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Inspection on 28/07/09 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`s suitability to work at the home is checked before they are offered a position which means that people who live at the home are protected. People`s care and support needs are assessed before a decision is made as whether they can move in. This means that people can be assured that their needs will be met. People said that they liked the food, and it looked nicely presented. People keep in contact with their relatives, and are supported to do this by the staff.

What has improved since the last inspection?

There was no evidence of improvements made since the last inspection. The requirements made at the last inspection have not been dealt with properly. These included improving the care plans, the risk assessments and making sure that the staff attend safeguarding training.

What the care home could do better:

The service must be managed effectively and there must be sufficient management input and management resources in place so that people`s needs are effectively met, and their health and welfare promoted. People living at the home must be supported by a staff team who are given direction, leadership and appropriate training. Work needs to continue to ensure that more than half the staff have a relevant National Vocational Qualification (NVQ) II qualification in care. The home was found to be in need of a thorough clean. Maintenance work must be completed so that the home is safe and suitable to meet people`s assessed needs.Woodfield Grange Nursing HomeDS0000001076.V376905.R01.S.docVersion 5.2Any complaints received by the service need to be dealt with, as stated by the home`s complaints procedure. Staff need training in safeguarding so that risks to people from abuse or suspected abuse can be minimised. A daily activities programme with allocated staff time must be established. Staff need to be made fully aware of people`s individual preferences, interests, needs and wishes through clear assessment and care planning processes, management leadership, observation and supervision. Individual personal, healthcare and medication support needs must be reflected and recorded in people`s care plans. The information relating to the healthcare needs of people living at the home needs to be organised, accurate, up to date and detailed so that individual healthcare needs can be ascertained, and the care and support they need given. People using the service or their relatives, should be asked to sign their terms and conditions of residence documents.

Key inspection report CARE HOMES FOR OLDER PEOPLE Woodfield Grange Nursing Home Saddleworth Road Greetland Halifax West Yorkshire HX4 8NZ Lead Inspector Mr T Brindle-Wills Key Unannounced Inspection 28th July 2009 09:30 DS0000001076.V376905.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Woodfield Grange Nursing Home DS0000001076.V376905.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Woodfield Grange Nursing Home DS0000001076.V376905.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 www.aermid.com Aermid Health Care (UK) Limited Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of Nurse in Charge(if applicable) Type of registration No. of places registered (if applicable) Manager post vacant 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.V376905.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. 4th February 2009 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. The current fee levels are: Single £310 - £473, Shared £310 - £415. In addition to the weekly fee there is an extra charge for hairdressing, chiropody and personal newspapers. Woodfield Grange Nursing Home DS0000001076.V376905.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 zero star – poor service. This means the people who use this service experience poor quality outcomes. Prior to the visit, we received a report from the local authority contracts team who had visited the home in July 09. Their findings indicated that standards within the home had fallen, and that outcomes for people living there were less than adequate. We therefore decided to undertake a key inspection to determine if the quality rating had changed and to assess the outcomes for people living at the home. Our visit was unannounced and last approximately seven hours. As this inspection was brought forward, no Annual Quality Assurance Assessment (AQAA – a self assessment form completed by the provider) was requested, as the timescales for completing such a document were very short. For the same reasons questionnaires were not sent out prior to our site visit, however, several were left at the home for people to complete and return to us. At the time of writing this report, none of the surveys had been returned. We looked at the following records; care assessments and care plan files, care reviews, personnel and training records, staff meeting minutes, health and safety records. We talked to people who live at the home and their relatives. We also spoke to the staff who work there. We watched how the staff interacted and supported people living at the home. We issued an Immediate Requirement Form (IRF) as we had serious concerns about how the home was being managed. The IRF gave details of action that the provider must take within 48 hours to meet our requirements. The registered provider was required to ensure that suitable management arrangements