Inspection on 17/07/07 for Woodfield Grange Nursing Home

This inspection was carried out on 17th July 2007.

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

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

Other inspections for this house

Woodfield Grange Nursing Home 09/12/09

Woodfield Grange Nursing Home 28/07/09

Woodfield Grange Nursing Home 04/02/09

Woodfield Grange Nursing Home 12/08/08

Woodfield Grange Nursing Home 14/08/06

Woodfield Grange Nursing Home 07/02/06

Woodfield Grange Nursing Home 15/09/05

Woodfield Grange Nursing Home 19/01/05

Woodfield Grange Nursing Home 29/09/04

Woodfield Grange Nursing Home 23/03/04

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Abbey The

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Larchfield Manor

Hawkhills

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The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Woodfield Grange Nursing Home Saddleworth Road Greetland Halifax West Yorkshire HX4 8NZ Lead Inspector Lynda Jones Key Unannounced Inspection 09:15 17th July 2007 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 DS0000001076.V339392.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. DS0000001076.V339392.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) Ancyra Health Limited Mrs Amanda Gosling Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places DS0000001076.V339392.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. 14th August 2006 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 £347 and £483 per week. There is an extra charge for hairdressing, chiropody and personal newspapers. DS0000001076.V339392.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last key inspection of Woodfield Grange took place in August 2006. There have been no other visits to the home since then. This visit was unannounced and was carried out by two inspectors who were at the home for 7.45 hours. During the visit we spoke with people who live at Woodfield Grange and with some of the visitors who called at the home. We also spoke with the staff on duty. We watched how care was given, looked at records, and looked around the building. One of us spent two hours in the lounge watching and recording the care being given to a small group of people with dementia. Using this observational tool as part of the inspection process helped us to understand the experiences of people living in the home who aren’t able to communicate their views because of their dementia or communication difficulties. Before we visited, the manager provided us with a detailed self-assessment about the performance of the home, information about staff and about the service provided. Surveys were sent to relatives and representatives of people who use the service. We also sent surveys to the local medical practice and to some of the social workers that have links with people who live at the home. These provide an opportunity for them to share their views of the service with us. Comments received in this way are shared with the owner without revealing the identity of those completing them. We received replies from seven people who use the service; they indicated that staff helped them to complete the forms. Five relatives also wrote to us with their comments. We received a reply from the medical practice and two responses from social workers. Information from the surveys has been used in this report. What the service does well: There are some good staff working at the home that are well liked by the people who live there and by their relatives. They said they have confidence in some of the staff. We saw some positive interactions between staff and people who use the service. Everyone is assessed before they move into the home to make sure it is suitable for them, wherever possible people are invited to call at the home to have a look round and meet people who already live there. DS0000001076.V339392.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The company must provide people with terms and conditions of living at the home so that people know about their rights and responsibilities. People who live at the home, and their relatives, have said they don’t feel 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. 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. Meals and mealtimes do not meet with everyone’s satisfaction and expectations. Some people told us they find the menus dull, the food uninteresting and not particularly wholesome. It is not clear whether this is because of budgetary constraints or lack of consultation with people who live there. There is evidence that the home is not meeting the dietary needs of some people. The organisation of mealtimes needs to be improved so that people are not sitting waiting for their meals for too long. Meals need to be served more efficiently so that, as far as possible, people can eat together. People told us they did not feel that their concerns were taken seriously, they did not feel that they were listened to. When we asked relatives what could be improved we were told “provide activities without having to pay extra as suggested”, “provide exercise classes, DS0000001076.V339392.R01.S.doc Version 5.2 Page 7 mental stimulation”. Hopefully, this will be addressed now that there is an activities organiser in post. The bathing facilities are clinical and people do not have a real choice of baths and showers because some of them cannot be used because people cannot get in and out of the baths. There has been no progress in improving these facilities. The toilets in the entrance area cause concern to people who live at the home and to visitors. Because of the location, they compromise the privacy and dignity of people who use them. This issue needs to be addressed urgently. The manager does not have a budget for staff training. This makes it difficult for her to establish a training plan for staff. There needs to be a development plan for the home which can be shared with people who use the service and their relatives. They would like to know about future plans for 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. DS0000001076.V339392.