Inspection on 23/01/08 for Woodfalls Care Home

This inspection was carried out on 23rd January 2008.

CSCI found this care home to be providing an Good 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

Woodfalls Care Home 30/06/06

Woodfalls Care Home 27/10/05

Woodfalls Care Home 24/05/05

Woodfalls Care Home 13/01/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Woodfalls Care Home Vale Road Woodfalls Salisbury Wiltshire SP5 2LT Lead Inspector Sally Walker Key Unannounced Inspection 09:35 23rd January 2008 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 Woodfalls Care Home DS0000062541.V350461.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. Woodfalls Care Home DS0000062541.V350461.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodfalls Care Home Address Vale Road Woodfalls Salisbury Wiltshire SP5 2LT 01725 511226 01725 513561 woodfallscare@tiscali.co.uk 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) Woodfalls Care Ltd Patricia Deborah Whitston Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24) of places Woodfalls Care Home DS0000062541.V350461.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category- Code OP - maximum 24 places 2. Dementia, 65 years and over- Code DE(E) - maximum of 24 places The maximum number of service users who can be accommodated is 24. Date of last inspection Brief Description of the Service: Woodfalls Care Home is a private residential care home offering accommodation and personal care to 24 older people, some of whom may have a dementia. The providers are Woodfalls Care Home Ltd and the registered manager is Mrs Patricia Whitson. The home is a detached property with residents’ accommodation to both floors. It is located in the small village of Woodfalls near Salisbury. The building has recently been extended to provide more accommodation. Seven of the bedrooms have ensuite facilities. All of the bedrooms are single accommodation. There is a passenger lift and a stair lift to the first floor. There is a small, enclosed garden to the rear and side of the property. Care staffing levels are a minimum of 4 carers during the mornings. There were 3 care staff working afternoons and evenings. There are 2 waking night staff. Details of the weekly fees can be obtained directly from the home. Woodfalls Care Home DS0000062541.V350461.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 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place on 23rd January 2008 between 9.35am and 5.50pm. Mrs Whitston was present during the inspection. Mr Cuthill, one of the owners, was refurbishing one of the bedrooms. We spoke with 4 residents and one staff. We made a tour of the building. We looked at medication records, care plans and daily records, fire log book, staff records and menus. As part of the inspection process we sent survey forms to the home for residents, relatives, staff and healthcare professionals to tell us about the service. Comments are found in the relevant part of this report. We asked Mrs Whitston to complete an Annual Quality Assurance Assessment. This was returned on time and completed in full. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: Mrs Whitston visits all potential residents before they come to the home to make sure that their needs can be met. As well as asking the person, Mrs Whitston consults a variety of sources for information about care needs. Healthcare professional input is well documented. Staff have good relationships with residents. They take time to ensure that residents are well groomed. Residents dignity and privacy is upheld. Residents have good access to activities both at the home and in the locality. Care plans identified residents social care needs. Those residents who could decide, followed their own routines and generally made their own decisions. Residents enjoyed the meals. A good range of nutritious meals were provided. Residents were consulted when the menus were decided. Staff are particularly considerate when supporting residents with encouragement to eat. Woodfalls Care Home DS0000062541.V350461.R01.S.doc Version 5.2 Page 6 Mrs Whitston was well known to residents. She regularly consults with them and their families about the quality of the service. Staff were confident in using the safeguarding adults procedure if allegations of abuse were made. What has improved since the last inspection? What they could do better: Care plans must be specific in identifying how care needs are to be met and monitored, for example, management of diabetes. Care plans must direct the care. Bathing risk assessments must clearly record whether residents bathe alone and how this is monitored. A gender working policy must be in place for the giving of intimate personal care by staff of a different gender. Residents should be consulted about who provides their care and decisions must be recorded in their care plan. The current storage facilities for medication, the drug trolley and medication records must be reviewed. The controlled drug cupboard must be attached to the wall. Mrs Whitston’s office is under the stairs, is cramped and provides no room for meetings. Consideration must be given to provide more appropriate facilities. Woodfalls Care Home DS0000062541.V350461.R01.S.doc Version 5.2 Page 7 The undersides of toilet surrounds must be included in the cleaning schedules. Laundry must not be stored on the laundry floor awaiting processing. Potential staff must never commence duties before their suitability for working with vulnerable people has been established by checking the Protection of Vulnerable Adults list. 