were put in place. Since our site visit, we have been informed that temporary management arrangements have been put in place. Following our site visit, a serious concerns letter was sent to the registered provider giving details of issues that must be dealt with regarding the health and welfare of people living at the home. These included concerns regarding care planning; risk assessments; people’s healthcare needs; and the maintenance of the building. Woodfield Grange Nursing Home DS0000001076.V376905.R01.S.doc Version 5.2 Page 6 We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk or harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: People’s suitability to work at the home is checked before they are offered a position which means that people who live at the home are protected. Peoples care and support needs are assessed before a decision is made as whether they can move in. This means that people can be assured that their needs will be met. People said that they liked the food, and it looked nicely presented. People keep in contact with their relatives, and are supported to do this by the staff. What has improved since the last inspection? What they could do better: The service must be managed effectively and there must be sufficient management input and management resources in place so that people’s needs are effectively met, and their health and welfare promoted. People living at the home must be supported by a staff team who are given direction, leadership and appropriate training. Work needs to continue to ensure that more than half the staff have a relevant National Vocational Qualification (NVQ) II qualification in care. The home was found to be in need of a thorough clean. Maintenance work must be completed so that the home is safe and suitable to meet people’s assessed needs. Woodfield Grange Nursing Home DS0000001076.V376905.R01.S.doc Version 5.2 Page 7 Any complaints received by the service need to be dealt with, as stated by the home’s complaints procedure. Staff need training in safeguarding so that risks to people from abuse or suspected abuse can be minimised. A daily activities programme with allocated staff time must be established. Staff need to be made fully aware of peoples individual preferences, interests, needs and wishes through clear assessment and care planning processes, management leadership, observation and supervision. Individual personal, healthcare and medication support needs must be reflected and recorded in peoples care plans. The information relating to the healthcare needs of people living at the home needs to be organised, accurate, up to date and detailed so that individual healthcare needs can be ascertained, and the care and support they need given. People using the service or their relatives, should be asked to sign their terms and conditions of residence documents. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Woodfield Grange Nursing Home DS0000001076.V376905.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.V376905.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 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. Peoples care and support needs are assessed before a decision is made as to whether they can move in. People are not provided with statements of terms and conditions of residency that they have agreed and signed. The home does not provide intermediate care. EVIDENCE: The Nurse in Charge explained the admissions process. This involves obtaining a local authority care needs assessment if one is available; meeting with the potential new person and their family; completion of the services own detailed assessment; visits to the home by the new person and over night stays if Woodfield Grange Nursing Home DS0000001076.V376905.R01.S.doc Version 5.2 Page 10 appropriate. During any trial visit the staff will continue to assess the individual to obtain further information to support the assessment process. We looked at the records for one recent admission and found that there was a detailed pre-admission assessment undertaken by the home as well as a local authority assessment. We spoke to three people who live at the home and asked if they had been given a contract to sign and if this had been discussed with them. All three said that they had. However the nurse–in-charge did not know if this process had happened and was unable to find any documentary evidence to show that people living in the home or their relatives had signed statements of terms and conditions. A recommendation about this was made at the last inspection. Woodfield Grange Nursing Home DS0000001076.V376905.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 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. People’s health and personal care needs are not being met. Medication practices are poor and do not protect the people living at the home. EVIDENCE: The nurse in charge explained that peoples individual personal and healthcare needs are usually documented in the care plan records and risk assessments. She told us that people are supported to attend healthcare appointments and that if this was not possible due to people’s healthcare and mobility needs, staff asked for home visits. The care plans were disorganised and poorly written and did not supply the reader with sufficient detail as to how people’s needs should be met. A number Woodfield Grange Nursing Home DS0000001076.V376905.R01.S.doc Version 5.2 Page 12 of the entries relating