Inspection on 11/06/08 for Woodford House Nursing Home

This inspection was carried out on 11th June 2008.

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

The inspector 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

Woodford House Nursing Home 24/08/06

Woodford House Nursing Home 19/01/06

Woodford House Nursing Home 06/07/05

Woodford House Nursing Home 24/01/05

Woodford House Nursing Home 06/07/04

Woodford House Nursing Home 14/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Woodford House Nursing Home The Green Trysull Staffordshire WV5 7HW Lead Inspector Amanda Hennessy Key Unannounced Inspection 11th June 2008 09:25 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 Woodford House Nursing Home DS0000022384.V365742.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. Woodford House Nursing Home DS0000022384.V365742.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodford House Nursing Home Address The Green Trysull Staffordshire WV5 7HW 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) 01902 324264 01902 894934 manager@woodford-house.co.uk Heart of England Properties Ltd T/A Woodford House Nursing Home Mrs Juliet McDonagh Care Home 40 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (14), Old age, not falling within any other category (14), Physical disability over 65 years of age (40) Woodford House Nursing Home DS0000022384.V365742.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. PD - Minimum age 60 years on admission The home may also accommodate four (4) service users minimum age 55 with a physical disability. Category PD The home may also accommodate four (4) service user minimum age 55 with a mental disorder. Category MD 24th August 2006 Date of last inspection Brief Description of the Service: The home is situated in the centre of Trysull village, conveniently located close to local amenities, overlooking the village green. The home provides nursing care for up to 40 older people. Over the years Woodford House has been transformed from the village hotel to a very comfortable care home with the necessary facilities in place to offer a high standard of care. Accommodation is on two levels with a passenger lift providing access to each floor, there is a staff call throughout the home and aids and adaptations for dependent people. There is an attractive roof garden with outdoor seating areas which is additional to pleasant gardens at the side and back of the home. Adequate car parking available at the front of the home. The service user guide was not viewed during this inspection and so no information was obtained about fees that are charged. As the fee information has not been included in this report we advise the reader to contact the service for this information and of any other costs that may charged for, in addition to the fees. Woodford House Nursing Home DS0000022384.V365742.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Inspector carried out this key unannounced inspection over one day in June 2008 between 09.25 and 18.00hrs. The home did not know we were coming. The manager who is also the proprietor was present throughout the inspection. Information for the report was gathered from a number of sources: a questionnaire- Annual Quality Assurance Assessment (AQAA) was completed before the inspection by the homes manager who is also proprietor which was sent to us; We looked at the environment including looking at the communal areas and a sample of the peoples bedrooms, there was discussion with the manager, care staff, people who live at the home and visitors to the home. We looked at how the service has responded to any concerns and how the service was protecting people from abuse including how the service recruited and trained staff. We also looked at the number of staff available to care for people at the home. Four people who live in the home were ‘case tracked’ this involves establishing people’s experiences of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes of the care that they receive. Tracking people’s care helps us understand the experience of people who use the service, how they spend their time and whether the service was promotes people’s privacy and dignity. We looked also looked at the arrangements for storing and administering medication. There were no requirements made at the previous inspection. Two requirements and ten good practice recommendations were made as a result of this inspection. We would like to thank people living at the home, the Manager and staff for their assistance and hospitality during the inspection. The overall rating for this service is 1 star. This means that the people who use the service experience adequate quality outcomes. What the service does well: The home is clean, homely, comfortable, tastefully decorated and furnished to a high standard. There is a good range of aids and adaptations available for dependent people. We feel that the home goes that “extra mile” to provide an environment that fully meets the needs of people who live at the home. Woodford House Nursing Home DS0000022384.V365742.R01.S.doc Version 5.2 Page 6 People only come to live at the home following an assessment of their needs undertaken by a qualified nurse. It is only following the assessment of their needs that there is agreement that their needs can be met by the home. There are appropriate arrangements in place for health care from other professionals. A relative made the following comment about the home;” I wanted her to come here as they have a reputation for good care”. There are sufficient, knowledgeable and well trained staff to meet peoples needs. Recruitment and selection processes are undertaken to a good standard and protect vulnerable people. Staff, are committed to caring for the people at the home. One person told us; “The staff are very good, they help me with things I can’t do myself”. A member of staff said : “ We do our best to ensure that people have the care that they need.” The home has good leadership from a manager who strives for ongoing improvement based on identified good practice and the views of people who live at the home and their families. The health, safety and welfare of people living and working at the home is promoted and they are protected from harm and the risk of accident as much as possible. What has improved since the last inspection? What