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Inspection on 15/09/05 for Woodfield Grange Nursing Home

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

This inspection was carried out on 15th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

Residents say the staff are helpful and pleasant but "run off their feet". Staff felt that they generally offer a good service but that this had been compromised when there were not enough staff on duty.

What has improved since the last inspection?

The home continues to ensure that all staff have access to NVQ training.

What the care home could do better:

Staffing levels must be improved as a matter of urgency. Minimal staffing levels are not always met and this is having an impact on the care residents are receiving. Staff recruitment procedures need to be improved to protect residents and to make sure that people are suitable for this type of work. Care plans; risk assessments and moving and handling plans were not in place for two people who recently moved into the home. A plan must be in place that gives staff detailed information about what they have to do to care for each person. Relying only on staff passing verbal information about care needs is not acceptable. All care records that are kept in residents rooms i.e. food/ fluid and turning charts must be completed. Footrests must be used on wheelchairs unless reasons are documented. When people use the toilet they should notneed to queue, toilet doors should be closed to maintain individual privacy and dignity.

CARE HOMES FOR OLDER PEOPLE Woodfield Grange Nursing Home Saddleworth Road Greetland Halifax West Yorkshire HX4 8NZ Lead Inspector Lynda Jones Unannounced Inspection 15th September 2005 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Woodfield Grange Nursing Home DS0000001076.V250378.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Woodfield Grange Nursing Home DS0000001076.V250378.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Woodfield Grange Nursing Home Address Saddleworth Road Greetland Halifax West Yorkshire HX4 8NZ 01422 377239 01422 311863 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) Ancyra Health Limited Mrs Valerie Ann Stokes 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.V250378.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th January 2005 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. The home is set in its own attractive gardens and there is a patio area to the front of the building where service users’ can sit in fine weather. There are carparking 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 and a separate dining room. There are also four small sitting areas, two each on the ground and lower ground floors, which are located in the corridors. 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. There are four bathrooms in the home and a separate shower room, in addition, there are nine separate toilets located around the building. Woodfield Grange Nursing Home DS0000001076.V250378.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out the inspection over a 5.15 hour period. Five residents, five members of staff and one relative were spoken to. Resident’s records, staff rotas and a sample of staff files were examined. What the service does well: What has improved since the last inspection? What they could do better: Staffing levels must be improved as a matter of urgency. Minimal staffing levels are not always met and this is having an impact on the care residents are receiving. Staff recruitment procedures need to be improved to protect residents and to make sure that people are suitable for this type of work. Care plans; risk assessments and moving and handling plans were not in place for two people who recently moved into the home. A plan must be in place that gives staff detailed information about what they have to do to care for each person. Relying only on staff passing verbal information about care needs is not acceptable. All care records that are kept in residents rooms i.e. food/ fluid and turning charts must be completed. Footrests must be used on wheelchairs unless reasons are documented. When people use the toilet they should not Woodfield Grange Nursing Home DS0000001076.V250378.R01.S.doc Version 5.0 Page 6 need to queue, toilet doors should be closed to maintain individual privacy and dignity. 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. Woodfield Grange Nursing Home DS0000001076.V250378.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodfield Grange Nursing Home DS0000001076.V250378.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected. EVIDENCE: Woodfield Grange Nursing Home DS0000001076.V250378.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. In the absence of individual plans of care, the needs of recently two admitted residents were not met. EVIDENCE: Case records relating to two residents were examined, both had moved into the home within the past month. One set of records was looked at because of concerns raised by a relative of the resident about the care provided. Some pre admission information was available and social workers and hospital staff had provided some detailed information about the two residents. The home failed to use this information to form a written plan of care for the two residents concerned. Information about both residents appears to have been communicated verbally amongst staff, this practice is unacceptable. No risk assessments had been completed and no moving and handling plans were in place. Daily record were brief and comments were made such as “ all care given” and “all care needs continue to be met as per plan”, as there was no care plan it is difficult to know what these comments referred to. It was Woodfield Grange Nursing Home DS0000001076.V250378.R01.S.doc Version 5.0 Page 10 noted that staff failed to make any notes about one resident on the day of admission to the home. There was no evidence to show that appropriate arrangements had been made to manage the pain relief that was needed by one resident. From speaking to this person, he was clear about the times of day when he most needed his medication but this had not been incorporated into his plan of care. According to this individual, having to repeatedly request medication made him feel “like a nuisance”. Records show that medication was “borrowed” from one person to give to another. The same medication was prescribed for both people but stock had “run out” for one person. Inspectors noted that food charts and change of position charts had not been fully completed in respect of some of the residents who were nursed in bed. One food chart had no entry on the day of the inspection; the change of position chart for the same person had not been completed since 6am that day. It is likely that these care needs were being monitored but there was no written evidence to support this. The organisation is introducing a new system of care planning. Inspectors were informed that the system should have been in place in July 2005 but this had not been possible due to staff shortages and the pressure of other work. Two residents spoken to said they were satisfied with the care they received, they thought the staff were helpful and noted that they were always very busy. The arrangements for assisting residents who need to use the ground floor toilets should be reviewed. The process was undignified and the privacy of residents was not taken into consideration. Residents should not be left queuing in wheelchairs whilst waiting to use the toilet and the toilet door should be closed. It was noted that many of the wheelchairs were used without the footrests in place. This practice could put residents at risk of injury. Woodfield Grange Nursing Home DS0000001076.V250378.