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. Woodfalls Care Home DS0000062541.V350461.R01.S.doc Version 5.2 Page 8 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 Woodfalls Care Home DS0000062541.V350461.R01.S.doc Version 5.2 Page 9 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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that as much as possible is known about potential residents’ care needs before a decision is made about a placement. EVIDENCE: Mrs Whitston was showing a family member of a prospective resident around the home when we arrived. Mrs Whitston carries out all the pre-admission assessments of prospective residents. She was clear about considering the needs of current residents before making decisions about further admissions. Mrs Whitston told us that she would not consider anyone unless she has carried out her own assessment. A member of staff would accompany her on the assessments to develop their own knowledge. Pre-admission assessments were very detailed and it was clear that different people were consulted about potential residents care needs. Woodfalls Care Home DS0000062541.V350461.R01.S.doc Version 5.2 Page 10 This included the resident, families, previous placements and healthcare professionals. Residents social care needs and routines were identified as well as medical and personal needs. Many of the residents spoken with said they had looked around the home and spoken to Mrs Whitston before they were admitted. Comments in residents survey forms included: “very fortunate to get a place here – it is close to my daughter and I couldn’t have chosen a better place – love it here.” “My son arranged all the details with the care home. I knew the care home, having had relatives at various times whom I visited. My son visited the care home to view the room and then took me to see it and discuss with the manager about my move.” Comments in relatives survey forms included: “My sister and I looked at a number of care homes when it became obvious that our [relative] needed permanent care and Woodfalls stood out from all the others and we have been very happy with our choice. My [relative] is settled and feels very at home there. The staff are so caring and cheerful – a very good choice.” “We are delighted we chose it for [our relative] after visiting many other places first.” “I chose Woodfalls Care Home for my [relative] for its friendly, caring and homely atmosphere and I have been very satisfied with the care [they] have received.” Woodfalls Care Home DS0000062541.V350461.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are variable in identifying individual care needs. Residents have good access to healthcare professionals. Medical input is well documented. People in the home are protected by the homes procedures for the safe handling of medicines. Staff uphold residents privacy and dignity as a matter of priority. EVIDENCE: Care plans were variable in the details of how assessed needs were to be met and monitored. Preferred individual routines were identified. Medical input was very well documented. However, some care plans had unclear statements, for example, ‘can be verbally aggressive’ and ‘requires assistance with personal care’. These need to be clarified. We advised that unclear statements in the daily reports must be avoided, for example, ‘no problems’. Woodfalls Care Home DS0000062541.V350461.R01.S.doc Version 5.2 Page 12 There was good evidence of residents being encouraged to choose clothing, use the lift themselves and with managing continence in a dignified manner. We advised that where fluid charts were indicated, they should state the amounts to be achieved each day. All of the drinking vessels should be measured so that totals could be made for monitoring purposes. One of the residents told us how they were supported with managing diabetes. They said that staff tested their blood glucose levels. There was very little detail in this residents care plan about how their diabetes was managed and monitored. We advised that the blood glucose parameters for wellbeing must be recorded in the care plan of those residents with diabetes. There must also be a record of who is monitoring and how often. Residents’ risk of developing pressure damage was being assessed. However the pre-printed formats for the nutritional risk and pressure damage risk do not relate to each other. For example, one resident’s nutritional score was 10 on one form, yet the pressure risk assessment showed the nutrition element as 0. The forms do not appear to relate to each other. Any risks to residents were identified in care plans together with actions to be taken to reduce any risks. The district nurse is informed as needed. Pressure relieving equipment was in place. All residents were regularly weighed and any significant loss referred to their GP. Food supplements were available when needed. There were separate records of appointments with GPs and district nurses. These showed good detail of any advice and interventions. There were some statements in the daily reports which should prompt a review of care and be reflected in the care plan, for example, ‘sore under breasts’ and ‘sore under tummy’. The treatments to reduce the soreness were recorded in the daily reports rather than in the care plans. We found evidence of regular written audits of care plans. The daily reports showed a very good picture of the care