they could do better: The Statement of Purpose and service user guide should be more widely so that people have all information about the home and the services it offers. It is positive that staff have a good knowledge of peoples needs although records to provide care instructions need to be improved. Care records should Woodford House Nursing Home DS0000022384.V365742.R01.S.doc Version 5.2 Page 7 be individualised and reflect people’s needs, choices and capabilities. Staff also need to more fully record and monitor changes to people health and record all visits by other health professionals. There is a need to develop the existing bed rail risk assessment and ensure that a risk assessment is in place for the use of any restraint used. There are generally good procedures in place for the safe keeping and recording administration of medicines. Improvements needed are the record of administration of nutritional supplements and creams; ongoing checks that all medicines are given as prescribed, and checks on the temperature of the medication storage room to give confidence that medicines are stored safely. These changes would give greater confidence that people receive their medicines as prescribed and that it is stored safely to ensure their effectiveness. The home has a new Activity Coordinator who is enthusiastic about her role. We advised that she develops an activity plan and that there is a record of who takes part in which activities. 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. Woodford House Nursing Home DS0000022384.V365742.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 Woodford House Nursing Home DS0000022384.V365742.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 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes assessment of peoples’ needs gives confidence that they are fully aware of their needs and can meet them. EVIDENCE: The Statement of Purpose and service user guide were not inspected during this key inspection. Peoples’ care records seen showed us that people wishing to live at the home have their needs assessed. We found that the pre admission assessment contained good information about peoples’ needs and gave staff instructions on how their needs can be met. The Manager confirmed that people are encouraged to visit the home before they make the decision to come to live there. An opportunity to “try before you Woodford House Nursing Home DS0000022384.V365742.R01.S.doc Version 5.2 Page 10 stay” is essential as it enables people to experience the home and help them to decide if it will be suitable for them. One person made the following comment; ‘I lived somewhere else before, I’m much happier living here”. This service does not provide intermediate care. Woodford House Nursing Home DS0000022384.V365742.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health care needs are met but there would be even greater confidence of this with improved record keeping. Medication practices are generally satisfactory and protect the well being of the people living at the home. EVIDENCE: People living at the home have a care plan. We found that the home uses “standard” care plans only substituting peoples names, but all care instructions for staff were the same. The use of standard care plans provides no opportunity to detail peoples’ individual needs, choices and capabilities. For example all care plans seen for personal hygiene stated: “ daily strip wash and a weekly bath”. There is no record that “ a weekly bath” is their choice and there is no information in relation to how much people can assist in their own care, which would assist people to maintain their independence for as long as possible. Woodford House Nursing Home DS0000022384.V365742.R01.S.doc Version 5.2 Page 12 People had a plan of care for “incontinence” yet we were made aware by staff that not all people whose records we looked at were incontinent. Care plans detailed the use of incontinence pads but there was no reference to assisting them to the toilet. We spoke to the Manager and staff who agreed that the promotion of peoples continence is essential to assist in the maintenance of their self esteem and dignity. We looked at people’s care records who had behaviour that may challenge. We again found that all care plans were the same and gave staff insufficient instructions on how they should manage and calm this behaviour. One extract from a challenging behaviour care plan said: ”develop a therapeutical relationship with X based on empathy and warmth”. We found no information on what was a “therapeutical” relationship or how staff would manage this person’s aggression. People living at the home should whenever possible be involved in the planning of their care and therefore plain English should be used. The use if plain English in care records will make them easier to read and understand. Staff told us that they have had special training in restraint and would use restraint in cases of extreme aggression as they had been taught. The use of any restraint was not included in the plans of care that we saw and no risk assessment detailed its use. Required instructions and risk assessments for the use of restraint if available would give confidence that staff are clear of all actions they are required to take to protect people. Another person required frequent dressings to their legs. There were good instructions for staff detailing which dressing products should be used and where. Staff had recorded that the person’s legs and their dressings needed reviewing every three days. No record was made of any review or that the persons legs had even been dressed, although staff confirmed that regular dressings were done. We also looked at care plans detailing how people ‘s diabetes should be managed. We saw instructions that identified: “ blood sugars to be tested and recorded weekly.” Care instructions then stated “any rise in blood sugar for no apparent reason to be reported to the GP”. Staff did not detail “what rise was acceptable”. We found in the daily care records for this person that their blood sugar had on occasions been very high. There was a note that said: “this evening her blood sugar was 25.8mmols. I retested BM at 21.30 it was still very high 19.5mmols. Please continue with regular testing”. This person blood sugar was checked another three times over the