Inspection on 09/12/09 for Woodfield Grange Nursing Home

This inspection was carried out on 9th December 2009.

CQC found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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 17/07/07

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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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Woodfield Grange Nursing Home Saddleworth Road Greetland Halifax West Yorkshire HX4 8NZ Lead Inspector Dawn Navesey Key Unannounced Inspection 9th December 2009 11:00 DS0000001076.V378663.R01.S.do c Version 5.3 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.V378663.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.V378663.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 registered manager (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.V378663.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. 28th July 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 range from £365 to £495 per week. In addition to the weekly fee there is an extra charge for hairdressing, chiropody and personal newspapers. Further information can be obtained by contacting the manager of the home. Woodfield Grange Nursing Home DS0000001076.V378663.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 1 star. This means the people who use this service experience adequate quality outcomes. The Care Quality Commission (CQC) inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.cqc.org.uk This was an unannounced visit by two inspectors. One was at the home from 11:00 until 17:06 and one was there from 11:00 until 15:45 on 9th December 2009. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people living there. And also to monitor progress on the requirements and recommendations made at the last inspection. Before the inspection evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the visit. An AQAA (Annual Quality Assurance Assessment) was completed by the home manager before the visit to provide additional information. This was reasonably well completed and gave us some of the information we asked for. Survey forms were left at the home at our last visit for people using the service, their relatives and staff. None of these have been returned at the time of writing this report. However, the home has distributed their own surveys to get people’s views and we have used comments made in these within this report. Following the key inspection in July 2009 we took legal advice as a result of breaches of the Care Homes Regulations. Since then there has been a further random inspection on 11th September 2009, where we did not see the required improvements we had asked for. We then sought further legal advice and in October 2009 we issued Statutory Requirement Notices for the home to respond to as they were still in breach of the Care Homes Regulations. During the visit a number of documents and records were looked at and some areas of the home used by the people living at the home were visited. Some time was spent with the people who use the service, talking to them and interacting with them. Time was also spent talking to staff and the manager. Feedback at the end of the visit was given to the manager. Woodfield Grange Nursing Home DS0000001076.V378663.R01.S.doc Version 5.2 Page 6 What the service does well: People said they were happy with their choice of this home. Their comments included: • • Its lovely here. We have no complaints here. The atmosphere in the home is relaxed. Everyone we spoke to said it felt like home. People were very positive about the food and meals in the home. They said: • • • Very good meals. No complaints. They know what we like and they make sure we get it. People who live at the home and their relatives spoke highly of the staff. Their comments included: • • • Kindness itself (regarding staff) All staff are kind caring and pleasant, no problems. There is always somebody in the room to ask for help. Staff said they received good training and felt well prepared for their job. Their comments included: • • • Staff training is much improved since our new manager came to the home. Very happy with the induction process and already received vast amount of training. We are encouraged to attend training and given every opportunity to do so. The home has an experienced and suitably qualified manager who also works alongside staff at times, to demonstrate good practice. Staff said she was a good manager and very approachable. Their comments included: Woodfield Grange Nursing Home DS0000001076.V378663.R01.S.doc Version 5.2 Page 7 • • • • • • • • Since our new manager took post- great improvement overall. Our manager and nurses supervise us well. Communication is improving. Teamwork is good, we all pull together. The staff have a more structured way of working and there is a lot more organisation and leadership for staff. She puts the residents first, always. She is very caring. She gets the job done; people respect her because she knows what she’s on about. People who use the service and their relatives said: • • Getting better with the new management. Problems in the past but under new team it is BRILLIANT. What has improved since the last inspection? The manager has worked hard since the last inspection and there have been significant improvements at the home, which seem to be having a positive effect on staff and on the quality of life