Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 12/08/08 for Woodfield Grange Nursing Home

Also see our care home review for Woodfield Grange Nursing Home for more information

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

What the care home does well

People can go and have a look around the home and pick up information about the service provided. People are very happy with the meals provided, they enjoy the food the cook prepares and they like the choice of meals available. There are some good staff working at the home that are well liked by the people who live there.

What has improved since the last inspection?

The dining room has been refurbished. A bathroom has been converted to a wet room.

What the care home could do better:

Woodfield Grange Nursing Home DS0000001076.V370057.R01.S.doc Version 5.2 Page 6Pre admission assessments need to be improved to make sure that people`s needs can be met when they move into the home. People who live at the home, and their relatives are not involved in the care planning process. Many people don`t know what a care plan looks like. People should be consulted about their care plans so that the records reflect the care they need and show how they want this care to be given. Care plans are not always up to date. Sometimes, even though the plan has been reviewed, the information does not reflect the current needs of each person which means that people may not be getting the care they need. The needs of people who are nursed in bed are not always being met because they are sometimes overlooked. Communication with relatives needs to be improved so that they are kept up to date with important information. Moving and handling plans are not always being followed; this is unsafe practice and could result in injury to people who use the service and to staff. Medication records need to be improved and medication must be administered as prescribed and accurately recorded. This will make sure people receive their medications correctly and the treatment of their medical condition is not affected. People should have the opportunity to take part in stimulating activities that suit their needs and preferences. Particular consideration should be given to people with dementia and those with physical disabilities. People should be consulted about what they would like to do. Medication administration needs to be improved, people must not be left waiting in the dining room for the nurse to give them their medication. The duties of care staff need to be better organised so that people who spend most of their time in their rooms receive the care they need and are not overlooked.All staff must receive appropriate training so that they are aware of their responsibility to safeguard people in their care. All staff must have up to date training in moving and handling, infection control, first aid, fire safety and health and safety. This will make sure that they are working safely. The organisation needs to keep us informed about changes in the management structure and about their plans for the development of the home. There needs to be a registered manager at the home so that there is someone legally responsible for the day to day running of the home.

CARE HOMES FOR OLDER PEOPLE Woodfield Grange Nursing Home Saddleworth Road Greetland Halifax West Yorkshire HX4 8NZ Lead Inspector Lynda Jones Key Unannounced Inspection 12th August 2008 9:30 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 Woodfield Grange Nursing Home DS0000001076.V370057.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. Woodfield Grange Nursing Home DS0000001076.V370057.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodfield Grange Nursing Home Address Saddleworth Road Greetland Halifax West Yorkshire HX4 8NZ 01422 377239 01422 311863 manager.woodfield@aermid.com 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) Aermid Health Care (UK) Limited Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Woodfield Grange Nursing Home DS0000001076.V370057.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Can provide accommodation and care for one named service user under 65 years of age. 17th July 2007 Date of last inspection Brief Description of the Service: Woodfield Grange is a care home with nursing providing accommodation and care for 36 older people. The home is situated on Saddleworth Road and is approximately ½ mile from the local shops and facilities in West Vale. There is a patio area to the front of the building where people can sit out in good weather. There are car-parking facilities to the side of the building; the car park is on a very steep slope. Accommodation at the home is arranged over three floors. There is one very large lounge on the ground floor that is divided into two sections by the arrangement of the chairs. The dining room adjoins the lounge on the ground floor. Each floor can be accessed by passenger lift. There are 34 single bedrooms and one double bedroom. None of the bedrooms have en suite facilities. Fees for the home are currently between £356 and £494 per week. There is an extra charge for hairdressing, chiropody and personal newspapers. Woodfield Grange Nursing Home DS0000001076.V370057.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 0 star. This means the people who use this service experience poor quality outcomes. This key inspection took place to assess the quality of care provided to people living at the home. The visit was unannounced and was carried out between 09:30am and 3:30pm by two inspectors. As part of the inspection process we looked at all the information we have received about the service since the last key inspection. Discussion took place with people who live there and with the manager and staff on duty. Care practice was observed, various records were looked at and a tour of the home took place. We sent surveys to a sample of people who live at the home, their relatives, and staff who work there. We received feedback from 2 staff and 5 people who live there, some of their relatives helped them to complete the surveys. We have included some of their comments in this report. The home can accommodate 36 people, when we visited there were 30 people living there. What the service does well: What has improved since the last