an ‘existing’ home - has been allowed to continue providing care in the current configuration of bedrooms, including a number of service users accommodated in shared rooms (four out of eleven places). The home may wish to consider - and it is strongly recommended - that a strategy Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 Page 19 concerning the future of the double rooms be devised in writing and be made available to service users and their relatives - so that both present and new service users can be appraised / reassured of the situation concerning ‘sharing a room’. Bedrooms inspected were generally warm, reasonably furnished and appeared comfortable; each had its own character and reflected the individual occupant’s personality. The single rooms were, obviously, more individualised and characterful - as service users, sometimes assisted by relatives, fully ‘take them over’. All bedroom doors within the house do not currently have an easy locking device that is deemed suitable. Such locks must be provided with a suitable type of ‘un-deadlock-able’ lock - and service users are to be offered the facility of a key if assessed to have the capability to use it. Another benefit of such locks is to allow a service user to lock their room when they are absent from the home; a great opportunity to provide reassurance – especially if some service users (as may be expected) ‘wander the home’ at times. Sharing has clearly been beneficial to the current service users – and this may remain the case; however the provision for scenarios covered by Standard 23.6 and 23.7 (i.e. - positive choice by both parties and - where a service user chooses not to share) should be evolved and clearly stated in writing – as a policy statement explicitly about double rooms and their occupancy. During the tour of inspection of the premises, the final bedroom seen (bedroom 17) was very cold - and it was noted that the radiator did not have a thermostatic control fitted, thus blocking any heat from entering the radiator. Heating was to be immediately restored through the fitting of a missing thermostat on the radiator; the registered manager was able to contact the handyman immediately and guarantee his attendance later that afternoon. The home continues currently to have the commode steriliser situated in the garage / outhouse / laundry which is located outside across a courtyard. The active use of this machine by staff in the depths of winter is less likely and also poses a hazard to staff members in regard to falls / slips. Steps must be taken to urgently install a commode steriliser within the house itself - to ensure both the minimisation of potential cross-infection caused by having to carry commode pots so far from the source of their use, and to ensure the health & safety of staff, especially during inclement winter weather. As a point of advice, the registered manager was reminded to ensure that - at the point of installation - a small wash hand basin must also be installed in the room. The home does have a sluice-cycle washing machine – an absolute ‘essential’ in this home, where seven of the eleven service users are indicated to be incontinent of urine with five being doubly incontinent. Again, the laundry is currently (not ideally) situated in the ‘garage / outhouse’. Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Service users can expect that their needs will be met by suitably qualified, vetted and competent care and nursing staff, who are provided in sufficient numbers to provide for the assessed needs as identified in the care plans. Staff members employed at the home undertake training, and the home strives to ensure that relevant training is provided to ensure that the home meets its statutory obligations, though certain training such as NVQs in care for care assistants and First Aid training must be seen as ‘mandatory’ to ensure the safety and best care of service users. EVIDENCE: Staffing at the home is provided at a minimum level of four staff in the morning, three staff on duty in the afternoon and reducing to two night staff both awake throughout the night. The person in charge is always a registered nurse. A cleaner is employed for five days a week and the designated chef / replacement cook works at the home each day. Just one bank worker has left the home’s employ since the last inspection visit. Two new nursing staff members have come to the home undertaking the occasional night shift cover. Shift spaces on rotas, if not covered internally, are generally covered by one of the continuing ‘bank’ of staff left from the company’s homes’ reorganisation - who can cover occasional shifts. Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 Page 21 50 of care staff should be qualified minimally to NVQ in Care Level 2 by the end of 2005; the figure currently for Beeches House is that three staff out of nine (including one ‘bank’ care worker) are undertaking the qualification – so 33 will be qualified to that level hopefully in the near future – however the figure will be below the minimum standard at the end of 2005 – the deadline by which at least 50 of care staff should be so qualified. Another two staff at least must urgently be recruited to NVQ training. The figure for staff trained currently in First Aid is four a significant reduction in the ‘in date’ number since the last inspection visit; two care staff and two nurses are currently trained in any level from “Appointed Person” status to “Basic First Aid” competence. Such training is required by Regulation 13(4) and expects the home to be covered on a twenty-four hour basis. It was calculated that, over a week, fifteen shifts were actually covered by a First Aider being present - leaving almost a third of the shifts yet to be covered. A wide span of training is required in this respect. The inspector is clear that the General Manager – who has the responsibility for staff recruitment and records (which are generally held at the company’s main office in Carshalton Beeches) is conversant with the due process of recruitment and selection - and is clear as to the home’s statutory obligations with regard to records, personnel checks and employment processes. He has confirmed that all present staff records are now fully in line with those required by statute. A full induction for new staff is in place; the home’s local induction processes (a three-day ‘orientation programme’) is available, followed by TOPSS (Training Organisation for Personal Social Services) standard-based Induction, and a subsequent Foundation module for all staff members. Staff training in Food Hygiene and Safety is progressively covering all staff members; four staff members have completed this training provided by the North East Surrey College of Technology (Nescot). Subsequent to this, a further four staff are expected to undertake this training. Training has also been provided in Moving and Handling, Catheterisation & Catheter Care, and eight staff will have soon completed the Course in Dementia Awareness – which, the manager has confirmed, has brought great benefits to the service at the home. Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36, 37 & 38. Service users can expect the home to be managed efficiently and well, through the manager supervising staff and with the support - and under the guiding eye - of the proprietors. A greater focus on quality assurance measures would benefit the home, through dialogue with service users & their representatives concerning the conduct of the home. Service users and their representatives can be confident that the home is kept in a safe and well-maintained way, thus ensuring the health and safety of all who engage with the home. Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 Page 23 EVIDENCE: Woodcote House is supported by a significant management structure beyond the home; the co-proprietors provide supervision and input to the home – such as Mr Brook being Appointee for a service user. The proprietors’ son, Jerry Brook, is the ‘General Manager’ and supports the two homes owned in Brook Care Homes Ltd through supervising the administrative side of things and is currently undertaking the Registered Manager’s Award himself. The proprietors also employ a bookkeeper / Administrator who keeps the financial side of the business in order. Ailish (Elizabeth) McNally is the registered manager in regard to Woodcote House itself, and she supervises the care service at the home – with the associated paperwork and delegation of tasks to staff at the home. The manager has a shift per week when she is supernumerary to the care rota; this allows a specific management focus on this day. Mrs McNally - the registered manager – is a qualified Registered Nurse. The National Minimum Standards require that as Manager registered to the home, she should [soon] be qualified to NVQ Level 4 in Management, in addition to her nursing qualification – or undertake the Registered Manager’s Award in its entirety (“Skills for Care” [previously TOPSS] can give clear advice as to ‘credits’ and transferable qualifications). In the light of the manager’s recent sad bereavement, it is almost fortuitous that this work has not been previously commenced. This training should now, however, be commenced at the earliest opportunity. The manager has indicated to the inspector that she would commit herself to the training as soon as it becomes available to her. The registered manager informed the inspector that the general manager was devising quality assurance survey material - but that she had not seen the documentation herself. She also understood that perhaps some ‘stakeholders’ (GPs?) had been surveyed – but she had not received, nor seen, any ‘outcome’ as yet. Such independent quality assurance / satisfaction surveys must be established to regularly enable / encourage service users - and their representatives - to affect / influence the way the service is being delivered at the home. The requirement to ensure that staff supervision was reinstated had been addressed by the registered manager – who was able to evidence such support ‘getting back onto the rails’ following her bereavement absence. Clearly this sad incident had disrupted the flow – but the manager is committed to restoring the frequency now to the six times a year as a regular commitment. An ‘Access to Personal Records’ policy and procedure is still to be put in place relating to both service users’ and staff members’ records held by the home; Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 Page 24 the registered manager assured the inspector that she knew the document was ‘on the drawing board’ and should be in place soon. Checks of records relating to fire – alarm tests, drills, etc were all found to be in order and health and safety audits were also in place. Health & Safety issues in regard to maintenance of the premises and servicing of equipment – and hence, the safety of service users, were protected through ensuring the regular servicing and maintenance of such items as necessary throughout the building. The home’s General Manager has provided all certification - either on site or directly to the Commission. Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 2 3 2 3 2 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X X 3 2 2 Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1) Requirement The suitability of out-of-category service users at the home must be formally confirmed with individual placement officers - in writing - with an agreed careplan being put in place to address any specific identified needs. (Timescales of 30.03.05 & 30.06.05 exceeded.) Dried / packeted foodstuffs in the basement and kitchen cupboards must be kept in sealed containers once the packets have been opened – to keep the contents fresh and to protect the contents from infiltration or contamination. Timescale for action 30/12/05 2 OP15 16(2) (g) (j) 25/11/05 3 OP19 13(4) & 23(2)(o) 30/12/05 The external area close to the house - the side entrance / exit from the house near the laundry and associated steps down to the lower lawn level - must be made safe and provided with such ramping and grab rails as make it safe and secure for all service users – and a protective gate provided at the top of the flight of stairs. DS0000007206.V254390.R01.S.doc Version 5.0 Page 27 Woodcote House (Timescales of 30.03.05 & 30.06.05 exceeded - some work has been completed at the other garden entrance – this work remains pending.) 4 OP19 16(2)(c) The flooring at the base of the stairs / chairlift - leading to the smoking area must be stripped and resealed, or an alternative flooring surface provided. (Timescales of 30.03.05 & 30.06.05 exceeded – the associated work in adjacent toilet now completed.) The deteriorating carpet surface - from the front door to the patio doors - must be replaced soon to ensure the décor of the home remains at a high standard and to avoid any health & safety risk developing. The Residents Dining Room and the Smoking Lounge must be freshened up / redecorated to remove the evidence of ‘wear & tear’ on the fabric of the room and to enhance the environment generally for service users. Call bell points must be provided in the lounge and dining room. (Timescales of 30.03.05 & 30.06.05 exceeded.) All bedroom doors must be provided with a suitable type of ‘un-deadlock-able’ lock and service user offered the facility of a key if assessed to have the capability to use it. 30/12/05 5 OP19 23(2)(b) 28/02/06 6 OP20 23(2)(d) 28/02/06 7 OP22 23(2)(n) 30/01/06 8 OP24 12(4) & 23(2)(e) 30/01/06 9 OP25 23(2)(p) Heating in bedroom 17 was to be 18/11/05 immediately restored through the fitting of a missing thermostat on the radiator. DS0000007206.V254390.R01.S.doc Version 5.0 Page 28 Woodcote House 10 OP26 23(2) (a) (k) Steps must be taken to install a commode steriliser within the house itself (not in the garage) to ensure the minimisation of potential cross-infection and the health & safety of staff. (Timescales of 30.03.05 & 30.06.05 exceeded - the location has been previously agreed with the inspector; work is yet to commence.) Independent quality assurance / satisfaction surveys must be established to enable service users - and their representatives - to affect / influence the way the service is delivered. (Timescales of 30.03.05 & 30.06.05 exceeded.) An ‘Access to Personal Records’ policy and procedure must be put in place relating to both service users’ and staff members’ records held by the home. (Timescale of 30.06.05 exceeded.) Staff members must be trained in First Aid competence – in sufficient numbers to guarantee that the rota is covered on a 24/7 basis. 30/12/05 11 OP33 24(1)–(3) 30/01/06 12 OP37 17 30/12/05 13 OP38 13(4) 28/02/06 Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 Page 29 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 OP3 Good Practice Recommendations An in-house assessment format should be evolved to enable the senior staff to ensure that all necessary information is accumulated to inform a full and focused assessment of need (3). Bathrooms throughout the home would benefit from refurbishment / ‘warming up’; they are currently very bleak and sterile in appearance (21). The situation concerning the future of double rooms and their occupancy at the home should be clearly stated in writing for the information of both current and possible new service users (23.6-8). 50 of care staff should be qualified minimally to NVQ in Care Level 2 by the end of 2005 (28.1). The registered manager should be qualified to NVQ Level 4 in Management – or undertake the Registered Manager’s Award in its entirety – this training should be commenced at the earliest opportunity (31). 2 OP21 3 OP23 4 5 OP28 OP31 Woodcote House DS0000007206.V254390.R01.S.doc Version 5.0 Page 30 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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