for the people living there. Care staffing levels have improved and the ancillary staff team is established meaning that care staff are giving priority to their caring duties and the quality of life has improved for people living at the home. People who use the service now have have detailed care plans and risk management plans, clearly outlining all their support needs. This makes sure they receive person centred support that meets their needs fully. Staff who are responsible for the administration of medication have now been trained to make sure their practice is safe. People have now been asked about activity they are interested in. The variety of activity available to people has been increased and an activities co-ordinator has been employed. Staff are more sensitive to the needs of people who find it difficult to eat and need help and encouragement with this. Staff give support to people helping them feel comfortable and unhurried. Woodfield Grange Nursing Home DS0000001076.V378663.R01.S.doc Version 5.2 Page 8 All staff have now received training in safeguarding adults, which makes sure they know how to protect people properly. The home has employed a new maintenance person. Staff and the manager said that jobs were being carried out well and attended to promptly now. Records showed that regular health and safety checks are carried out and any action identified is addressed. The manager has developed a programme of renewal and refurbishment that is being delivered in two phases to improve the environment of the home. Some of the work has been been or is almost completed. The improvements include: • • • • • • • • • • Two new toilets on the ground floor that are wheelchair and hoist accessible. New furnishings in a number of bedrooms. Some bedrooms re-decorated. Entrance area made more welcoming and attractive. New cutlery and glasses. New bedding and curtains. A new carpet cleaning machine. New soft furnishings in the lounge. Building work to divide and create office space and a new reception area. New kitchen flooring. The manager has now developed a training plan which shows clearly who has completed what training and when updates are due. The availability of training for staff has improved. Since our last visit to the home a number of training events have taken place. We saw that visits are now being undertaken by designated people from the company and a written report is being produced to show what is being discussed, how the information is gathered and gives an overview of the conduct of the home. The manager now sends out annual questionnaires to people who live at the home, relatives of people who live at the home and health professionals, asking for their views on any improvements that could be made. The manager has made sure that people who use the service have an up to date contract with the home. These have now been signed by people who live at the home if they are able or their relatives. This makes sure people are in agreement with them and know what they are paying for. Woodfield Grange Nursing Home DS0000001076.V378663.R01.S.doc Version 5.2 Page 9 What they could do better: 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.V378663.R01.S.doc Version 5.2 Page 10 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.V378663.R01.S.doc Version 5.3 Page 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have the information needed to choose a home that will meet their needs. They can also be sure that the home will meet their needs following assessment. EVIDENCE: People said they were happy with their choice of this home. Their comments included: • • Its lovely here. We have no complaints here. DS0000001076.V378663.R01.S.doc Version 5.3 Page 12 Woodfield Grange Nursing Home There have been no new admissions since our last inspection of the home. In the AQAA, the manager said they were ‘looking forward to being able to admit new residents, Head Office are having new brochures printed & a viewing room has been set up.’ This will make sure people have information they need when choosing a home. The manager is currently reviewing the home’s pre-admission assessment document to make it more person centred and individual to people. She described the admissions procedure that will be followed. She said preadmission assessments will be carried out by her or one of the registered nurses. The manager said they can carry out the assessments in peoples own homes or if people are in hospital. She also said that people thinking of moving in to the home can visit with their families as much as they like before making any decisions about moving in. This can include overnight stays. The manager is aware of how to access community support resources such as specialist nursing services. This makes sure they have the right support to meet peoples needs properly. The manager also described the on-going assessment of people whose needs have changed. We saw records that showed care plans had been updated as changes occurred and people had been referred to specialist services to get the help and support they needed. In the AQAA, the manager said, ‘The monthly assessment of needs highlights risks & changes that can be addressed. Changes to health status are acted upon immediately & care plans developed. We share information through detailed handovers & the written word.’ The manager has made sure that people who use the service have an up to date contract with the home. These have now been signed by people who live at the home if they are able or their relatives. This makes sure people are in agreement with them and know what they are paying for. Woodfield Grange Nursing Home DS0000001076.V378663.R01.S.doc Version 5.3 Page 13 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, the health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: People look well cared for clean, tidy and well groomed. Attention had been paid to detail. People had clean glasses and had their hair styled as they wished. Staff were patient, gentle and kind when interacting with people. They were discreet and respectful of peoples dignity when attending to any personal care needs. Most people who live at the home and their relatives said they were well looked after. One said that since her mother was admitted she has put on a healthy amount of weight and moving into the home has made a big Woodfield Grange Nursing Home DS0000001076.V378663.R01.S.doc Version 5.3 Page 14 difference, a positive difference. She thinks her mother has settled in better as she isn’t on the phone everyday asking whether she can return home. Other comments included: • • Well cared for and feel comfortable. Staff are good at keeping her informed of her mothers welfare. Staff said they had enough staff to make sure they could meet people’s needs well. In the AQAA, the manager said, ‘The plan of care is formulated from information produced from Risk Assessments, through conversation with the resident to determine choices, or their relatives where necessary. The new care plans developed over the last 3 months give detailed & Person Centred instructions on the delivery of care.’ It was clear that a lot of work had been done to make sure the records were up to date and relevant. It was evident that this had been done in a purposeful and organised way and not just to satisfy the regulator, the records were a working document and accurately reflected the person being described. At the previous inspection in September, a newly appointed nurse was rewriting the care plans. These were not useful or suitable and a new version has now been written, mainly by the Deputy manager. She told us she had done this over time and in consultation with the existing staff, who knew the people well, their families and the person using the service. There was time allowed initially for her to get to know people to make sure the care plan included all of their needs, preferences and personalities. This is good person centred practice. All the care plans included detailed information about people’s current care needs. The information gave specific instructions about each aspect of care. Each care plan had been reviewed monthly to make sure it was still relevant. There was a full range of risk assessments in the files and daily progress sheets had been completed by nurses and carers, dependent on who had delivered the care. Staff could talk confidently about the support they give. They were able to describe peoples preferred routines with regard to their personal care and what works well for people. They said they found the care plans useful and informative on people’s care needs. One person said, “They are much easier to use now and they have good information on the care people want and need.” Records showed that health needs are monitored well. Help and advice is sought from health care professionals to make sure that people get the special help they need to maintain their health. Woodfield Grange Nursing Home DS0000001076.V378663.R01.S.doc Version 5.3 Page 15 In the AQAA, the manager said, ‘We have an excellent relationship with our 3 GP practises, & enjoy links with Continence Advisers & our Tissue Viability Nurse has been invaluable. The Dietician provides excellent support to all staff.’ Nursing staff have been trained to meet the specific health needs of people who use the service, such as PEG tube feeding, continence care, medication awareness, moving and handling and first aid. Care assistants said they had been trained by the nurses to monitor people’s health care needs and to report issues such as skin condition and nutritional needs. They also said they were trained to meet people’s individual moving and handling needs. Some staff have completed dementia awareness training which equips them to meet the needs of people who have memory loss problems or dementia. The manager is hoping to deliver an accredited course to all staff in the coming year on dementia awareness and person centred care. Staff said they would welcome this training and that they thought it would help them to do their job better. They did however, show a fairly good understanding of the needs of people with dementia and memory loss. Comments included: • • • It’s about seeing people as individuals and appreciating every human being has their differences. It’s good to ask people about their past so we can chat about things people know about and reassure people. We use reminders and do things the same way so as not to confuse people further. The home uses a monitored dosage, pre-packed system for medication. All staff who administer medication have been trained to use the system. We checked some medication administration records (MAR) sheets. These were found to be in good order. There are good ordering and checking systems in place. A record is kept in the home of medication ordered. This