inspection? What they could do better: Woodfield Grange Nursing Home DS0000001076.V370057.R01.S.doc Version 5.2 Page 6 Pre admission assessments need to be improved to make sure that people’s needs can be met when they move into the home. People who live at the home, and their relatives are not involved in the care planning process. Many people don’t know what a care plan looks like. People should be consulted about their care plans so that the records reflect the care they need and show how they want this care to be given. Care plans are not always up to date. Sometimes, even though the plan has been reviewed, the information does not reflect the current needs of each person which means that people may not be getting the care they need. The needs of people who are nursed in bed are not always being met because they are sometimes overlooked. Communication with relatives needs to be improved so that they are kept up to date with important information. Moving and handling plans are not always being followed; this is unsafe practice and could result in injury to people who use the service and to staff. Medication records need to be improved and medication must be administered as prescribed and accurately recorded. This will make sure people receive their medications correctly and the treatment of their medical condition is not affected. People should have the opportunity to take part in stimulating activities that suit their needs and preferences. Particular consideration should be given to people with dementia and those with physical disabilities. People should be consulted about what they would like to do. Medication administration needs to be improved, people must not be left waiting in the dining room for the nurse to give them their medication. The duties of care staff need to be better organised so that people who spend most of their time in their rooms receive the care they need and are not overlooked. Woodfield Grange Nursing Home DS0000001076.V370057.R01.S.doc Version 5.2 Page 7 All staff must receive appropriate training so that they are aware of their responsibility to safeguard people in their care. All staff must have up to date training in moving and handling, infection control, first aid, fire safety and health and safety. This will make sure that they are working safely. The organisation needs to keep us informed about changes in the management structure and about their plans for the development of the home. There needs to be a registered manager at the home so that there is someone legally responsible for the day to day running of the home. 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. Woodfield Grange Nursing Home DS0000001076.V370057.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 Woodfield Grange Nursing Home DS0000001076.V370057.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): 1, 2, 3, 4 & 5 (standard 6 does not apply) People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are assessed before they move in but there is no assurance that the home can meet people’s assessed needs. EVIDENCE: We asked people if they had enough information about the home to help them decide if it was the right place for them. Four people said they did, one person did not. Two people told us they picked information up when they visited the home and they commented on the friendliness of the member of staff who showed them round the building. We also asked if people had been given a contract outlining their rights and responsibilities and those of the homeowners giving details of the service they could expect. This is an area that people are not clear about. Four people said Woodfield Grange Nursing Home DS0000001076.V370057.R01.S.doc Version 5.2 Page 10 they didn’t have a contract, one person said they had nothing from the home but they thought they had a placement agreement from Calderdale Council. When we asked the manager we were told that contracts are usually issued by the company “after a few weeks” and these are only given to people who pay their fees privately. We were informed that everyone has a copy of their terms and conditions of residence in their bedrooms; we saw these pinned on the bedroom walls when we looked round. The documents are not personalised, they do not have individual names on them and none of them have been signed. It is important that people are given a contract or terms and conditions of residence document on or before the day they move in to the home. This will make sure that people are properly informed about their rights and responsibilities. We looked at some of the care plans and we saw that people are assessed before they move into the home. This is to make sure that the needs of each person can be met by the home. However, although individual assessments have been completed some people’s needs are not being met because the home is not appropriately staffed to care for the number of very dependent people who live there. The home does not provide intermediate care. Woodfield Grange Nursing Home DS0000001076.V370057.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 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Care plans are not kept up to date and do not accurately reflect the care that people need. This means that people may not always receive the care they require. Risks to people are identified but not always acted upon, which means that people’s care is not being managed and monitored properly. EVIDENCE: We looked at a selection of care plans because we wanted to see what individual needs had been identified and what action staff are expected to take to meet these needs. We looked at four care plans. We could see from these plans that people are receiving health care from a range of people such as doctors, community psychiatric nurses and tissue viability nurse. Details of visits are documented Woodfield Grange Nursing Home DS0000001076.V370057.R01.S.doc Version 5.2 Page 12 in the care plan together with any advice given although some entries were very difficult to read and not very detailed. There were care plans in place for people that gave staff some information about what they needed to do in order to meet that person’s needs. Some of the plans have not been reviewed on a regular monthly basis. For example on two