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were inspected. EVIDENCE: Woodfield Grange Nursing Home DS0000001076.V250378.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Complaints are handled in accordance with the homes procedure. EVIDENCE: Two complaints have been made since the last inspection in January. These were about cleanliness in the home, lost property, delays in answering call bells and limited social activities. Both complaints were received by Calderdale’s Health and Social Care department and were forwarded to the home. The manager of the home investigated, she offered explanations to the complainants and did not uphold the complaints. She noted that there had been limited social activities recently as the activities organiser left at the end of June 05. The post is still being advertised. Improvements need to be made in the staff recruitment procedure to ensure that residents are protected (see section on staffing). Woodfield Grange Nursing Home DS0000001076.V250378.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 The home is clean and tidy. The shared areas would benefit from upgrading. EVIDENCE: Although a full tour of the building did not take place, the areas that inspectors visited were noted to be clean and tidy. Residents said they felt the domestic arrangements were good and that staff worked hard to keep everywhere clean. They were satisfied with their bedrooms and said they were comfortable. A visitor to the home who called at various times of the day said the he always found the home clean. The manager of the home and the operations manager acknowledged that some of the communal areas would benefit from redecoration. They said there was an ongoing plan to upgrade bedrooms when they were empty. Some work is scheduled to improve the facilities at the entrance to the building. Woodfield Grange Nursing Home DS0000001076.V250378.R01.S.doc Version 5.0 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29. The home is not sufficiently staffed at all times to meet the needs of residents. Staff recruitment procedures must be improved to ensure that residents are fully protected. EVIDENCE: The staffing notice issued by the previous regulatory authority shows that for between 31-35 residents there should be 6/7 members of staff on duty during the day and 3 members of staff on duty at night. One member of staff must always be a qualified nurse. Staffing levels increase for 36-40 residents when there should be 7/8 staff on duty and 3/4at night. These staffing levels are minimal requirements and change may be required should the dependency levels of residents increase. The staff rota for w/c 12/9/05 & 19/9/05 showed prospective shortfalls on all but 4 occasions during the day. The rotas clearly show that there are insufficient permanent staff to cover all of the shifts. There is evidence that at times the home is operating with less than the required number of staff on duty. The home is adequately staffed at night. Woodfield Grange Nursing Home DS0000001076.V250378.R01.S.doc Version 5.0 Page 15 The manager acknowledged the poor staffing situation at the home. She said attempts to recruit permanent staff had been unsuccessful. She commented that she had been unable to complete some of her management duties because she had been providing direct care at times. The deputy manager of the home has left recently and the company have decided not to fill this post, this does not ease the position of the manager. Staff spoken to said that meeting all of the residents care needs had been difficult. They said some of the recent work patterns had been very tiring. One resident who is very dependent on staff said she had to wait to get up in the mornings, sometimes until 10am. She thought this was because staff were busy. She said she enjoyed her breakfast but she often had it so late in the morning, she was not hungry by the time lunch was served. Staff shortages in the afternoons has meant that staff have struggled at times to serve all of the tea time meals and the kitchen assistant has had to help out. One of the concerns raised by a relative was about the length of time residents had to wait before the emergency call system was answered. This was also raised in one of the complaints referred to earlier in this report. Two staff files were examined to check on recruitment procedures. There was no current CRB check in place in respect of one member of staff who had started work at the home recently. There was evidence that the second member of staff had started work in the home before a CRB check had been received. In one file there was no evidence that gaps in employment history had been explored or that the reference taken up had been obtained from the most appropriate person i.e. the last employer. Staff training records were not examined on this occasion. The manager confirmed that all staff have access to NVQ training and one member of the team said he was enjoying the course. Woodfield Grange Nursing Home DS0000001076.V250378.R01.S.doc Version 5.0 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed. EVIDENCE: Woodfield Grange Nursing Home DS0000001076.V250378.R01.S.doc Version 5.0 Page 17 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 X X X X X X X 3 STAFFING Standard No Score 27 1 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Woodfield Grange Nursing Home DS0000001076.V250378.R01.S.doc Version 5.0 Page 18 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 OP7 Regulation 15 Requirement Care plans must contain sufficient detail to provide clear guidance to staff on the actions to be taken to meet the health and welfare needs of residents. Prescribed medications must not be used for anyone other than the person for whom they were prescribed. Personal care must be delivered in a way that respects the privacy and dignity of residents. To reduce the risk of injury to residents, footrests must be used on wheelchairs unless otherwise indicated through a risk assessment. The registered person must ensure that appropriate checks are carried out on all staff before they commence employment at the home. (Previous timescale of 19/11/04 not met) The registered person is required to ensure that at all times suitably qualified, competent and experienced persons are working in the home in such numbers as are appropriate for the health DS0000001076.V250378.R01.S.doc Timescale for action 30/11/05 2 OP9 13 15/09/05 3 4 OP10 OP8 12 13 15/09/05 15/09/05 5 OP29 19 15/09/05 6 OP27 18 15/09/05 Woodfield Grange Nursing Home Version 5.0 Page 19 and welfare of service users. (Previous timescale of 19/11/04 not met). 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.V250378.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Woodfield Grange Nursing Home DS0000001076.V250378.R01.S.doc Version 5.0 Page 21 - 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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