and support offered to residents. We advised that the care plans must also be reviewed and revised as needs changed during the month. Bathing risk assessments were generally very detailed and personalised; including making sure that the resident is dried properly. Mrs Whitston said that residents were never left in the bath alone; particularly those residents who had a dementia. We advised that bathing risk assessments must record details of whether residents can bathe alone. If residents do wish to bathe without staff, then monitoring times must be clearly recorded. Moving and handling risk assessments showed equally good personal detail. Residents were well groomed. One of the residents told us that they would be taken to the opticians in Salisbury. Infection control measures were in place where indicated. Guidance was written in care plans for managing any infections. Woodfalls Care Home DS0000062541.V350461.R01.S.doc Version 5.2 Page 13 The local Primary Care Trust had implemented its ‘red flag’ alerting system in the home. This was a procedure and guidance for referring when concerns were noted. Mrs Whitston said that it also meant that the Trust would provide training, but this was still awaited. She said that residents were well supported by the Trust staff. The local falls co-ordinator had carried out a risk assessment to establish any patterns of falls. A stand-aid was to be purchased to support residents with moving and handling. The Pharmacist Inspector looked at arrangements for the handling of medicines. A new medication policy and list of suitable homely remedies was in place. All staff who administer medicines have had recent training. The manager commented on the support they have had from the local primary care pharmacist. No residents currently self medicate. Medication administration (MAR) sheets were correctly completed and we saw evidence of regular audits. Some written entries had not been signed and checked by two members of staff to check their accuracy. We saw records of changes to medication and doses from the doctor that could be cross referenced with the MAR sheet. Some residents had specific medical needs which required close monitoring. These checks, which included blood tests, were done but the care plans did not reflect this need. Care staff showed that they knew the residents well and handled them with sensitivity, particularly if they refused their medicines. Some medicines had been changed to more palatable forms at the request of the staff. Storage arrangements were not ideal. The controlled drug cupboard must be attached to the wall. The drug trolley is in the hall and there is no dedicated secure area for the storage of medicines or records. We discussed this problem with the manager who told us that she had to use a vacant room to organise and check the monthly medication order. Comments from residents survey forms included: “Very prompt in informing medical team of any problems and acting on advice.” Comments from relatives survey forms included: “The manager, Trisha, always makes sure that the appropriate information regarding [my relative] is given to my sister and I. I am convinced that it is only because of the excellent care given to [my relative] that [they] are still with us. When [my relative] could communicate with us we could phone [them] or visit as we wished. We can still visit at any time. Trisha is very prompt in calling me when necessary. I could not ask for better care for my [relative].” “No one is ever neglected and it has been a privilege to be a ‘fly on the wall’ on occasions as I sit with [my relative] to listen to the staff interact with residents.” “I believe that these are met at the highest possible level whilst maintaining the dignity and individuality of the resident. Woodfalls Care provides a family atmosphere where residents are truly loved. Each is cherished as an individual and their needs and personalities are met as fully as possible.” “I am extremely happy with the care that has been given to [my relative] over the last 8 years.” Woodfalls Care Home DS0000062541.V350461.R01.S.doc Version 5.2 Page 14 “The home keeps me well informed on a daily basis when I go in to visit my [relative]. They also ring me at home to inform me of situations. The care that they give is exemplary and I can’t think that it could be bettered.” “[My relative] can be moody but the staff always treat [them] with great kindness and respect. Even the junior staff seem dedicated to the residents.” “A proactive approach is taken in dealing with potential incontinence (regular trips to the toilet in a discreet manner).” “All residents dress smartly and look clean and well groomed. One member of staff even gives females manicures. It would be difficult to improve the care offered at Woodfalls.” “The staff always phone me when it is necessary to call a doctor or ambulance.” “My [relative] is always clean and tidy.” Comments from healthcare professionals in survey forms included: “They do contact the district nursing team when our intervention is required i.e. Deltaparil, insulin, pessary etc. Extremely caring and diligent. Respectful of each client, privacy and dignity always addressed on individual basis. As far as care is concerned they always refer to us appropriately and appear to work well as a team. Care of patients we oversee at the care home is of a consistently high standard. Communication between all parties is effective.” Woodfalls Care Home DS0000062541.V350461.