of the care plans we looked at there was a gap of 11 months between reviews. There was no evidence that people using the service or their relatives were involved in these reviews. It is important that people are involved in these reviews so they or their relatives have the opportunity to discuss the care and support that is being provided. Two of the care plans we looked at were not up to date although the records indicated that they had been reviewed. For example one person is being fed via a tube into their stomach. They do not take any food or drinks orally and therefore need a plan to make sure their oral hygiene needs are met. No plan was in place and when we spoke to this person their mouth was dry and their tongue encrusted and sore. We asked the staff about this they told us that there was a spray that is used but that this had run out and hadn’t been available for over a week. In another care plan staff had documented that a person was incontinent of urine and faeces. There was no plan in place about how often staff should offer to take them to the toilet and/or if pads should be used. Care staff told us that they report important changes about people living in the home, but the nurses don’t always do anything. There was evidence in one care plan that nursing staff had not acted in a timely way when a person started to develop a pressure sore. Staff had written in the care plan that the tissue viability nurse needed to be involved when they noted that the person had stated to develop a pressure sore. A month later staff had written that the sore had deteriorated further and the skin was broken. Two days after this the tissue viability nurse was contacted for advice by telephone. Although in the care plan staff have written that this person needs to be repositioned every 3 hours and needs to have a nutritious diet, there is no way to monitor this as there are no repositioning charts or food/fluid intake charts in place. The weight records show that this person has lost 3kg in weight since June. In the daily notes we did see that staff have been giving some fortified drinks, however, the medication administration record shows that the doctor hasn’t prescribed these. At lunchtime this person was forgotten and wasn’t given a meal until we pointed this out to staff. There were other examples of staff not following issues up for people. One person lost their dentures when they were in hospital in February 2008. Staff noted in the care plan that the hospital will pay for the dentures when a dentist can be arranged. To date no one at the home has arranged for the dentist to visit. Another person was due an eye test in March 2008 and again this has not been arranged. One of the doctors had asked for a urine sample to be Woodfield Grange Nursing Home DS0000001076.V370057.R01.S.doc Version 5.2 Page 13 sent off to check if the antibiotics they had prescribed for a urine infection would work. The specimen bag was still in the care plan and there was no evidence that staff had done this. A relative told us about an example of poor communication amongst staff. This person wanted to make contact with a health provider who was due to visit her relative living at the home. Staff were unable to tell this person when the appointment was due and unable to provide information about who had seen the relative after the appointment had taken place. The relative was advised to ring the hospital switchboard to find the information out for herself because it had not been recorded by staff at the home. This is poor practice which is very distressing for people who entrust the care of their relatives to staff at the home. People are not always receiving the care that they need and people feel that the staff do not have enough time to give them the support they require. There are a lot of people living at the home that need the assistance of two staff to move them safely and to attend to their needs. This means that there are periods of time when there are no staff supervising in the lounge. Some of the people living in the home told us that they often have to wait longer than they would like to get assistance and some of the more dependent people are relying on other people living in the home to get staff to attend to them. One person said “they are often short of staff and we have to wait, sometimes, for an uncomfortably long time”. We asked people if the staff listened to them and acted on what they said, in the surveys they said they did. One person told us “most do, but some staff (mostly the younger ones) do not always listen or have time to wait for me to explain what I want. Sometimes I feel they don’t care. But most are very good”. In the surveys we asked people if they receive the medical support they need. Five people said “usually”. We were told that outside agencies are brought in fairly promptly when needed but “ staff may have some problems following their advice through lack of time”. There was a problem with the nurse call system during our visit. The lights were flashing outside off two bedrooms, one for about 20 minutes, the buzzer was not ringing and the control panels indicated that there was staff presence in the room, when in fact no one was present. We told the manager about this fault and she agreed to get the system looked at. Some of the moving and handling plans that we saw were not up to date. Two people are currently in bed most of the time. There was nothing on their care plans about how staff should change their position in bed. In the daily records for one person it mentioned that a slide sheet was being used but in the moving and handling plan it stated that the person moved themselves in the Woodfield Grange Nursing Home DS0000001076.V370057.R01.S.doc Version 5.2 Page 14 bed. It is important that the plan is up to date so that people are moved in the correct way. We did not observe a full medication round. We looked at the medication records. Staff are not booking the medication in. All medication that is received must be checked and booked in on the medication administration records. This makes sure that staff are checking that the right amounts of medication have been sent by the pharmacist. We found that staff had been putting the pharmacists ‘sticky labels’ with the details