CARE HOMES FOR OLDER PEOPLE
Woodford Care Home 594 - 596 Holderness Road Kingston upon Hull East Yorkshire HU9 3EU Lead Inspector
George Skinn Key Unannounced Inspection 23rd October 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000068471.V353462.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000068471.V353462.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Woodford Care Home Address 594 - 596 Holderness Road Kingston upon Hull East Yorkshire HU9 3EU 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) 01482 712639 F/P 01482 712639 S & M Care Homes Limited Position Vacant Care Home 23 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (23) of places DS0000068471.V353462.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 27th April 2007 Brief Description of the Service: Woodford Care Home is a large building situated on a main road on the outskirts of the City of Hull. There is easy access to local public transport and amenities. The home is registered to provide care for a maximum of 23 people. The home has eleven single bedrooms and six double bedrooms. The home has two lounges and one dining room. The home has a quiet lounge that is also used as a library and visitors room. Accommodation is provided over two floors. The home has a small outdoor patio for service users to use when the weather permits. The home does not have a car park. The current scale of charges range from £287.50 to £368.00. DS0000068471.V353462.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The key inspection has used information from different sources to provide evidence. These sources include: • • • • Reviewing information that has been received about the home since the last inspection. Information provided by the registered provider on an Annual Quality Assurance Assessment (AQAA); Comment cards returned from service users, relatives and staff A visit to the home carried out by one inspector. A site visit was carried out which lasted 8 hours. Service users, relatives and staff were spoken with. Records relating to service users, staff and the management activities of the home were inspected. During the visit care practices were observed, where appropriate, and time was also spent watching the general activity within the home The assistant manager was available to assist throughout the day. What the service does well:
The home provides a clean environment for the people who live there. The people who live at the home are given choices about their lives and are respected by staff. Peoples needs are assessed prior to them moving in to the home to ensure the home can meet their needs, this is confirmed to the service user and or the family/representative in the form of a formal letter. The home provides an informative Service User Guide to help people who are thinking of moving into the home to make a positive and informed choice. Everyone who is thinking of moving into the home are encouraged to visit and meet the staff prior to making a decision. Staff have received medication training, which is accredited by the University of Abertay, Scotland. The home have a good range of indoor activities which includes entertainers who visit the home. The home have a clear complaints policy.
DS0000068471.V353462.R01.S.doc Version 5.2 Page 6 The home always make sure that staff are interviewed, and the proper check are done to ensure the safety of those people who live there. More than 50 of staff are NVQ trained. What has improved since the last inspection? What they could do better:
DS0000068471.V353462.R01.S.doc Version 5.2 Page 7 The registered provider needs to make sure the acting manager is registered with the CSCI. The registered provider needs to make sure that the records about the people who live at the home are properly filled out and reflect their needs; and there are plans in place to help eliminate risks. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000068471.V353462.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 DS0000068471.V353462.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use this service experience good quality outcomes in this area All service user needs are assessed before being admitted to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users’ files looked at as part of the site visit contained evidence of assessments undertaken by the local authority and the home prior their admission. The home has developed care plans from these assessments. The registered provider has drawn up new contracts/terms and conditions these are agreed with the service users or their representatives. DS0000068471.V353462.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use this service experience adequate quality outcomes in this area All service users have a plan of care, the quality of risk assessment is variable. Service users’ health care needs are met. Service users are protected by the homes procedure for handling medication. Service users feel they are treated with dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last site visit the registered provider has introduced new records to be used to record the service users’ needs. These contained information on the service users’ physical needs, mobility needs, emotional needs and daily living tasks. Risk assessments are undertaken with regard to mobility, falls and tissue viability, however the quality of these was variable. One-service user’s
DS0000068471.V353462.R01.S.doc Version 5.2 Page 11 file indicated that the home had not undertaken a thorough risk assessment of their individual needs. There was a small entry in the service user’s file which did not fully take into account the implications, repercussions or the impact their behaviour could have on their lives. There was no evidence that the home had sought advice from health care professionals on how to support the individual to ensure their safety; or that a best of interest meeting had been held to ensure the individual was receiving the best care possible or the correct intervention when needed. Documentary evidence was available which indicated that the use of bed rails was in accordance with recently introduced legislation and guidance from the Department of Health. Observation made during the site visit indicated that the service users’ health care needs are met; staff were seen taking service users to the opticians as a result of advice given following a GP’s visit. Evidence was seen on service users’ files which indicated they are regularly seen by GPs, chiropodist and District Nurses. The staff have received training on the administration of medication which has been provided by a pharmacist; they have also received accredited training on handling medication and were observed to be handling the medication safely. The staff assist one service user to administer her own insulin; this is done in accordance with guidelines given by the district nursing services. Observation made during the inspection indicates that the staff treat the service users with respect. They were sensitive to the needs of the service users and any conversation was respectful; staff practise was appropriate to the needs of the service users. DS0000068471.V353462.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use this service experience good quality outcomes in this area Service users are able to participate in activities both in the home and in the local community; and have regular contact with their relatives. Service users can exercise choice in their daily lives. Service users received a well-balanced and wholesome diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Outside entertainment is arranged on a regular basis, and in house activities continue to be accessed by the service users. During the site visit staff were engaging with the service users both in groups and on an individual basis. Some service users are able to arrange their own outings and activities and this is encouraged by the home. Service users interests are recorded in care plans; new documentation records this in more detail. The home has restricted visiting times and has advised relatives that they would prefer them not to visit during lunchtime. This is as a direct result of