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): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have good access to a range of activities at the home and in the locality. Residents’ contact with family is maintained. Those residents who can decide, retain control over their daily lives. Residents enjoyed the quality and variety of meals provided. EVIDENCE: It was clear from talking to residents that those who could choose followed their own routines. Other residents relied on staff for direction. One resident said they could catch up on their sleep and have a lie in if they wanted. They said they could go out when they liked. They also talked about how their visitors could come at any time and were always made welcome with refreshments. The resident said a hairdresser regularly visited the home. They told us about the local library visiting. Care plans identified social activities residents were involved in. Woodfalls Care Home DS0000062541.V350461.R01.S.doc Version 5.2 Page 16 Mrs Whitston told us that some of the residents liked to be involved with household activities, for example, watering plants, folding laundry and laying tables. Some go to a local shop. Others went to a day service nearby. Mrs Whitston said that there were fundraising activities to pay for activities, music equipment and trips out. There had been a tea party with a raffle. One of the residents told us that they enjoyed the exercise classes and going on outings. Another resident showed us their knitting they had done. Mrs Whitston said that outside activities and trips were more frequent in the better weather. Mrs Whitston hired a minibus for trips which have included: a tour of the Christmas lights in Salisbury, afternoon tea at a local country house, cream teas, to the pub in the village for lunch and to the seaside. One resident told us they regularly went out for coffee. Church services were held in the home each month by different denominations. Mrs Whitston told us that she was considering providing further suitable activities for those residents who had a dementia. The activities were displayed on the notice boards. Residents could choose from 3 different juices at mealtimes and to have in their rooms. There was also a tray of juices and glasses in the sitting room for residents to help themselves. Three residents confirmed that they preferred to have water with their meals. Other residents said they could have their meals where they wished. All of those residents spoken with said they enjoyed the range and variety of meals provided. One resident told us that staff would ask them the day before what they wanted for meals. They could not remember what they were having that day but remembered their choice of cottage pie for the following day. The resident described their diet to manage diabetes. Another resident told us that the food was so good they had put on weight. The chef told us about discussing the menus with residents, both in meetings and individually. They said that they planned the dishes so that they were well balanced in terms of nutritional and calorific value. All meals were cooked ‘from scratch’ from fresh ingredients and all the cakes were made in the kitchen. The daily menus for 2 choices at lunch and one for the evening meal were displayed on a notice board in the dining room. The choices were braised beef or cauliflower cheese or jacket potato. One resident had a fish dish. There were two vegetables and gravy. We observed the lunch being served. Some of the residents were discretely asked if they wanted an apron to protect their clothing. Those residents who needed support with eating either had mashed or pureed components of the meal. The member of staff described each dish to residents in an appetising way. The meal was well presented and served according to individual appetites. Condiments were available on all of the tables. Woodfalls Care Home DS0000062541.V350461.R01.S.doc Version 5.2 Page 17 Comments in residents survey forms included: “Enjoy the exercise to music and love it when the accordionist plays and we can sing along – also very grateful to staff for taking me to church every Sunday. Look forward to mealtimes everything home made and nicely presented – highlight of the day. A member of staff there if needed.” “Keep fit, accordion player, plates and music, pianist, outings, also encouraged to do individual activities at my local church. Suppers used to be rather small. This has been rectified.” Comments from relatives survey forms included: “I wish that there were more funds for outings and stimulus coming into the home.” “Residents are entertained in various ways (musical events, gentle physio/exercises, visits from outside organisations – choirs etc.).” “The food is good, made from fresh ingredients (not processed) and is varied. Little treats (birthdays etc.) are always enjoyed by everyone and residents are all well nourished. Special diets e.g. Diabetics are understood and catered for.” “There is always a second choice if the main is not to the residents liking.” “The staff take time to help [my relative] with [their] food” “I am able to visit my [relative] at any time, as far as I know.” “The food is lovely. Cooked on the premises FRESH produce. Residents are taken out for trips entertainments are arranged.” Woodfalls Care Home DS0000062541.V350461.