to the type of care to be provided and how to it is to be provided contradicted each other. In one person’s file it stated that the person could see to their own personal hygiene without assistance, however on the same page it stated that the person needed the assistance of 2 carers. In another person’s plan it stated that the person had a persistent urinary tract infection, and that regular urine tests were required. There was no record to show that these tests had been carried out. Some people’s dependency needs were classed as “High” and at “High Risk”, and we found that their care plans had not been reviewed for a number of months, and in one case not since December 2008. We found that people who require their weight monitoring had not been weighed as required. There was no written evidence to show that staff are putting in place the appropriate care and support for individuals. We found that there was no evidence to show that people’s food intake was being monitored, and it was unclear as to whether the staff are putting into place the appropriate care and support for individuals. One person, who moved into the home in March 09, did not have any care plans written up until May 2009. Therefore it was unclear as to what care and support the person had had during that time period. There is no clear record of when people have baths or showers so we could not tell when people had last been washed. Some general risk assessments were in place; however others were not, in particular, those relating to potential choking risks, risks associated with diabetes, and the use of peg feeds. This meant that people were potentially at risk of becoming ill when taking part in activities such as eating and drinking, and having their nutrition given to them via a PEG. (A PEG is a feeding tube which passes through the abdominal wall directly into the stomach, so that nutrition can be provided without swallowing). The nurse in charge told us that people are supported with their individual medication requirements, by way of ordering medication on their behalf, keeping it safely on the premises and dispensing it appropriately. A random check of the medication held at the home was undertaken. Poor practice was taking place in relation to missing signatures in medication administration records (MAR) sheets and codes not being used correctly. This meant that there wasn’t clear record of when people had been given their medication. The training records showed that staff who work with medication had not had appropriate training that included legislation, roles and responsibilities, Woodfield Grange Nursing Home DS0000001076.V376905.R01.S.doc Version 5.2 Page 13 Auditing , ordering medicines, receipt of medicines, administration of medicines and their disposal.. People living at the home told us that they often have to wait for long periods to go to the toilet, and to get a drink. One person said that some of the staff don’t know how to get them up in a morning, and often need to be told how to do things. One relative said that they did not believe their relative was getting the right care as they often looked unkempt, their finger nails needed to be cleaned and cut, their hair needed brushing, and their clothes needed to be changed as they were dirty. A visiting social care professional said that after talking to the relatives of a person at the home; the person themselves and after looking at the person’s care records; they were not satisfied that the person was receiving the right level of care and support from the staff. Woodfield Grange Nursing Home DS0000001076.V376905.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 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. People’s social care needs are not being met. Nicely presented meals are on offer to people; however, those who need support with eating their meals are not receiving it in a person-centred way. EVIDENCE: The nurse in charge told us that people usually take part in a variety of activities. These usually include craft work, sing-alongs, bingo and watching TV. However, she told us that the service has been without an activities coordinator for some time. We found that people do not engage in any in-house activities based on their individual needs and interests, apart from weekly visits by the hairdresser, sitting around watching TV, reading the newspaper and occasional input from Woodfield Grange Nursing Home DS0000001076.V376905.R01.S.doc Version 5.2 Page 15 very busy care staff. People living at the home said on numerous occasions that they were often bored with nothing to do. Throughout the day people were seen to be sitting in the chairs in the lounge. Some of them were seen to be watching TV, whilst others were seen to be a sleep for most of the day, only waking to have some lunch. People told us that they do see their relatives and friends as several visit on a daily basis and we saw this while we were there. The menus offer people a variety of meals, with a good nutritional balance. People said that the food was very good. We saw people having lunch and the food was nicely presented, and people were enjoying it. People said that the meals were nice, tasty and always good quality. However, we saw some poor practice when 2 staff were supporting 5 people at one table. All 5 people needed help with their meals. One staff member was seen to feed one person with a spoon full of food, and then move onto the next person, and then return back to the other. The other staff member sat at the table did the same. Rather than giving their attention to the people being supported, the staff were seen to be chatting between themselves. The manner in which people were being supported was not person centred, but staff centred. Woodfield Grange Nursing Home DS0000001076.V376905.