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 DS0000001076.V339392.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5. Standard 6 does not apply to this service People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. People’s needs are assessed before they move into the home and they are provided with written information about the services and facilities provided. People are not provided with terms and conditions of residence; this means they are not being given information about their rights and responsibilities and those of the company. EVIDENCE: The home has a Service User Guide and Statement of Purpose, which gives information about the service and the facilities in the home. Copies are available in the entrance for people to take away. The manager said that people are very welcome to visit the home at any time to view the accommodation. Moving into a care home can be a very unsettling DS0000001076.V339392.R01.S.doc Version 5.2 Page 10 experience for some people, therefore it is vital that both they and their relatives know that the home is suitable for them before they make any decisions about moving in. We looked at the records relating to two people who moved in recently because we wanted to know if they had been assessed appropriately before they moved in. This is important because this should indicate whether Woodfield Grange is suitable for them and whether their needs can be met at the home. We found that they had both been visited by the manager before moving in and detailed pre-admission assessments had been carried out to make sure that their health, personal and social care needs could be met. These two people did not have terms and conditions of residence. These documents are very important because they tell people about their rights and responsibilities and about the rights and responsibilities that the company has towards them. Some of the relatives who returned surveys said that they had never seen a contract or a terms and conditions document. One person living at the home wrote to us saying, “If a contract was issued to everyone within the home, why didn’t I get one?” This issue needs to be addressed so that the rights of everyone living at the home are protected. DS0000001076.V339392.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. People are not consulted about their care plans and the plans are not always being updated to reflect the changes in people’s needs. This means that individual care needs are not always being met. Working practices sometimes compromise the privacy and dignity of people who live at the home. EVIDENCE: We looked at a selection of care plans relating to people who were new to Woodfield Grange and people who have lived at the home for some time. We wanted to see what individual needs had been identified and what action staff were expected to take to meet these needs. The home has a standard format for the care plans; this means that the same sort of information should be gathered about everyone living at the home. DS0000001076.V339392.R01.S.doc Version 5.2 Page 12 Various assessments are carried out when people first move in to the home, covering areas such as nutritional needs, whether people are at risk of developing pressure sores, moving and handling assessments and personal hygiene needs. Once the needs of each person have been established, a care plan is set up which provides the staff with details about the action they must take to make sure individual needs are met. We found the care plans for the people who had moved in recently were more comprehensive and contained more detail than the plans for people who had lived at the home for some time. To ensure that the plans are working tools for the staff to follow, they need to be reviewed regularly and updated as soon as there are any changes. We found that some of the reviews repeatedly read “no change to plan” even though there had been significant changes in people’s care needs. For example, we knew that one person was now spending most of her time in her room following a couple of accidents. The care plan told us this individual was fully mobile and used a zimmer frame to get about. The plan had not been altered to reflect the changes in mobility, nothing had been added to show how this person’s needs were to be met now that she was confined to her room. We could find no overview of what had changed in this person’s life in recent months, we could not find any reference to the accidents in the care plan or in the reviews, nor could we find out what measures had been taken to reduce the risk of further accidents. The surveys that we received from Local Authority staff that have contact with the home told us that they sometimes find care plans and reviews are not up to date. They said that actions flagged up at reviews are not always followed up by the home, eg. making sure people have dental appointments when they need them. Concerns were also expressed that staff were not always following what was in the moving and handling plans. This puts the people who need assistance, and the staff, at risk of injury. People told us that they had seen staff moving people without using the correct equipment and that footrests were not always in place when wheelchairs were used. We saw this happening during our visit and we also saw different staff using a variety of moving techniques when assisting one individual. This suggests that staff were not following an agreed plan. We talked to the manager about this at the end of our visit. The care staff know the people who live at the home well and they try to make sure that their needs are met but they do this with little reference to the care plan. Most of the communication about individual care needs appears to be passed on amongst the team verbally. If, for any reason, the regular staff were unable to work at the home, it would not be possible for agency staff to provide care with consistency, in the way people prefer, because some of the plans do not have enough detail in them. DS0000001076.V339392.R01.S.doc Version 5.2 Page 13 Detailed, up to date care plans are of vital importance because some people who live at the home are unable to say what their needs are. We noted that when the home’s last quality assurance survey took place in December 2006. 