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure that residents and their families can complain about the service. Records show good evidence that concerns or complaints are taken seriously and changes made. Staff are trained in recognising abuse and are confident in reporting to the safeguarding adults procedure. Woodfalls Care Home DS0000062541.V350461.R01.S.doc Version 5.2 Page 19 EVIDENCE: The home operates a complaints procedure. Action had been taken to address the good practice recommendation we made about recording sufficient detail and supporting evidence in the complaints monitoring forms. The complaints log showed good detail of investigations, outcomes and the response to the complainant. Any concerns were also recorded. Residents told us that Mrs Whitston would regularly ask them if there was anything that they were not happy with. One resident said they would also talk to staff. Another resident told us that complaints had to be in writing and there was a form for this. We asked staff what they would do if they suspected or witnessed any abuse of residents. They were quick to tell us the procedure for reporting allegations to the local Safeguarding Adults process. Comments in residents survey forms included: “I haven’t needed to make one [complaint].” Comments in relatives survey forms included: “I’ve never had to complain.” “I rarely have cause for concern.” “I know my [relative] feels happy confident enough to tell/discuss any worries with the staff.” “I would be the first to complain if needed ( praise) especially as my [relative] is entrusted to their care but in the [number of] years that [the resident] has been [there] I have had no reason to complain about anything.” Woodfalls Care Home DS0000062541.V350461.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well maintained, clean, warm and homely environment. EVIDENCE: Since the last inspection the home has been extended to provide a large conservatory and four new bedrooms. Some bedrooms had been fitted with wooden flooring. Mrs Whitston said that residents could have this type of flooring or carpet. The home was well signed. Notices showed where the lift was and which rooms were toilets or bathrooms. Residents had identifying photographs or pictures on their bedroom doors. Woodfalls Care Home DS0000062541.V350461.R01.S.doc Version 5.2 Page 21 Action had been taken to address the requirement we made that an audit was made of the suitability of the lighting throughout the home. We saw that toilet lights were left on for residents. Other areas were well lit. Action had been taken to address the good practice recommendation we made about considering appropriate storage of cleaning materials. No cleaning materials were seen on display. The home was generally cleaned to a good standard. No unpleasant odours were detected at any time during the inspection. We saw yellow drip marks on the undersides of toilet surrounds. Mrs Whitston told us that 2 of the 3 cleaners were off sick and staff were helping out. We advised that the undersides of toilet surrounds must be added to the cleaning schedules. Staff are employed to cover laundry duties six days a week. We advised that laundry awaiting processing must not be stored on the floor. Otherwise we found the laundry area to be clean and well organised. Comments in residents survey forms included: “Personal bedroom always spotless and smells nice. Clothes washed and always smell fresh. Communal rooms light and bright.” “Exceptionally clean and fresh.” “Since the installation of the passenger lift my independence and quality of life have been improved 100 .” Comments in relatives survey forms included: “The recent extension to the conservatory has provided a more spacious and pleasant environment.” “The owners have recently built on more rooms and made the sun lounge much larger and open. Combined with the new carpeting, this has had the effect of making the main living area considerably lighter and bright; a better feeling all round.” Woodfalls Care Home DS0000062541.V350461.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): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are maintained to meet the needs of the residents. Staff have good access to training. The majority of staff have NVQ Level 2 or above. Residents are not always protected by the home’s recruitment procedures. Residents and staff have good relationships. EVIDENCE: The care staffing rota showed a minimum of 4 carers during the mornings. This had increased since the last inspection to accommodate the extra bedrooms that were built. There were 3 care staff working afternoons and evenings. On occasions this was increased to 4 care staff during these times. There are 2 waking night staff. In addition there was a cook from 9.00am to 5.00pm. Two housekeepers worked 9.00am to 1.00pm Monday to Friday and 9.00am to 2.00pm at weekends. Mrs Whitston told us that there were 4 staff vacancies. In addition, 3 care staff were on sick leave. These hours were covered by current staff or agency staff. Woodfalls Care Home DS0000062541.V350461.R01.S.doc Version 5.2 Page 23 Staff engaged with residents and it was clear that good relationships were established. All of those residents spoken with made very positive comments about the staff. One resident told us that staff considered their bedroom to be private and would always knock on the door and wait to be invited in. We found evidence that staff have to sign up to the home’s policy on residents privacy. The records showed details of times when keyworkers spent individual time with their allocated resident. This time was spent in discussion as well as more practical time