next twenty-four hours at each occasion it was at least double the normal blood sugar reading. There was no record that the Doctor had been contacted or that a requested urine test had been sent. Staff did tell us that the urine test was collected and the Doctor was aware of the person’s blood sugar, but agreed that records should reflect the care given. Woodford House Nursing Home DS0000022384.V365742.R01.S.doc Version 5.2 Page 13 People have risk assessments in place to identify and minimise the possible risk of pressure sore formation, malnutrition, appropriate moving and handling, falls and the use of bedrails. All had required actions that staff should take to minimise the risk to the person, although the bed rail risk assessment needed further expansion. People living at the home and their relatives were very positive about the care given at the home telling us: “No concerns about the care received”. Relatives said: “Very pleased with the care that she receives” and “ They offer an excellent standard of care and provide us with peace of mind knowing that my mothering law is well looked after”. People are seen by other Health Professionals such as Doctors, Chiropodists, Dentists and Opticians. Records of Professional visits are generally recorded in the home diary rather than individual’s care records. We discussed a need for records to be maintained individually so that the frequency of visits and advice given at that time can be monitored as a good practice issue. Medication practices are generally safe and protect the people living there, although some improvements are needed. There are appropriate systems in place to order repeat prescriptions and a record of all medicines that are received is made. We found that staff do sign to confirm that they give the majority of medicines but do not always sign to confirm that creams and nutritional supplements are given as they are required to. The failure to sign for medication means that we (and other staff) do not know whether people have had this medication. The failure to sign means that there is a risk that another staff member may give this medicine again or that the person has not had their medication. We did check some medicines and found two medicines where more tablets were left than their should have been suggesting, although staff have signed that they had given the medicine this was not the situation. There is a need to do regular checks on medication to give assurance that people are receiving their medicines as prescribed. Staff do regular checks on the temperature of the medicines fridge showing that medicines stored there are stored safely within required temperatures. We did highlight a need to check the medicines room temperature to show that medicines stored in there are also stored safely. . We saw that people were treated respectfully and were spoken to politely. Some staff initiated conversation and involved people in decision-making. Other staff appeared reluctant to engage in conversation with people. We observed that one person we sat with was only spoken to once by staff in the five hours we spent in the lounge, and then only when he was asked whether he wanted to go into the dining room for his lunch. Another lady was only Woodford House Nursing Home DS0000022384.V365742.R01.S.doc Version 5.2 Page 14 spoken to twice in the same five-hour period once again when staff asked her if she wanted to go into the dining room for lunch. Woodford House Nursing Home DS0000022384.V365742.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at the home can maintain relationships with friends and relatives and are provided with a choice of tasty meals. A range of activities are available but there is a need to more fully explore peoples interests and choices to give assurance that activities and daily life at the home is suitable for people who live there. EVIDENCE: The home has a member of staff who organises activities. She told us that she plans outside visits in advance but does not have a daily activity plan. We advised that one would be helpful if available. We were told that activities are arranged for both individuals and small groups, although there was no record of who takes part in which activities. We did see that people had a social care plan stating their interests, although as previously identified care plans were all the same examples of which follow: “ provide daily newspapers and books as requested by x” and “Allow X to watch TV, listen to the radio and play tapes, provide X with games and jigsaws Woodford House Nursing Home DS0000022384.V365742.R01.S.doc Version 5.2 Page 16 and maintain her interests”. It is a suggestion that people may benefit if staff to find out what television programmes and music people like and remind them when these are on, rather than state ‘allow to watch TV and listen to the radio’. We spoke to the Activity Coordinator who is enthusiastic about her new role. She has organised several trips out to the local garden centres and parks and she said that they were hoping to take some residents on holiday later in the year. We were told that entertainers such as singers regularly visit the home. A garden party was held over the weekend before the inspection and although we were told that it was “ a bit chilly” “ people thoroughly enjoyed the buffet and cream scones”. There is a pleasant room upstairs where one to one activities take place. On the day of the visit people were doing arts and crafts and music was playing for the majority of time in the other lounge. The Activity Coordinator came in to say that the film would be on shortly and turned on the television. Unfortunately another member of staff turned the television off and put the music back on without asking the people in the lounge. There are pleasant gardens with raised flowerbeds enabling people living at the home to assist in their planting and weeding if they want to. We were also told that people enjoy helping to water the plants and feed the birds in the garden. Visitors are welcome at any reasonable time in the day. We observed several visitors arriving and leaving during the day of the inspection. Visitors we spoke to were all very positive about the home. “I have no complaints at all, I know they are very good to mum”. People are able to choose where or how they spend their day. People told us