of the medication on to the medication administration records. Staff shouldn’t use these as they could cover up other information. Staff must write the details onto the medication record by hand and get another member of staff to countersign the entry to confirm that the right details have been written down. We also found that there were blank spaces on the medication administration records. Staff must sign the records to show that either they have given the medication or enter a reason why the medication has been withheld. Staff told us that people are in the dining room for up to 3 hours waiting for their morning medication. They said that one nurse tells them not to move people until they have done the medication round. The manager needs to look at this issue and make sure that people are not left in the dining room for longer than is necessary. These improvements need to be made to make sure that the medication system is managed properly and that people get their medication at the right time. Woodfield Grange Nursing Home DS0000001076.V370057.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. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People do not have a quality social life because there is very little taking place in the way of stimulating activities and only limited meaningful interaction between staff and people who live there. This means that individuals can be left for long periods without moving about and without anyone talking to them. EVIDENCE: From looking at the records and from talking to people, we could find no evidence of any stimulating activity taking place. On the subject of activities, the service user guide tells people that “the home aims to provide a variety of ways in which people can engage in social activities, hobbies and leisure interests”. There is no explanation of how this will be achieved. In the surveys we asked people if there are any activities arranged by the home for them to take part in. These are some of the comments we received: Woodfield Grange Nursing Home DS0000001076.V370057.R01.S.doc Version 5.2 Page 16 “Not a lot is undertaken. I like to join in when I can. They take a small number out on a rota basis infrequently. I have been out once in 2 ½ years. There are no craft sessions, no games, no simple physio/excercises” “I have not seen any activities arranged by the home” “There’s not enough activities or stimulation” A relative told us “the lack of stimulation and 1:1 conversation is a real concern” In the information sent to us before the inspection we were told “since our activity organiser went on maternity leave, organisation of structured activities has been sporadic”. We asked about plans for improvements in this area over the next 12 months and we were informed that a part time activities organiser will be recruited so that a meaningful activity programme can be developed. The care plans do not contain detailed information about the sort of daily routine that people like to follow. There is very little information about when people prefer to get up/go to bed; whether they like to spend time in their rooms or in the lounge; what time they like to eat etc. If the staff have this information it must be passed on amongst them verbally, it is not written down. This means that people may not always be being supported to follow a routine that suits them. During the morning we sat with people in the ground floor lounge. One person was enjoying watching the Olympics on TV, one person was reading. There was very little conversation, most people sat quietly or fell asleep. When the staff were in the room they rarely spoke to anyone, they focused on the tasks they had to perform. We saw staff transfer one person from an armchair to a wheelchair with out speaking. We also saw staff transfer people using a hoist, one group of staff explained what they were doing to the person they were assisting, the other group of staff carried out the transfer without saying anything. This is very poor practice. We noted that some people were still sitting in the dining room having breakfast at 10:40am. It was not clear whether the late breakfast was a matter of individual choice or because staff were running late with their duties. The same people were back in the dining room for lunch at 12:30pm. We noted that one of the complaints recently received by the home was from someone concerned that their relative was still in bed at 11:20am and about breakfast rolling into the lunchtime period. In the last two inspection reports we said the lunchtime arrangements were unsatisfactory because people were sitting in the dining room for a long time waiting for lunch to be served. We could find no evidence of improvement in this area. There is still a long delay between the time people start to take their Woodfield Grange Nursing Home DS0000001076.V370057.R01.S.doc Version 5.2 Page 17 seats in the dining room to the serving of the meals. We talked to two people who said the food was very good “but the meals get later and later everyday”. The menu for the day is on display in the dining room. The meals we saw were served hot and looked appetizing. In the surveys, people confirmed that they enjoyed the food. Woodfield Grange Nursing Home DS0000001076.V370057.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. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is no evidence to show that staff have received appropriate adult protection training so that they are clear about their responsibility to make sure people are safe. EVIDENCE: The complaints procedure is on display in the entrance area. According to the information provided before the inspection, 10 complaints have been received by the home in the last 12 months. 