100 of the relatives that replied (five relatives) said they were not involved in the care planning process. The action that was to be taken was “to try to involve families in reviews”. There is no evidence of any improvement in this area, the relatives that we talked to and surveyed recently also told us that they were not really aware of the care plans or of the care plan reviews. The manager needs to make sure that progress is made as soon as possible; relatives told us they did not feel involved and they did not feel that they were being listened to. When we surveyed relatives we asked them if they thought the home was meeting the needs of their family member. Two people said “always”, three said “sometimes”. One person didn’t think dietary needs were being met, another felt that more attention should be paid to how people looked. We were told visitors sometimes found people unshaven, with untidy hair and dirty fingernails. Some relatives were of the opinion that the staff were always in a rush. These are some of the comments they made; “No-one has time to care properly. The staff are always rushed off their feet or they are short staffed. Residents just sit in the lounge staring into space or they sleep”. “Most staff are committed, attentive and pleasant. Possibly staff break times should be revised. Staff take breaks together or leave 1 or 2 members of staff supervising residents”. In the surveys we asked people using the service whether they received the care and support that they needed, three people said “sometimes”, two said “usually” and one said “always”. When we talked to the manager about these comments, she acknowledged that there had been times when the home was short staffed and staff were very busy. She said the home was now appropriately staffed and this should not be happening. During this visit, we observed that staff did not appear rushed and breaks were staggered. For anyone who needs assistance using the toilet, this is not a dignified and private matter. The toilets that are most easily accessed by people who use a wheelchair are in the entrance area. At the front of the entrance there is an area where wheelchairs are stored and the door is usually left open. The toilets are at the back of this area, when the toilets are in use the toilet doors are closed. In the morning (particularly before lunchtime) people were asked if DS0000001076.V339392.R01.S.doc Version 5.2 Page 14 they wanted to use the toilet. We noticed people sitting in wheelchairs, queuing to use the toilet. This is unacceptable practice. All of the relatives who contacted us said they were very distressed and dissatisfied with the location of the toilets and the lack of dignity that they witnessed. We refer to their comments on the location of the toilets again in the environment section of this report. The medication is supplied to the home in blister packs from a local pharmacy. All medication is securely kept and is administered by nursing staff. The Medication Administration Records are accurately completed and signed when medication is administered. DS0000001076.V339392.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. Some activities are provided but this could be developed further by involving people more and giving them more choice over their daily lives. People have little choice of what they eat and mealtimes are poorly organised and not relaxed social occasions. EVIDENCE: The staff need to be more aware of how their behaviour impacts upon people who live at the home. During the morning, we observed staff at work to see how they interacted with people who were sitting in the lounge areas. On the whole, the interactions that we saw were good. We saw evidence of some positive contact, staff chatted to people in a friendly manner, asked how people were, commented on their appearance and engaged in some light hearted banter. However, most of the contact was focused around tasks, eg giving people drinks, getting ready for lunch, taking people to the toilet. The staff did not sit with people and engage in conversation, despite the fact that DS0000001076.V339392.R01.S.doc Version 5.2 Page 16 there were opportunities to do so at various points. There were long periods when there was little activity or interaction. We noticed that staff engaged with some people more than others. We felt that some people who spent periods sitting quietly or dozing probably did so because they lacked stimulation. We noticed that when staff stopped to chat, these individuals seemed quite animated and happy to talk. We observed some staff talking exclusively to each other, although this only happened briefly. When they had finished their conversation they went about their business unaware that one person had been trying to attract their attention. This person gave up when the staff dispersed. We gave feedback on these observations to the manager at the end of our visit. People who live at the home and their relatives told us there were not many organised activities taking place. The last recorded activity on the care plans that