that they spend their time either in one of the three lounges or their bedroom. People can choose whether to join in with activities or not. People told us that they can choose when they to go to bed and get up in the morning. Care plans focused on “doing for people”. We discussed with the manager a need to identify people capabilities and promote their independence to maintain their daily living skills for as long as possible. The home has a menu offering a hot choice at breakfast dinner and tea. Tables in the dining room were attractively presented with tablecloths, cruets and cutlery. We saw staff supporting people to have their meal and this was done in a relaxed and sensitive manner. Hot drinks are provided several times throughout the day and evening. The manager said that the menu had recently been revised and reflected peoples preferred choices and this had been successful. One person did say that food was “ not as good as it used to be”. Woodford House Nursing Home DS0000022384.V365742.R01.S.doc Version 5.2 Page 17 We did try the food when all people were served and found it tasty and home cooked. Woodford House Nursing Home DS0000022384.V365742.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and concerns are listened to and acted upon although more written information should be available to assist people to raise concerns they may have. Appropriate and comprehensive risk assessments will give greater assurance that people will be kept safe. EVIDENCE: The home does have a complaints procedure although we did not see it displayed in the home. The Manager told us that she has an open door policy and the location of her office by the front door means that people pop in and discuss any concerns that they have. She feels that any concerns can be easily addressed before they become a major problem, which is crucial given the needs and dependency of people living at the home. We advised that the complaints procedure is displayed so that people have the written information on how to make a complaint if they wish to. There has been one complaint about the home, which came direct to the Commission for Social Care Inspection (CSCI) and was anonymous. The concerns highlighted the cleanliness of the kitchen and staffing levels. This complaint was investigated by the home and was not substantiated. Woodford House Nursing Home DS0000022384.V365742.R01.S.doc Version 5.2 Page 19 Information on Advocacy services was not seen during this inspection. The Manager did say that advocacy services are contacted when people have no one to assist them to make decisions. There is a need for information on Advocacy services to be more accessible so that people can contact them independently if they feel they need to. It is positive that all staff have had training to highlight their responsibilities under the Mental Capacity Act. The Home has an appropriate adult protection policies and procedures. There have been two Adult Protection Investigations in the previous twelve months during which the home highlighted concerns to the appropriate agencies. It was positive that staff under “Whistle blowing” procedures raised the concerns and they were fully investigated by the Manager. It is also positive in that when we spoke to staff they were aware of their responsibilities to highlight poor practice and were clear of what actions they would take. Staff receive training in adult protection and also training on how to restrain people when needed. Risk assessments for the use of bedrails are available but need more information so that the risk of injury when they are used can be minimized. Risk assessments were not available for people who may need other forms of restraint, particularly those restrained during episodes of physical aggression. We advised that this is required for to protect people from risk of harm and maintain their safety. We found that Manager immediately responded to advice that we gave her and started to implement new procedures and risk assessments giving assurance that people would be protected and kept safe. Woodford House Nursing Home DS0000022384.V365742.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is a homely, clean, comfortable and a safe place to live that meets the needs of people who live there. EVIDENCE: The home is clean, homely and pleasantly decorated and furnished. All areas of the home are decorated and furnished to a high standard. There is also an ongoing decoration programme that ensures all areas are kept well maintained. The home has an enclosed roof terrace with garden furniture and pleasant secure landscaped gardens around the home, which also have garden furniture. We were pleased to see the raised flowerbeds that people living in the home are able to plant and keep tended. Woodford House Nursing Home DS0000022384.V365742.R01.S.doc Version 5.2 Page 21 There is a large lounge with television, a smaller quiet lounge come dining room with conservatory area. The home has a separate dining room. The Manager and staff told us that they are developing “themed” corridors to aid people’s orientation to where they are in the home. The home’s bedrooms vary in size with the majority having an en-suite toilet and wash hand basin. Bedrooms are pleasantly decorated and have adequate storage and good quality furniture and furnishings. We were told that the majority of bedrooms now have a door lock and that new locks are currently being fitted. People are able to bring in pieces of furniture and bedrooms seen were personalised with a range of pictures, photographs and ornaments. There is a new staff call system throughout the home, there are hoists and a range of aids and adaptations for people who are dependent. The home has also “wander alarms” that alert staff that people who are at risk of falling have got up and may need assistance. All external doors are alarmed telling staff that one has been opened and that someone has gone outside. Bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of people who use the service and are in sufficient numbers around the home and are of good quality. The home is clean and tidy throughout. The home uses hygienic disposal bowls, urinal bottles and when needed commode liners (most rooms have ensuite toilet available) to give assurance that risk of cross infection is minimised. People told us that: It’s a very clean home.’ Staff were observed to use gloves and aprons to complete personal care tasks. The Manager has good proposals to further improve the environment of the home for people who live there. She is planning to convert rooms so that there will be less double rooms and more single rooms with en-suite facilities there are also plans for an additional assisted shower room. We feel that the service goes that “extra mile” to provide an environment that fully meets the needs of people who live at the home. Woodford House Nursing Home DS0000022384.V365742.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are sufficient, knowledgeable and well trained staff to meet peoples needs. Recruitment and selection processes are to a good standard and protect vulnerable people. EVIDENCE: The home is staffed with appropriate numbers and skill mix of staff to meet people’s needs. Staff we met spoke positively about support and training they receive at the home. We also found that when we spoke to staff they were knowledgeable about peoples needs. Training at the home is supported. All new staff receive formal induction training, which the Manager was able to confirm meets the “Skills for Care” standards. It is very positive that 50 of care staff being trained to National Vocational Qualification (NVQ) level two standard has been exceeded at the home. Staff recruitment and selection is completed to the required standard. All staff files seen contained appropriate checks such as criminal records checks, Woodford House Nursing Home DS0000022384.V365742.R01.S.doc Version 5.2 Page 23 references and when appropriate nurse registration. We did advise that a record of the staff interview is maintained. Woodford House Nursing Home DS0000022384.V365742.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has good leadership with a manager who strives for ongoing improvement based on identified good practice and the views of people who live at the home and their families. The health, safety and welfare of people is promoted and protected. EVIDENCE: The home is led by an experienced and well-qualified manager who is also a registered nurse. The manager holds frequent staff meetings and maintains a record of these to ensure that staff are kept updated and informed of changes. Woodford House Nursing Home DS0000022384.V365742.R01.S.doc Version 5.2 Page 25 The Annual Quality Assurance Assessment (AQAA) was completed by the homes Director/ Manager and was sent to us when we asked for it. The AQAA gave us clear, relevant information about the home and told us where we would be able to find the evidence to support the information given. The AQAA told us about all changes that have been made in the previous twelve months and where they still need to make improvements and how they were going to do this. Surveys of peoples’ views are undertaken annually. Findings of the audits and peoples’ views inform the development plan for the home. Staff at the home do not manage any person’s personal allowance but look after small amounts of money on their behalf. Sampling showed that suitable records were being kept with receipts supporting expenditure. We did find that balances checked were not all correct and the Manager told us she would look into this. Staff supervision records were not all available at the time of the inspection. The Manager showed us the new revised documentation that has been developed following the involvement of the home in a pilot stude looking at supervision in care homes and covers all aspects of practice. The Manager has a matrix that shows her that all staff receive supervision at the required frequency which again is good practice. The home has an up to date health and safety policy for safe working practice. We did highlight a need for risk assessments for the use of any form of restraint Staff receive training and regular updates in infection control, health and safety, moving and handling and fire training. We saw records to show that the home has regular fire drills. Maintenance contracts were randomly selected and were found to be up to date. Woodford House Nursing Home DS0000022384.V365742.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 4 4 4 4 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 4 x 3 x 2 2 x 2 Woodford House Nursing Home DS0000022384.V365742.R01.S.doc Version 5.2 Page 27 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 OP8 Regulation 13(7) Requirement There should be a risk assessment in place for the appropriate use of restraint so that people can be both protected and kept safe. There should be a record of every occasion of physical restraint, the circumstances leading to the restraint and the nature of the restraint so that the safety of people can be maintained. Timescale for action 17/06/08 2 OP8 13(8) 17/06/08 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. 2 3 Refer to Standard OP1 OP7 OP7 Good Practice Recommendations The service user guide should be readily accessible for both people living at the home and prospective residents. Care plans should be person centred and reflect all people’s needs, choices and capabilities. Care plans for people with diabetes should detail the range DS0000022384.V365742.R01.S.doc Version 5.2 Page 28 Woodford House Nursing Home 4 5 6 7 9 10 OP7 OP7 OP8 OP8 OP9 OP9 of acceptable blood sugar levels, frequency of blood sugar testing and actions to be undertaken if blood sugars are outside the “normal” range identified. Care plans for challenging behaviour should record the actions staff should take to de-escalate any incident. Care plans should focus on strategies to maintain continence rather adopting strategies to manage incontinence to promote people ‘s dignity and self esteem. Staff should record when dressings are undertaken and regularly review the process of wound healing. Staff should record Professional visits in peoples individual care records to give confidence that regular checks are being undertaken. Regular audits should be undertaken of medication at the home. There should be regular temperature monitoring of the room where medicines are stored which should be below 26Oc to ensure the safety and effectiveness of medicines stored there. Woodford House Nursing Home DS0000022384.V365742.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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