7 of these have been upheld, 1 is still being investigated. The recording of complaints needs to be improved so that it is clear what the complaints is about, it should include details of investigation and any action taken. We could not find any responses to two complaints made by relatives so we are unable to say whether these complaints were investigated and what the outcome of the investigation was. In the surveys, people told us they knew how to make a complaint and they knew who they would talk to if they were unhappy about anything. They did not tell us whether this was a member of staff or a member of their family. Woodfield Grange Nursing Home DS0000001076.V370057.R01.S.doc Version 5.2 Page 19 We (CSCI) have made 3 safeguarding referrals to the adult protection coordinator during the last 12 months. One was about staff “drag lifting” someone instead of using safe moving and handling techniques; this is a practice that is unsafe and could cause injury to the person concerned and to staff. The second referral was about staff failing to respond to the emergency call system when someone needed help in their bedroom. Both were investigated by the Director of Care for Aermid and resulted in disciplinary action being taken against staff. The third safeguarding referral was made as a result of observations by a visiting health care provider who raised concerns about staff not following advice from the tissue viability nurse about the treatment of a pressure ulcer. We have not been informed of the outcome of this investigation. We have already said earlier in this report that people do not feel that they are listened to. It is their view that the staff are often too busy to listen to them. We were unable to ascertain whether staff have had any training about their responsibility to protect people in their care and to report any practice they see that concerns them. Some staff told us they had received training in this area in November 2007 but the acting manager could not find any details to confirm this. The staff training matrix indicates that only 2 staff have had Protection of Vulnerable Adults training this year but the matrix is not up to date. One person told us “the language of members of staff is appalling at times”. The acting manger must investigate this matter as soon as possible and staff must be made aware that this behaviour is unacceptable. Woodfield Grange Nursing Home DS0000001076.V370057.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, 23, 24, 25 & 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable home but many areas require refurbishment and redecoration to improve the facilities. EVIDENCE: There is level access to the home. The grounds are accessible by wheelchair and there is space to sit outside in the good weather. The reception area not particularly welcoming and would benefit from redecoration. The carpet in reception is “rippled” and presents a trip hazard. Woodfield Grange Nursing Home DS0000001076.V370057.R01.S.doc Version 5.2 Page 21 The toilets located just inside the reception area were a source of great dissatisfaction when we last visited the home. People felt that the location of the toilets compromised individual privacy and dignity. On this visit the toilets were not in use, the acting manager said they are due to be refurbished. This is disappointing, because the people who live there, and their visitors, want the toilets to be relocated. Generally, the home appeared clean when we looked round. In the surveys we asked we asked people if the home is fresh and clean and people said “usually”. One person said the toilets smell sometimes and another person said “the carpet in the lounge could do with a good clean”. These are some of the points we noted and fed back to the acting manager after we looked round the building: • • A trolley full of cleaning products was left in the shower room unattended. This is a health and safety hazard, the trolley must be locked away when not in use. The electric wall heaters in the shower rooms and toilet were very hot to the touch. There are regulators on the heaters but they were turned to the highest setting and there are no guards in place. These need to be checked regularly to prevent anyone from burning themselves. In one bedroom (17) the wardrobe doors do not close properly. To keep them closed they are held together with an elastic band. The doors need to be repaired or the wardrobe replaced. • Last year we said the decorative standard and fittings were in need of improvement but little has changed since then. The dining room has been refurbished and one bathroom has been converted to a wet room. In the information sent to us before the inspection we were told that there are plans for considerable refurbishment in the coming year and this will include bathrooms and disabled access toilets. Lounge areas and bedrooms are also due to be improved. We were not provided with details of when this is due to take place. We were also told that the hot water system is inadequate, especially in the mornings when the maximum amount of water is drawn. This is also included in the improvement plans. Woodfield Grange Nursing Home DS0000001076.V370057.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. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not always receiving the care and support that they require. The staff need additional training so that they understand what they must do to meet people’s needs properly. EVIDENCE: At the time of this visit, there were 30 people living in the home. The duty rotas showed that, during the day there is one nurse on duty with 4-5 care assistants. At night, there is one nurse and 2 care assistants on duty. On the day of out visit, there was one nurse on duty with 5 care assistants. There was also another nurse on duty who has started working at the home recently. She was ‘shadowing’ the nurse as part of her induction. All of the care staff were very busy trying to meet everyone’s needs. All of the care staff we spoke to felt there were not enough staff to meet the needs of the people currently living there. They also said that usually there are only 4 care assistants on duty, which means it is even more difficult for them to meet people’s needs. Woodfield Grange Nursing Home DS0000001076.V370057.R01.S.doc Version 5.2 Page 23 According to the information provided before the inspection, 29 people need help with bathing and washing and 25 people need help to go to the toilet and to dress and undress. 