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 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. People’s concerns and complaints are not being dealt with effectively and a lack of awareness by staff in relation to safeguarding issues places people potentially at risk. EVIDENCE: The nurse in charge told us that the complaints procedure is displayed in the home, and is given to people within the homes Service User Guide. Three complaints were recorded in the complaints book however, none of these had been dealt with. One person living at the home said,” If theres a problem or I want to make a complaint I would speak to the staff”. When asked if they were confident that the complaint or concern would be dealt with properly, their answer indicated that they were unsure. When asked to say why they were unsure, people said it was because the staff are always busy, and that there is never a manager around who can deal with things such as complaints. A relative who was spoken with said that they had recently put a Woodfield Grange Nursing Home DS0000001076.V376905.R01.S.doc Version 5.2 Page 17 complaint in the complaints book, but this had not been dealt with, and that they were waiting for someone to speak to them about it. The adult safeguarding procedures were found to be satisfactory, however, the staff training records showed that several staff have not had training in safeguarding policies and procedures. One staff member who was spoken with gave a very poor explanation of what they would do if they suspected someone had been abused. A discussion took place about when referrals to the Local Authority Safeguarding team and notifications to the Commission would take place. Again, staff working at the home were unclear about the processes. People living at the home said that they felt safe. One person visiting the home said that they did not worry that their relative would be abused, but did worry that they might be neglected because of a lack of staffing, no activities and a lack of insight into people needs by the staff. Woodfield Grange Nursing Home DS0000001076.V376905.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 25 and 26 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. People live in a home that is not kept clean and that is not properly maintained. EVIDENCE: Several bags of domestic rubbish were found to be left around outside the home waiting to be picked up. This was dealt with during the site visit when a new waste bin provider arrived with 2 new bins. The fly screens in the kitchen need replacing, and the fly exterminator machine in the kitchen did not have a tray attached to it to collect dead flies. Woodfield Grange Nursing Home DS0000001076.V376905.R01.S.doc Version 5.2 Page 19 We found a hole in the floor of the kitchen that according to the local Environmental Health Officer’s report was in need of repair. We also found all the fridge handles were broken and in need of attention. Part of the guttering on the main house was found to be missing and in need of repair. The toilet door locks on the ground floor were not working and as a result a risk was posed to people’s privacy and dignity. Six bedroom sinks were not securely fastened to the wall and as a result they pose a health and safety risk to people using them. The toilet/bathroom on the 1st floor was in a state of disrepair and as a result people living on that floor can not use it, there only option being to go in the lift to the ground floor to use the toilet or bath. A number of other maintenance jobs need completion eg paper towel dispensers need to be securely placed on the wall in the bathrooms. The staff rotas showed that the home had not had any domestic staff for 2 weeks. The home was found to be dirty, untidy and unclean. People living at the home said that it is in need of a thorough deep clean. Visiting relatives agreed with this. Woodfield Grange Nursing Home DS0000001076.V376905.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 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. People’s needs are not being met consistently due to insufficient staffing levels, poor leadership and a lack of training. People are protected by the staff recruitment procedures, which ensure people are suitable before they start work. EVIDENCE: During our visit we saw that staff are well meaning and happy to help people; however, they were being given no leadership and are inadequately trained. Two staff were observed to support a number of people with mobility support needs. Their practice was poor with very little or no verbal communication with the person being supported. On one occasion, the staff were seen to be trying to use a glide sheet, and it was clear that they did not know how to use it. This resulted in them undertaking a drag lift on a person, rather than seeking the assistance of other trained and competent staff. Woodfield Grange Nursing Home DS0000001076.V376905.R01.S.doc Version 5.2 Page 21 On another occasion, one person was hoisted into a chair, but was left sitting on the edge of the chair in a dangerous position. Staff were