DS0000068471.V353462.R01.S.doc Version 5.2 Page 13 service users complaining that some visitors do not respect their privacy and let children run around while they are eating. One relative commented that they found this restricting and would be speaking to the management about the arrangement. Many relatives and friends were visiting the home during the site visit, they commented on being made to feel welcome and could appreciate the views of the service users around meal times. Prior to the site visit some concerns were raised around service users’ freedom of choice around times of getting up and going to bed. Service users spoken with commented on being able to get up when they please and go to bed when they please. It was well documented in the care plans of those service users who could not voice an opinion their preference on going to bed and rising. Observation made during the site visit confirmed that the food continues to be good and all service users commented positively. The service users are able to choose from a menu and the meal times are as flexible as possible, especially breakfast. The cook commented on having plenty of provisions to use; the meal on the day of the site visit looked appetising and well presented and service users commented positively. Staff assisted service users sensitively and the service user set the pace. DS0000068471.V353462.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use this service experience good quality outcomes in this area. Service users are protected by the homes procedures for dealing with complaints. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s Statement of Purpose contains details for making a complaint, and a complaint procedure is posted around the home; this is also available in the Service User Guide. Service users spoken with said they would talk to the acting manager if they had concerns and they were confident that this would be taken seriously. A complaint record is maintained and the complainant signs as to their satisfaction with the outcome of any investigation. All the staff spoken with during the site visit confirmed they knew what to do if they suspected any form of abuse was taking place. They were very clear that they would not tolerate any forms of abuse and they would report to other authorities if they were not satisfied with the acting manager’s or the registered provider’s response. There has been training provided for all staff with regard to the protection of vulnerable adults.
DS0000068471.V353462.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use this service experience good quality outcomes in this area. Service users live in a home which is well maintained and clean. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last site visit the registered providers have decorated many parts of the home; those areas that had been redecorated showed a marked improvement. The registered provider obtained a grant and has improved carpets and other aspects of decoration. Responses from relatives’ surveys indicated that there has been an improvement in the physical environment.
DS0000068471.V353462.R01.S.doc Version 5.2 Page 16 The registered provider has undertaken a risk assessment for each service user to establish if service users want or are able to be safe with the provision of lockable bedroom door. Those who have been assessed as being safe have been identified and locks are to be fitted to their doors. Generally the home was tidy and clean and the service users commented on being satisfied with their rooms. The registered provider has produced a plan of refurbishment which has set time scales. DS0000068471.V353462.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use this service experience good quality outcomes in this area Service users’ needs are met by the numbers and skill mix of the staff on duty. Service users are protected by the homes recruitment procedures. Staff are appropriately trained to meet the service users’ needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered provider now complies with the staffing levels recommended by the Staffing Forum Guidelines for Residential Homes issued by the Department of Health. The registered provider has invested a lot of time and effort into ensuring the staff are appropriately trained to met the needs of the service users. There is now a comprehensive induction process in place. When interviewed staff confirmed that they had received mandatory training within the last year. The staff confirmed that there are training opportunities outside of the home and they had attended training on diabetes and dementia. DS0000068471.V353462.R01.S.doc Version 5.2 Page 18 Staff files looked at contained evidence of proper checks being undertaken before staff commence work at the home; there was evidence of Criminal Records Bureau checks (CRB) and references. DS0000068471.V353462.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use this service experience adequate quality outcomes in this area. The manager is not registered with the CSCI. The home is run in the best interest of the service users. Service users financial interests are safeguarded. The health and safety of the service users is safeguarded. This judgement has been made using available evidence including a visit to this service. DS0000068471.V353462.R01.S.doc Version 5.2 Page 20 EVIDENCE: The home is currently managed by an acting manager, she has 18 years experience of caring for older people, she has NVQ 3 and 4 and the NVQ assessors award. The registered provider needs to make application the CSCI for the registration of the acting manager as a matter of priority. The acting manager and the registered provider have worked hard on the development of the home and have done some good work with the staff especially with regard to training. The registered provider has used surveys to establish stakeholder views and has conducted service user and relative meetings; from these goals and action plans have been produced for achievement in the next 12 months. The service users continue to be protected by the homes financial procedures. The staff have received all mandatory training since the last inspection. Maintenance certificate were up to date. DS0000068471.V353462.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PROVIDERAL CARE Standard No Score 7 2 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 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 3 3 DS0000068471.V353462.R01.S.doc Version 5.2 Page 22 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 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. 2. Standard OP7 OP31 Regulation 15 4, 5, 18 & 19 Requirement Timescale for action 30/01/08 Generic and specific risk assessments must be completed. and reviewed at least monthly. The registered provider must 30/01/08 submit an application for registration for the acting manager. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000068471.V353462.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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