we looked at took place in April 2007. Some people had been on a trip out recently, which they enjoyed and another one was planned. Two relatives told us they had received a request for a voluntary monthly contribution towards outings and activities and they were very unhappy about this. They were under the impression that activities were provided by the home and were included in the fee. They did not have terms and conditions of residence documents so they were unable to verify this. There is no reference to this voluntary contribution in the home’s Statement of Purpose. The manager told us that a new activities organiser had recently started work at the home. During the afternoon of our visit, we saw three people playing dominoes with staff and a small group taking part in some flower arranging. The activities organiser, who works between 1 pm and 3.30 pm, Monday to Friday was talking to people individually, telling them about the proposed summer fair and asking what sort of activities people wanted to take part in. We asked people what they thought about the food provided and the responses were mixed. No-one was particularly enthusiastic; some people said it was “OK”. We received seven surveys from people who live at the home, one person receives all their nutrition in prescribed liquid feeds, three people ticked a box indicating that they “always” enjoyed their meals, two people said they “sometimes” enjoyed their meals and one person said they “never” enjoyed the meals. We received the following comments “I think the meals are very drab and uninteresting”, “I think the menu should be kept wholesome and varied”, “I know you can’t please everyone but still they don’t please anyone”. One person said, “We should have more meetings about food and be able to put our opinions forward”. We were told that there has been some recent consultation with people about the meals and, as a result, the menus have been changed, although the new menus were not in use when we visited. DS0000001076.V339392.R01.S.doc Version 5.2 Page 17 Some of the relatives who we had contact with expressed strong opinions on the food provided. They told us they did not think there was enough variety on the menus, they thought that the food was “cheap” and lacked nutritional value. One person told us “Most of our concerns revolve around the lack of decent food – more fresh veg, fruit instead of cheap Cornish pasties, chips, baked beans, mushy peas and powdered soups”. The Service User Guide states that there is a choice of meal at each mealtime and that, through discussion with the cook, all dietary requirements can be catered for. This was not the experience of one person who told us “In their literature it says they cater for special diets. This is not true”. We are aware that some people are taking food into the home because they are not confident that the home is catering for their relatives appropriately. We asked the manager to address this issue as soon as possible. When we last visited the home in August 2006, we said that the serving of lunch was not particularly satisfactory and we felt that the process needed to be improved. In the information provided before we visited, we were told that this had been addressed but we saw no evidence of this. There is only one sitting at lunchtime. The first people were assisted to the dining room at 11.30; it took 30 minutes for everyone to be seated. This meant that some people were waiting at the table for 30 minutes. The first meal was served at 12.00 pm. In the surveys, two people commented on the length of time they had to wait for their meals. The lunchtime menu was either fish fingers or scampi with chips and peas. We did not feel that offering two fish dishes was providing people with much choice. We did not see anyone actually offered a choice of fish fingers or scampi; the meals were served already plated up. One person was given a plate of food with peas on it, but said they did not like peas. We saw a member of staff turn the plate around so that the peas were presented on the opposite side of the plate. No attempt was made to remove the peas or offer an alternative. Part way through the serving of the meal, the supply of chips ran out and more needed to be cooked. This added further delay to the process and meant that some people were sitting for a considerable time without food while other people at their table were eating their meal. Some people needed assistance to eat; there was a big variation in the way this was done. We noted that some staff took time with people; they sat next to them, talked about the meal and waited patiently until they were ready to continue eating. This was in sharp contrast to three staff at one table who stood up, towering over the people they were assisting. This is not respectful and is not conducive to an enjoyable mealtime. DS0000001076.V339392.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. Complaints need to be better managed, some people do not feel confident that their views are listened to and taken seriously. EVIDENCE: There is a complaints procedure and details are included in the Service User Guide. The procedure is also on display in the entrance area. We looked at the record of complaints and we felt that this needed to be improved. The records did not always clearly show when complaints were received and how they had been addressed. The record must include details of the investigation and any action taken. Six out of seven people who live at Woodfield Grange said they knew how to complain, one person said, “I would open my mouth and tell someone”. One person said they didn’t know how to make a complaint and went on to say they had not needed to. Most people felt that the staff listened to what they had to say although three out of seven said the staff only listened “sometimes”. DS0000001076.V339392.R01.S.doc Version 5.2 Page 19 Of the five relatives who replied, only three said they knew how to complain. Some people did not feel confident that they would be listened to. One person said, “What’s the point, nothing would change”. One person said they had repeatedly brought issues to the attention of staff and, although they had recently seen signs of improvement, they said, “I feel tired out with it all”. We asked people if the service responded appropriately to issues that they raised. One person said “always”, two said “usually”, two said “sometimes”. Relatives told us “it depends who you speak to”, “some staff are indifferent, and some are very caring”. The manager told us that there is a procedure in place for dealing with any allegations of abuse and for ensuring that people who live at the home are appropriately protected. Most staff have received training about adult protection issues and about their responsibilities in this area. The manager said the home could improve in this area by making sure that adult protection training was provided on a regular basis. Some staff already have places on the training provided by Calderdale MBC over the coming months. However, only a few places can be booked according to the manager, therefore detailed training will need to be provided by the company. DS0000001076.V339392.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21, 26. 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. Overall, the standard of accommodation is adequate but some aspects of the facilities are extremely poor and do not afford people the privacy and dignity that they have right to expect. EVIDENCE: We did not look round all of the building but focused on the bathrooms, toilets and on the proposals to upgrade the bedrooms. In the last two reports (Feb 2006, August 2006) we commented on the poor bathing facilities and lack of choice of bath/shower at Woodfield Grange. Although the home has the right number of bathrooms, the people who live there really have very little choice in what they can use as many of them cannot get in and out of some of the baths and the shower is unusable. DS0000001076.V339392.R01.S.doc Version 5.2 Page 21 After the last visit in August 2006, we were told that there was a plan to improve all the bathing and toilet facilities throughout the home. This included repositioning the wash hand basins in the toilets so that it is easier to get wheelchairs in and out, replacing the shower and increasing the number of assisted bathing facilities. The manager said that she was waiting for costings for the improvements but she was unable to provide any timescales for the work to be carried out. The work has still not been carried out. On this visit, the manager said she was still waiting for a date for the work to commence. This means that people who use the service continue to have very little choice of useable baths/showers. In the surveys, the area that was commented upon most, and one that people held very strong views about, was the toilets that are located in the entrance area. We were told “those toilets need sorting out, they smell when you walk in”, “the toilet situation is disgusting, as visitors we do a quick dash past because of the smell”, “those toilets need closing off, there is often a bad smell there”. People living at the home said they found it “…embarrassing, people who use wheelchairs have to queue up to use them”, “ there’s no privacy”. Those people who can walk about have a choice of toilet that they can use. People who need assistance do not have the same choice available to them. They are sometimes left waiting in a queue just inside the entrance area. This is completely undignified. The owners of the home must address this issue as soon as possible to avoid further embarrassment and loss of dignity to the people they provide a service to. Relatives felt that the home in general was in need of improvement. One person said, “It needs completely refurbishing”, another told us “it hasn’t been decorated for years, the bedrooms have always had the same wallpaper on”. Another person said “they could do with some more tables for people to rest their drinks on in the lounge, they leave people with full cups of tea and nowhere to put it. That’s why people are always spilling things on their clothes”. The home has thirty-four single bedrooms and one double room. None of the bedrooms have en suite facilities. The manager said a few of the rooms are beginning to be upgraded but she expected that this would take some time as the work was being carried out by the home’s handyperson. We saw one room that had been redecorated and fitted out with a new bed, carpet and curtains. A new wardrobe and cabinet were on order. The manager does not have a budget for decoration and renewal of furniture and the owners have not provided any development plan for the home. DS0000001076.V339392.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. There are sufficient staff to meet the needs of people using the service. The recruitment process is good which means that people in the home are protected. Staff training needs to be further developed to make sure that staff have competencies/skills to meet people’s needs. EVIDENCE: We asked people who live at Woodfield Grange whether the staff were available when they needed them. Six people said “usually”, one person said “never”. People who use the service and their relatives said that the staff didn’t have enough time to spend with them because they were always very busy. One of the relatives said “The staff are not allowed to stay & talk to residents as there is more important work to do, it’s a pity as all most of them want is stimulation”. The manager acknowledged that there had been times in the past when there had been staff shortages but she said