is checked against medication delivered and recorded as correct before any medicines are dispensed. The arrangements for medication are good and well organised. Woodfield Grange Nursing Home DS0000001076.V378663.R01.S.doc Version 5.3 Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their lifestyle. Social, cultural and recreational activities meet people’s expectations. They also benefit from a good, healthy and varied diet. EVIDENCE: In the AQAA, the manager said, ‘Activities are advertised on a weekly basis, however, changes are happily made when its discovered that people are not in the mood for a particular activity’. The home now has an activities co-ordinator who works Monday to Friday 124pm. She said that when she started work at the home she was given time to get to know the people who live there and find out what they are interested in. Woodfield Grange Nursing Home DS0000001076.V378663.R01.S.doc Version 5.3 Page 17 She said she has developed a programme of activity based on this. Activity on offer to people includes: • • • • • • • • • Quizzes. Floor darts and board games. Movie afternoons. 1-1 activity such as nail painting or reading newspapers. Sing-a-long with Karaoke and musical instruments. Entertainers and community groups such as carol singers. Clothing parties. Special event parties. Cake decorating. The activities co-ordinator also said that some events in the local community were currently being planned. These included a meal out at a local carvery and a trip to a ceramics café where people would be able to enjoy pottery making and a meal out. She said she was hoping to make good use of local resources such as the home’s garden and local shops in the better weather. On the day of our visit, people seemed content and relaxed. Some people were joining in with group activities such as floor darts, a sing-a-long and playing musical instruments. Some people preferred to watch but were clearly engaged and entertained. Others enjoyed 1-1 activity such as dancing or having their nails done. Staff said they felt they had enough staff to provide people with a decent amount of activity and said they didnt feel people were bored at the home. Staff said they also felt they had enough time to just sit and chat with people. One said, “Just time to sit and hold someone’s hand if they are upset is time well spent”. Another said, “The activities are really really good now. Residents enjoy them, we enjoy them and we love joining in”. Records we looked at showed that people are regularly participating in activities if they want to be. They also showed that staff are monitoring how successful they are and how people are enjoying the activities. The activities co-ordinator said they can then adjust the programme of activity to suit people better, depending on how they enjoy it. We also saw photographs displayed in the home of people enjoying activities such as dressing the Christmas tree and craft activities. In the main, people were very positive about the food and meals in the home. They said: • • Very good meals. No complaints. DS0000001076.V378663.R01.S.doc Version 5.3 Page 18 Woodfield Grange Nursing Home • • • They know what we like and they make sure we get it. The menu is improving. Gets a little boring at times but always tastes nice. We observed the lunch time meal in the home. This looked appetising and well presented. We looked at menus at the home. These are planned around peoples likes and dislikes and include plenty of choice and variety. People said they can always have an alternative to what is being cooked if people dont like it and drinks and snacks such as smoothies and home baking are readily available and offered regularly. The choice of foods available to people for snacks is varied and plentiful. Food is available 24 hours per day. Anyone who is nutritionally at risk is supported to maintain a healthy diet and the manager makes sure professionals such as dieticians or general practitioners are referred to for advice. Staff are sensitive to the needs of people who find it difficult to eat and need help and encouragement with this. Staff gave support to people helping them feel comfortable and unhurried. The atmosphere in the home is relaxed. Everyone we spoke to said it felt like home. People said they can get up and go to bed when they want. People are free to move about the home as they wish and are able to have their things around them. Staff gave good examples of how they encourage people to make choices on a daily basis such as choosing their own clothing, choosing when to have a bath or what to eat. In the AQAA, the manager said, ‘Since the introduction of Person Centred Care, we no longer have toileting time, eating & drinking time, bathtime or bedtime. All needs are met in accordance with the preferences of each individual resident, avoiding stringent routines & institutionalisation.’ Woodfield Grange Nursing Home DS0000001076.V378663.R01.S.doc Version 5.3 Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and are, in the main, protected from abuse. EVIDENCE: Most people said they knew what to do if they were unhappy about anything and knew how to complain. They said they would speak to the staff, manager or their relatives. It was clear from staffs interactions with people that the people who live at the home seemed confident to raise their wishes or concerns. The home has not received any formal complaints since the last inspection. The complaints procedure is displayed in the entrance hall to the home. The manager has not made this available in alternative formats such as large print yet. Some consideration should be given to doing this as it would make the procedure more accessible. Woodfield Grange Nursing Home DS0000001076.V378663.R01.S.doc Version 5.3 Page 20 All staff have received training in safeguarding adults, which makes sure they know how to protect people properly. The manager initially does this with staff on their induction and then makes sure they attend a course run by an accredited trainer. The manager has now also been trained to deliver this course herself. Staff were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They were also able to describe the different types of abuse. All staff were very clear on their responsibility to report abuse or allegations of abuse. Staff were familiar with the whistle blowing procedure and said they would have no hesitation in using it if they thought they needed to raise concerns outside of the home or organisation. They also knew how to do this and who to contact. The manager is familiar with the local authority safeguarding referral system. This means people are properly protected. There have been five safeguarding issues at the home this year. These have been addressed properly and referred to the right people for investigation. Some of which have resulted in staff dismissals. However, we asked the organisation to tell us of the outcome of an internal investigation they have conducted. This has not been done and we therefore can not say if the matter was properly investigated and therefore have people been properly protected. The CQC must be advised of the outcome of investigations if they have requested this information. This will make sure people are properly protected. Woodfield Grange Nursing Home DS0000001076.V378663.R01.S.doc Version 5.3 Page 21 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): 19and 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall people live in a reasonably comfortable and safe environment. EVIDENCE: In the AQAA, the manager said, ‘The refurbishment programme is underway, & has been planned to minmise disruption as far as is practicable.’ A tour of the building was carried out. Communal areas, bathrooms and bedrooms were visited. Despite the refurbishment work that was going on, the home was clean, tidy and homely. Staff work hard to make sure the home is kept clean. There are no malodours in the home. The manager has made sure Woodfield Grange Nursing Home DS0000001076.V378663.R01.S.doc Version 5.3 Page 22 there are good cleaning routines in place to make sure the home is clean and fresh smelling. People who live at the home were pleased with their bedrooms and had personalised them with their own things such furniture and pictures. Additional portable heating had been provided for people who found their rooms a little cold. The manager has developed a programme of renewal and refurbishment that is being delivered in two phases to improve the environment of the home. Some of the work has been completed. The improvements include: • • • • • • • • • • Two new toilets on the ground floor that are wheelchair and hoist accessible. New furnishings in a number of bedrooms. Some bedrooms re-decorated. Entrance area made more welcoming and attractive. New cutlery and glasses. New bedding and curtains. A new carpet cleaning machine. New soft furnishings in the lounge. Building work to divide and create office space and a new reception area. New kitchen flooring. The second phase of the work to be completed includes: • • • • • Bathrooms to be updated and re-decorated. A new central heating system. A number of toilets to be decorated and made less clinical. Carpets and floor coverings to be replaced. A full refurbishment of the dining room. The manager showed us the plans of expected completion dates for the ongoing work and said they are monitoring this regularly to make sure work does not slip and jobs are completed in a timely manner. The home has employed a new maintenance person. Staff and the manager said that jobs were being carried out well and attended to promptly now. Records showed that regular health and safety checks are carried out and any action identified is addressed. People who use the service and their relatives said: • • • Home is much cleaner now. It’s always nice and warm. It could be warmer in winter. DS0000001076.V378663.R01.S.doc Version 5.3 Page 23 Woodfield Grange Nursing Home A staff member said, “Things are moving along well, it will be lovely when it’s all done”. Clinical waste is properly managed. Staff have received training in infection control as part of their induction and were able to say what other infection control measures are in place. Hand washing and hand drying facilities were available in all areas of the home. Liquid soap or paper towels were available. This ensures good hygiene practice. Woodfield Grange Nursing Home DS0000001076.V378663.R01.S.doc Version 5.3 Page 24 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 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. Staff in the home are in the main, trained, skilled and in sufficient numbers to support people who use the service and to support the smooth running of the home. EVIDENCE: People who live at the home and their relatives spoke highly