oblivious to this, and it wasn’t until a nurse from another established came into the lounge and immediately saw the problem, that appropriate action was taken to make the person safe and comfortable. Significant gaps in the training matrix held at the home were found. These included training in safeguarding adults, health and safety and nutrition. The training records showed that less than half the staff have a National Vocational Qualification (NVQ) II qualification in care, and one staff member said that they had been working at the home for 6 months, and no one had discussed doing NVQ training. Gaps in the staff supervision records were evident, and one staff member we spoke to explained that they had not had formal supervision since starting work at the home 8 months ago. The nurse in charge explained that employment checks are undertaken such as a criminal records bureau check and a check against the Protection of Vulnerable Adults List. The recruitment files of 3 staff working at the home were seen to be satisfactory. Relatives we spoke to said they believed there to be a low ratio of staff to people living at the home. A visiting social care professional also expressed a concern about the staffing levels. What we saw during our visit supported this view, with staff seen to be always rushing about in order to support people; staff not having the time to meaningfully engage with people; and people wanting to go to the toilet being left for long periods of time. Woodfield Grange Nursing Home DS0000001076.V376905.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 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. People live in a home that is not managed in the best interests of the people living there. People are not supported by effective leadership and management.. EVIDENCE: Woodfield Grange Nursing Home DS0000001076.V376905.R01.S.doc Version 5.2 Page 23 The nurse in charge told us that there has been a management vacancy at the home for sometime. She said that one of the nurses had been asked to take on the role of acting manager until a new one could be recruited. The staff rotas showed that the acting manager was currently off sick. The nurse in charge told us that no one had been out in overall control of the home whilst the acting manager was off sick, and no one from senior management had been visit the home, or made enquiries as to how the home was operating. The manager from another Aermid home visited on the day of our visit, and explained that she pops in from time to time to give support to the nursing staff. We found that there is very little attention paid to quality assurance systems such as auditing and monitoring with particular reference to the work undertaken by staff, the care plans, the risk assessments, the environment and the medication held at the home. The records we saw show that health and safety checks such as fire testing, lift maintenance and food preparation do take place, however, the personnel and training records show that there are significant gaps in the training undertaken by staff in relation to health and safety, fire training and fire drills. A check of the personal monies held by the service was undertaken whilst we were at the home and no discrepancies were found. We found that there have been a number of missed monthly management visits to the home. In July 08 a comment was recorded in the management report that “the standards of care at the home were poor”, and that “care plans did not reflect people’s needs”. No evidence was found to demonstrate that this had been dealt with. In September 08 a comment was made in a management report saying that “standards had to improve”, and again there was no evidence to demonstrate that this had been dealt with. In the management report of June 09 comments were made to show that there is “no system in place for reviewing care plan information, no system in place for recording maintenance jobs that need doing and that the personnel files were disorganised”. Despite all these issues being raised, the only action point made on the report was the need to ensure that “new assessment documents were put in place”. Several people living at the home, and visitors we spoke to said that they believed the home to be poorly managed, with no one in overall control. One visitor said that despite raising issues with staff at the home about the maintenance of the building, the lack of activities and rubbish left outside, nothing has been done. Woodfield Grange Nursing Home DS0000001076.V376905.R01.S.doc Version 5.2 Page 24 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 2 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 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 1 17 X 18 1 1 X 1 X X X 1 1 STAFFING Standard No Score 27 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 1 X 3 2 1 1 Woodfield Grange Nursing Home DS0000001076.V376905.R01.S.doc Version 5.2 Page 25 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 provider/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 Accurate and up to date written care plans and risk assessments must be completed in detail so as to provide the staff team with sufficient information about people’s care needs and how those needs are to be met effectively. Suitable arrangements for locking bathroom and toilet doors must be made. Doing this will make sure that people’s privacy and dignity is promoted and protected. Timescale for action 06/09/09 