there had been an improvement in this DS0000001076.V339392.R01.S.doc Version 5.2 Page 23 area - “we have employed more staff and have tried to ensure that enough staff are on duty for each shift”. We asked if relatives thought the staff had the skills and experience to look after people properly. One person said “always”, two said “usually”, two said “sometimes”. One person said “the established staff are very good but there has been a big turnover of younger staff who don’t seem that interested”. We were told that, of twenty-five permanent staff, 17 are qualified to NVQ level 2 or above, and two other members of the team are working towards this qualification. We asked what plans the company had for providing ongoing training to ensure that the staff were skilled and equipped to meet the changing needs of people using the service. The manager said she had not been provided with any information about the company’s plan for training. We looked at three staff files for evidence that the correct checks had been carried out before new staff started work at the home. This is to ensure that people who live there are safe and protected. We noted that Criminal Records Bureau checks had been carried out and references had been obtained. We felt that some of the references were vague and deserved further enquiry to make sure that they were valid. We talked to the manager about this and about the importance of exploring any gaps in employment histories with prospective staff. DS0000001076.V339392.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38. People who use this service experience adequate 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. Health and Safety is generally managed well which means that people living and working at the home are safe. EVIDENCE: The registered manager is a qualified nurse with experience of working with older people. DS0000001076.V339392.R01.S.doc Version 5.2 Page 25 The manager has had very little contact with the company and was unable to give details of any plans for the future development of the service. This means that she is unable to tell people who live there and their relatives about plans for the home. We noted that the home’s last quality assurance survey took place in December 2006 and, in their responses, relatives said they knew nothing about the care planning process. No action has been taken to address this issue. There are clear policies and procedures for handling finances, which means that people’s personal finances are held safely. A small amount of money is held on behalf of some the people who live there. Records are kept of all transactions and receipts are available for all purchases. There is no evidence that formal staff supervision is taking place. There was evidence of regular maintenance of equipment such as the hoists and lifts. Fire alarm checks and fire drills are taking place. Although the names of staff taking part in fire safety training are recorded, the manager needs to make sure that they all have the opportunity to take part. The maintenance file showed that a gas inspection in December 2006 had identified that gas flues for a boiler needed to be replaced as they were becoming unsafe. A warning notice was issued by the contractor. The manager explained that she was told there was no immediate danger. This information has been forwarded to the head office according to the manager but the work has not yet been done. This must be addressed as a priority before the winter. DS0000001076.V339392.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 CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 1 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X 1 X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 1 DS0000001076.V339392.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 OP2 Regulation 5 Requirement People must be provided with a statement of the terms and conditions of residence at the point of moving into the home so that they are informed of their rights and responsibilities. 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. 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. Staff must ensure that people who live at the home are treated with dignity and respect at all times. The menus and mealtime arrangements must be reviewed to make sure that a) all dietary requirements are catered for b) meals are varied, wholesome and nutritious c) people are not waiting for DS0000001076.V339392.R01.S.doc Timescale for action 14/09/07 2 OP7 15 31/08/07 3 OP7 13 31/08/07 4 OP10 18 10/08/07 5 OP15 12, 31/08/07 Version 5.2 Page 28 6 OP16 Schedule 4 7 OP21 23 8 OP21 23 9 OP30 18 10 OP38 13(4) long periods for their meals to be served d) staff provide assistance sensitively A record must be kept of all complaints made which includes details of investigation and any action taken. This is so that people can know their complaints will be taken seriously and acted upon. An action plan is required showing plans to improve the bathing facilities in the home. People must be provided with a choice of usable baths/showers. (Previous timescales of 31/03/06 and 31/10/06 not met) The toilets in the entrance area must be improved so that the dignity and privacy of people using them can be maintained. The training needs of all staff must be reviewed to make sure that they are competent to carry out their work safely. The gas flues identified in the warning notice given in December 2006 must be repaired or replaced to ensure the system is safe. 10/08/07 14/09/07 14/09/07 31/08/07 30/09/07 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 DS0000001076.V339392.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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 DS0000001076.V339392.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. 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