spent tidying their bedroom We advised that a gender working policy must be produced. Staff roles with regard to providing intimate personal care to residents of a different gender must be made clear. We asked some of the female residents whether they had been consulted about care being provided by male staff. They said that they did not provide personal care. There was no information about this in care plans. A member of staff told us that they had good access to relevant training. They said they had recently received training in care for people who are dying and dementia care. They said they had regular supervision. Staff meetings were held each month. Mrs Whitston said staff contributed to the agenda. She said it was important to get staff feedback and for them to express their feelings in these meetings. Mrs Whitston kept a matrix of mandatory training to plan future training. Courses included: safeguarding adults, first aid, health and safety, infection control, fire safety and dementia. Staff had recently attended training from the speech and language therapist on swallowing difficulties. All staff have access to NVQ training. 85 of staff have NVQ Level 2 or above. No action had been taken to address the requirement we made about no staff starting work without at least a Protection of Vulnerable Adults list check. This is to establish people’s suitability to work with vulnerable adults. One person was found to have commenced work without this check being carried out. Mrs Whitston said that this person was not a carer, they had been working alongside other staff and when the Criminal Records Bureau certificate was received it was negative. However Mrs Whitston was advised to familiarise herself with the Department of Health guidance on Criminal Records Bureau and Protection of Vulnerable Adults list checks. Other staff files showed a robust recruitment process with all the information and documents required by regulation in place. There was evidence of staff’s induction into their role. Comments in residents survey forms included: “The staff are all – without exception caring and all my needs are taken care of respecting and maintaining my dignity. Keep my daughter informed on everything. Woodfalls Care Home DS0000062541.V350461.R01.S.doc Version 5.2 Page 24 We like the fact that there is always at all times someone in the communal rooms if we need them.” “Most staff are always helpful sometimes it is frustrating not to get clearer answers.” Comments in relatives survey forms included: “I believe that the majority of staff are very skilled and carry out their job of looking after everyone to the highest standard.” “The carers all use their skills and strengths in their different directions. The care they give is all done with love and kindness.” “All staff are encouraged to gain qualifications (NVQ etc.). All the staff work as a team and pay attention to little things that make the lives of all the residents happy.” “Because of recent staffing problems the care home has to call in agency staff, which although they are always friendly and competent, can be confusing fro an elderly person with dementia.” “The staff never switch off from the needs of the residents and are constantly keeping their eyes open, making sure the residents are OK. There is always a happy and friendly atmosphere when I visit.” “All staff listen act upon what they are asked or told.” “I call regularly unannounced at times, often outside normal ‘visiting times’. At all times I have been extremely impressed by every member of staff. They are very gentle, caring, patient understanding but also experienced/skilled enough to keep control to ensure safety wellbeing of the residents. I am very happy to trust my [relative’s] welfare to them.” “Residents are treated as individuals I notice if one person is sitting alone for a while a staff member will go to them with a hug or word of encouragement. Families/visitors are made extremely welcome.” Comments from staff survey forms included: “One of the most friendly and easy-going environments I’ve ever worked in. Really good and approachable manager.” “I would employ a full time maintenance person, employ a full time PA for the manager and create more office space and secure the car park. All the staff and the manager work really really well together as a team. The care and commitment from the staff with the service users and their relatives is excellent. Woodfalls Care Home DS0000062541.V350461.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): 31, 33, 36, 37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Mrs Whitston is now qualified and has much experience of working at the home. The home is run in the best interests of the residents. The home does not deal with residents finances. Staff receive regular supervision. Residents records were at risk of being accessed inappropriately. Systems are in place for ensuring the health and safety of residents. Woodfalls Care Home DS0000062541.V350461.R01.S.doc Version 5.2 Page 26 EVIDENCE: Mrs Whitston was registered as manager in January 2007. She had been the deputy manager since 2005. She has worked at the home since 1992 and was well known to residents and staff. Mrs Whitston had recently completed the Registered Managers Award and was awaiting the certificate. It was clear from talking to residents that Mrs Whitston was well known to them and had regular contact. Residents told us that she visited them every morning. A quality assurance system was in