27 people have a physical disability, 17 people living at the home have dementia and 2 people need to be cared for in bed. The information provided also told us that 22 people need 2 or more staff to help them with their care during the day and 20 people need help during the night. This means that many people are heavily reliant upon staff to support them When staff assess people who want to move into the home, they must look at the staffing levels and the dependency levels of people already living in the home to make sure there are enough staff to meet everyone’s needs. In the interim, additional staff must be on duty. Agency staff must be used if necessary. In the information provided to us before the inspection we were told that all staff have thorough pre employment checks before they start work in the home. This is to make sure that new staff are suitable and to make sure that people living there are safe. We checked a sample of staff files and found that all of the required checks had been carried out. We were told that 75 of staff have NVQ (National Vocational Qualification) at level 2 or 3. We were unable to look at the overall picture of training that has taken place and of staff training needs because the staff training matrix was not complete. Woodfield Grange Nursing Home DS0000001076.V370057.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. Communication with people who use the service and their relatives is poor; they are not being consulted about the way the home is run. EVIDENCE: There have been several changes of manager over the last twelve months. The organisation does not keep us up to date with changes in the management structure and changes in the direct management of the home. We were not informed that the last registered manager left the home in September 2007 and we took this up at the time with the Director of Care. In November 2007 a Woodfield Grange Nursing Home DS0000001076.V370057.R01.S.doc Version 5.2 Page 25 new acting manager was appointed who we were informed, would be applying to be registered with us. This acting manager is no longer in post. On this inspection we discovered that another acting manager had been recruited in February 2008, we were also told that the Director of Care has now left the company. We have not been notified of any of these changes and we have received no information about any proposals to register a manager with us. The acting manager was unable to tell us anything about future plans for the development of the service. There is no evidence that people are asked for their views about the way the home is run and there is no strategy to enable people to affect the way in which the service is delivered. We could find no evidence of any consultation taking place with people living at the home or their relatives about the service provided. There is nothing on the care plans to indicate that people have been asked about the care they receive and whether they think it could be improved upon. We were shown a copy of a letter intended for relatives, introducing the new acting manager and inviting people to attend a care plan review meeting. We could find no evidence to confirm whether any meetings had actually taken place. We were told there were plans to introduce meetings with people who use the service and their relatives but none have yet been scheduled. We were informed that the company has a quality monitoring system that can be used to ask for the views of people using the service but the acting manager said she had not seen this and did not have any information about the system. Staff do not receive regular supervision where their care practice can be discussed and where their training needs can be highlighted. We could find no evidence of a training plan for the staff team. On a day to day basis, there is a lack of leadership. No one has oversight of the care that needs to be delivered and who is responsible for delivering it. We have already mentioned earlier in this report that people who spend most of their time are at risk of being overlooked and may not always be receiving the care and sustenance that they need. The information provided to us before the inspection told us that equipment in use within the home is regularly maintained and serviced so that it is safe to use. Woodfield Grange Nursing Home DS0000001076.V370057.R01.S.doc Version 5.2 Page 26 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 We checked a sample of CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 Score 2 2 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X 2 2 2 2 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 3 X X 2 Woodfield Grange Nursing Home DS0000001076.V370057.R01.S.doc Version 5.2 Page 27 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 Requirement When assessing people before they move in, the staffing levels and the needs of the people already living there must be considered before a place is offered. This will make sure that people can be confident that the home can meet their needs. People who use the service and/or their representatives must be consulted about their care plan. The plan must be kept under review so that it reflects current needs. Requirement outstanding from 17/7/07. Moving and handling plans must be reviewed to make sure they are up to date and relevant, so that people are assisted safely and appropriately. Requirement outstanding from 17/7/08. All medication must be administered as prescribed and accurately recorded on the MAR chart. This will make sure people receive their medications correctly and the treatment of DS0000001076.V370057.R01.S.doc Timescale for action 31/10/08 2 OP7 15 31/10/08 3 OP7 13 31/10/08 4 OP9 13(2) 31/10/08 Woodfield Grange Nursing Home Version 5.2 Page 28 their medical condition is not affected. 5 OP12 16 Activities must be provided that 31/10/08 meet the range of needs and abilities of the people who live there. Wherever possible, people must be consulted about the sort of activities they wish to be involved in. This will enable them to take part in activities of their choice. The training needs of all staff 31/10/08 must be reviewed to make sure that they are competent to carry out their work safely. We must be notified of any changes that affect the day to day running of the home. 31/10/08 9. OP30 18 10. OP31 38 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Woodfield Grange Nursing Home DS0000001076.V370057.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Woodfield Grange Nursing Home DS0000001076.V370057.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!