2 OP10 12 06/09/09 3 OP8 13 06/09/09 Where risk assessments identify people as being at risk of developing pressure sores or losing weight, detailed care plans must be put in place. Care plans must be updated to reflect any changes in individual needs. This will make sure that people’s healthcare needs are identified and met. Previous timescale: 31/03/09 Woodfield Grange Nursing Home DS0000001076.V376905.R01.S.doc Version 5.2 Page 26 4 OP12 16 Consultation with people living at 06/09/09 the home about their social interests must take place, and arrangements made to enable them to engage in local, social and community activities. People must be consulted about the programme of activities arranged for them and facilities for this type of recreation must be provided. Doing this will enable people at the home to engage in meaningful activities that are based on their needs, wishes and desires. Complaints received by the service must be dealt with appropriately. Doing this will enable people to have their concerns and complaints looked into with a view to them being put right if needed. All staff must have adult protection training so that they all know how to recognise abuse and what action they need to take if it is suspected. This will help to make sure people living in the home are not at risk. Previous timescale: 31/05/09 06/09/09 5 OP16 22 6 OP18 13 06/09/09 7 OP19 23 Maintenance jobs that need to be completed must be undertaken so as to make the property safe and well maintained. Doing this will ensure that the property meets people’s individual and collective needs in a safe, comfortable and homely way. Appropriate toilet and bathroom facilities must be provided for people who live on the first floor. DS0000001076.V376905.R01.S.doc 30/09/09 8 OP21 23 30/09/09 Woodfield Grange Nursing Home Version 5.2 Page 27 Doing this will appropriately support people with this personal hygiene needs. 9 OP25 16 Following consultation with the relevant environmental health and safety officers, action must be taken to ensure that the building complies with any requirements they make. Doing this will ensure that the building is safe for people to live in. 30/09/09 10 OP26 23 The premises must be kept clean 06/09/09 and hygienic. Doing this ensure that the home is a pleasant place to live in. An appropriate mix of qualified 06/09/09 and unqualified staff must be in place in place appropriate to the assessed needs of people. Doing this will ensure that people’s assessed needs are properly and effectively met. There must be a staff training and development programme in place which meets the National Training Organisation. Doing this will ensure that the people living at the home are supported by an effective and competent staff team, and that there needs are effectively met. There must be an effective quality assurance and quality monitoring system in place, based on seeking the views of people, to measure success in meeting the aims and objectives of the service. Doing this will ensure that the best interests of people using the service are promoted. The records required by DS0000001076.V376905.R01.S.doc 11 OP27 18 12 OP30 06/09/09 18 13 OP33 24 30/09/09 14 OP37 17 30/09/09 Version 5.2 Page 28 Woodfield Grange Nursing Home regulation for the protection of people and for the effective and efficient running of the business must be maintained, keep up to date and accurate. Doing this will ensure that the best interests, health and welfare of people living at the home are promoted and protected. 15 OP38 13 As is reasonably practicable, the health, safety and welfare of people living at the home must be promoted and maintained by way of appropriate risk assessments, audits and monitoring. Doing this will ensure that the best interests, health and welfare of people living and working at the home are promoted and protected. Monthly management visits must take place so that a picture of the way the home is operating can be sought. When issues arise, effective measures must be taken to address these. Doing these will ensure that the best interests, health and welfare of people living and working at the home are promoted and protected. 06/09/09 16 OP38 26 06/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP2 Good Practice Recommendations People using the service or their relatives, should be asked to sign their terms and conditions of residence documents. DS0000001076.V376905.R01.S.doc Version 5.2 Page 29 Woodfield Grange Nursing Home 2 3 4 5 6 OP9 OP15 OP28 OP32 OP36 Medication practices must be improved. Appropriate staff support should be offered to people who need help with eating and drinking. This should be done in a person centred manner. Work needs to continue to ensure that more than half the staff have a relevant National Vocational Qualification (NVQ) II qualification in care. The management approach of the home should be positive, offering good leadership and direction. Suitable supervision arrangements should be in place for all staff working in the home. Woodfield Grange Nursing Home DS0000001076.V376905.R01.S.doc Version 5.2 Page 30 Care Quality Commission Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 61 61 61 Email: enquiries.yorkshirehumberside@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Woodfield Grange Nursing Home DS0000001076.V376905.R01.S.doc Version 5.2 Page 31 Woodfield Grange Nursing Home DS0000001076.V376905.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!