place. Questionnaires are given to residents and sent to families. Responses are collated and an action plan established. The home does not deal with residents finances. Either residents manage their own or this is done by families. Mrs Whitson’s office is under the stairs. The area is cramped, provides little storage and is not conducive to holding meetings or supervision. The care records were not kept securely. There was no room in the office for these records to be kept or accessed regularly by staff. Consideration must be given to providing more secure storage for the records. Mrs Whitston regularly reviewed the home’s policies and procedures. We advised that at the next review, where necessary, details of our contact address should be amended. A visiting relative told us that they regularly filled out forms to make comments on the service. Action had been taken to address the requirement we made about staff receiving regular supervision. We saw the plans for the year and notes were evident in staff files. Action had been taken to address the requirement we made that the checks, drills and staff instruction were made with regards to fire safety. The fire log book was well maintained. While we were at the home we were able to witness staff responding to the fire alarm. It was later discovered to have been a faulty low energy light bulb. We observed staff follow the home’s procedure and discuss the issues with the attending Fire and Rescue Authority. Environmental risk assessments were in evidence and regularly reviewed. Comments from residents survey forms included: “An excellent manager who leads a very happy and caring team.” Woodfalls Care Home DS0000062541.V350461.R01.S.doc Version 5.2 Page 27 Comments from relatives survey forms included: “I wonder if the care manager could do with an extra pair of hands in the office to help her? Her office is really too small but that is just the nature of an old house used for these purposes.” “I whole heartedly support Trisha and her staff and think they do a fantastic job.” “They are led by a manager who is brilliant at her job. She leads by example and sets the tone of the home which is warm, loving and caring.” “Since the home has been in the hands of Mr and Mrs Cuthill, there has been a dramatic and worthwhile improvement in the quality of care, as well as activities for the residents. Since Trisha has taken over as manager, both she and the staff are much more buoyant. If only she had less paperwork to do.” Comments from staff survey forms included: “The home is well run by the manager and the well being of the service users are always a top priority.” “Manager to have more assistance with paper work in order to do less hours after her working day, as she never seems to have enough time otherwise always working very hard. Creates a happy, friendly atmosphere, home from home feel and really treats residents like they were one’s own family Woodfalls Care Home DS0000062541.V350461.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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/A 3 2 3 Woodfalls Care Home DS0000062541.V350461.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 OP9 Regulation 13(2) Requirement In order that medicines and records can be kept securely and staff are able to work with them safely, a review of the current storage facilities must be carried out. The registered individuals must ensure that all members of staff are not employed without at least obtaining a POVA first check. (this is outstanding from the inspection of 30/06/06). The person registered must ensure that all individual resident’s care needs are identified in their care plans. If needs change the care plan must be reviewed and revised. Care plans must identify how care needs are to be met and monitored. The person registered must ensure that bathing risk assessments record whether residents are ever left alone in the bathroom. The person registered must ensure that the undersides of DS0000062541.V350461.R01.S.doc Timescale for action 15/03/08 2. OP29 19(1)(b) 23/01/08 3 OP7 17(3)(a) 23/01/08 4 OP7 13(4)(b)& (c) 23/01/08 5 OP26 16(2)(j) 23/01/08 Woodfalls Care Home Version 5.2 Page 30 6 OP10 12(2) toilet surrounds are added to the cleaning schedules. Laundry must not be stored on the laundry floor. The person registered must ensure that residents are consulted about intimate personal care being provided by staff of a different gender. Care plans must state the resident’s choice. A gender working policy must be in place. 31/03/08 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 2 3 Refer to Standard OP9 OP7 OP7 Good Practice Recommendations Written additions to the printed medication administration record should be signed, dated and checked by two members of staff. Unclear statements in care plans and daily records should be avoided. Drinking vessels should be measured so that monitoring of fluid intake can be assessed. Fluid charts should show how much is to be achieved each day. Daily amounts should be totalled to see if this is achieved. Consideration should be given to providing suitable office accommodation for the manager to successfully carry out her administrative duties. 4 RCN Woodfalls Care Home DS0000062541.V350461.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue BS1 4UA 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 Woodfalls Care Home DS0000062541.V350461.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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