of the staff. Their comments included: • • • Kindness itself (regarding staff) All staff are kind caring and pleasant, no problems. There is always somebody in the room to ask for help. There are usually four care staff on morning shifts and three or four on evening shifts. In addition to this there is a nurse in charge at all times. There are also catering, domestic, laundry and maintenance staff available each day. And as mentioned in the Daily Life and Social Activity section of this report, an Woodfield Grange Nursing Home DS0000001076.V378663.R01.S.doc Version 5.3 Page 25 activities co-ordinator four hours per day through the week. At night there are two care staff and a nurse. People who live at the home and their relatives and staff said there were enough staff to meet people’s needs properly. Staffs interactions with people who live at the home were respectful and caring. They showed they had respect for peoples individual needs, dignity and independence. However, on the day of our visit, one of the nursing staff had been working excessive hours due to staff sickness. The manager said they did not have enough nursing staff to be able to cover such emergencies, that they had vacancies and she had found it difficult to recruit nurses. She said they had been reluctant to use agency nurses as they would not know the needs of the people who live at the home. We discussed this situation with the manager, who agreed in hindsight, it would be beneficial to use regular agency staff rather than have staff working excessive hours which could affect the welfare of people who use the service. The manager contacted an agency during the visit to make arrangements for their future use. There must be an appropriate number of nursing staff available to meet the needs of the people who use the service. This will make sure people’s needs are properly met by staff who have not been subject to the effects of working excessive hours. In the AQAA, the manager said, ‘The new Home Manager is managing the Human Resources well, along with her Administrator & Deputy Manager. The recruitment & selection process ensures that new starters are suitable for the post.’ We looked at the recruitment process for people working at the home. The files had the relevant information to confirm these recruitment processes were properly managed. This included application forms, references and CRB (criminal records bureau) checks. In the AQAA, the manager said, ‘We have recruited suitable staff that have been thoroughly trained, supervised & a performance management programme has also had an impact on Woodfield.’ We looked at training records. These showed that the manager runs the induction training on the skills for care common induction standards. Staff said they found this useful and it had equipped them well for their job. Staff who have worked at the home for some time are also undertaking this induction training so that the manager can be sure that everyone’s skills are up to date. The manager has also developed a training plan which shows clearly who has completed what training and when updates are due. The availability of training for staff has improved. Since our last visit to the home a number of training events have taken place. These have included; moving and handling, safeguarding adults, medication, first aid, record keeping and report writing and nutrition. The manager is planning to introduce more training on person Woodfield Grange Nursing Home DS0000001076.V378663.R01.S.doc Version 5.3 Page 26 centred care and other health related issues such as continence care and pressure area care. As mentioned in the health and personal care section of this report, all staff should receive dementia awareness training. This will make sure they can meet people’s needs more fully. Staff said they received good training and felt well prepared for their job. Their comments included: • • • Staff training is much improved since our new manager came to the home. Very happy with the induction process and already received vast amount of training. We are encouraged to attend training and given every opportunity to do so. There is a commitment from the home for staff to complete an NVQ (National Vocational Qualification) in care in level 2 or above. This is good practice and means the home has staff who are qualified to carry out their job. Over half of the staff team have now achieved this. Woodfield Grange Nursing Home DS0000001076.V378663.R01.S.doc Version 5.3 Page 27 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, 32, 33, 35, 36, 37 and 38 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. Overall, the home is well managed. The interests of people who use the service are seen as important to the manager and staff and are, in the main, safeguarded and respected. EVIDENCE: Woodfield Grange Nursing Home DS0000001076.V378663.R01.S.doc Version 5.3 Page 28 In the AQAA, the manager said, ‘The home has a strong leadership team now that bases its leadership on evidence. The Manager leads with integrity & provides clear direction & gives honest feedback.’ The manager is committed and enthusiastic about her role in continuing to improve the service and quality of life for the people living at the home. She said she is well supported by the organisation. She is an experienced and suitably qualified manager who also works alongside staff at times, to demonstrate good practice. She has applied to register with the CQC. This will make sure there is someone accountable for the running of the home. Staff said she was a good manager and very approachable. Their comments included: • • • • • • • • Since our new manager took post- great improvement overall. Our manager and nurses supervise us well. Communication is improving. Teamwork is good, we all pull together. The staff have a more structured way of working and there is a lot more organisation and leadership for staff. She puts the residents first, always. She is very caring. She gets the job done; people respect her because she knows what she’s on about. People who use the service and their relatives said: • • Getting better with the new management. Problems in the past but under new team it is BRILLIANT. Staff said they regularly were given support and opportunity to discuss how they were getting on in their job. Records showed the manager had done this. The manager said she receives good support from the provider, and that she visits the home regularly to carry out monitoring visits, to make sure the home is running well. We saw that visits are now being undertaken by designated people from the company and a written report is being produced to show what is being discussed, how the information is gathered and gives an overview of the conduct of the home. We received the homes AQAA (Annual Quality Assurance Assessment) when we asked for it. It had been fairly well completed and had identified improvements the manager has made to the service and what future improvements are needed. Woodfield Grange Nursing Home DS0000001076.V378663.R01.S.doc Version 5.3 Page 29 The manager now sends out annual questionnaires to people who live at the home, relatives of people who live at the home and health professionals, asking for their views on any improvements that could be made. Some of these had been returned to the home. They were, in the main, positive about the service. The manager has not yet fully analysed the returned questionnaires but has already acted on comments made about the variety of food available. She organised a meeting with people who use the service and their relatives to discuss new menus. These will be introduced in the New Year. Arrangements are in place to make sure of safe working practices. The home has a range of health and safety policies and procedures in place. In the AQAA, the manager said that all policies were reviewed and up to date. She also said that all equipment used in the home has been serviced or tested as recommended by the manufacturer or other regulatory body. For example, the hoist and gas safety. We saw the homes electrical wiring certificate and gas safety certificate was up to date. Records relating to health and safety such as hazard checks, water temperatures and fire records were much improved. However, the manager had not yet completed environmental risk assessments. She said she currently makes sure that people who carry out jobs that have associated risks, for example, carrying laundry baskets are fully informed of the risks. She is aware of the need to complete the environmental risk assessments to make sure of safe practice. We looked at accident records in the home. The manager completes a monthly analysis of these to look for any patterns or trends or ways of avoiding future accidents. Records showed that there had been a significant decrease in the number of falls people have had in the last three months. We checked the personal monies held by the service of some people. These were in order and no discrepancies were found. Woodfield Grange Nursing Home DS0000001076.V378663.R01.S.doc Version 5.3 Page 30 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 3 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 2 Woodfield Grange Nursing Home DS0000001076.V378663.R01.S.doc Version 5.3 Page 31 Are there any outstanding requirements from the last inspection? NO 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 OP18 Regulation 13 Requirement The CQC must be informed of the outcome of safeguarding adults investigations, if they have requested this information from the organisation. This will make sure people are properly protected. The plans to refurbish the home must continue to make it more comfortable for the people who live there. There must be an appropriate number of nursing staff available to meet the needs of the people who use the service. This will make sure people’s needs are properly met by staff who have not been subject to the effects of working excessive hours. Timescale for action 31/12/09 2. OP19 23 30/06/10 3. OP27 18 31/12/09 Woodfield Grange Nursing Home DS0000001076.V378663.R01.S.doc Version 5.3 Page 32 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 OP16 Good Practice Recommendations Some consideration should be given to producing the complaints procedure in alternative formats. This will make it more accessible. All staff should receive dementia awareness training. This will make sure they can meet people’s needs more fully. Environmental risk assessments should be fully completed to make sure of safe working practice. 2. 3. OP30 OP38 Woodfield Grange Nursing Home DS0000001076.V378663.R01.S.doc Version 5.3 Page 33 Care Quality Commission Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 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. 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