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Inspection on 06/07/05 for Woodford House Nursing Home

Also see our care home review for Woodford House Nursing Home for more information

This inspection was carried out on 6th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The Home is extremely well organised, with a committed care management team. Emphasis goes into involving the residents and their families in the process of care, ensuring a highly personal approach to meeting individual needs. Nursing care is of a high standard with named nurses and key workers actively deployed. Assessment procedures and care planning is of an excellent standard, offering detailed information on each resident`s progress in the meeting of objectives. The housekeeping and support services all contribute to the team approach, and are recognised by the management for their efforts. Maintenance of good staffing levels, staff training and supervision are well established in safeguarding the interests of residents. Overall the attitude in meeting clinical and organisational demands is highly commendable, with forward thinking, planning and application contributing to an excellent service.

What has improved since the last inspection?

Marked improvement on the organisation of personnel files and training records. Attention to risk assessment has produced an excellent foundation for planning and management. Although there is extensive building work under way the managers have managed to keep the disruption to a minimum. No resident voiced any concerns about the activities going on around them.

What the care home could do better:

There were some damaged locks on certain storage cupboards, which have been overlooked during the building work, although limited to linen areas. The supervision of staff process has concentrated upon clinical training issues and would benefit from extending the process to encompass general working conditions and performances.

CARE HOMES FOR OLDER PEOPLE Woodford House Nursing Home The Green Trysull Staffordshire WV5 7HW Lead Inspector Keith Jones Announced 6 July 2005 9:00 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 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 E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 3 SERVICE INFORMATION Name of service Woodford House Nursing Home Address The Green Trysull Staffordshire WV5 7HW 01902 324264 01902 324264 julietmc@tiscali.co.uk Heart of England Properties Ltd Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Juliet McDonagh Care Home 28 Category(ies) of 4 DE(E) registration, with number 14 OP of places 28 PD(E) Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: PD(E) Over 60 Years Date of last inspection 24 January 2005 Brief Description of the Service: The home holds a centre point in the very attractive Trysull village, conveniently located close to local amenities, overlooking the village green.The home provides care of the elderly for up to 31 service users including general nursing care. On the day of inspection there were 26 service users in residence. Over the years Woodford House has been transformed from the village hotel to provide a very comfortable care home with the necessary facilities in place to offer a high standard of care. Situated on two levels with a passenger lift, the home boasts an attractive split-level roof garden with outdoor seating areas. There are pleasant gardens, well maintained throughout the year for the pleasure and convenience of service users, although an area has been set aside for the extension presently under construction. There is adequate car parking available. It was noted that recent refurbishment had taken place, and also evidence that a continual programme of upgrading is established and is planned to continue following the completion of building to provide 40 beds. The CSCI will be appraised and involved in the planning and commissioning process. Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was conducted over one day, by one inspector, the care manager and senior staff, in a professional and cordial atmosphere. The last inspection report was discussed, and it was noted that all outstanding recommendations had been dealt with satisfactorily. On the day of inspection there were 26 service users in residence, of which 16 were categorised as requiring nursing care. A tour of the Home allowed free and open access to all areas for inspection. The opportunity was taken to speak with a number of residents, relatives and members of staff. Service users and staff took an active role in the inspection process and contributed to the subsequent report. Throughout the entire inspection a sense of homeliness and familiar confidence pervaded into all aspects of daily activity expressed by those people met. A comprehensive review of the administrative arrangements confirmed solid practice and effective management. A full verbal report was offered at the end of the inspection to the care manager. The inspector thanked all concerned for their contribution to a pleasing and constructive inspection. What the service does well: The Home is extremely well organised, with a committed care management team. Emphasis goes into involving the residents and their families in the process of care, ensuring a highly personal approach to meeting individual needs. Nursing care is of a high standard with named nurses and key workers actively deployed. Assessment procedures and care planning is of an excellent standard, offering detailed information on each resident’s progress in the meeting of objectives. The housekeeping and support services all contribute to the team approach, and are recognised by the management for their efforts. Maintenance of good staffing levels, staff training and supervision are well established in safeguarding the interests of residents. Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 6 Overall the attitude in meeting clinical and organisational demands is highly commendable, with forward thinking, planning and application contributing to an excellent service. What has improved since the last inspection? What they could do better: 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. Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 and 5 Woodford House ensures that prospective residents have the necessary information to enable an informed choice to be made. Aims and objectives, terms and conditions are clearly presented in a way to facilitate easy understanding of services and standards of care. The care manager ensures that the admission process is a reflection of a joint understanding that residents are aware, and that staff are able to meet expectations to realise a comfortable transition. EVIDENCE: The Statement of Purpose and guidelines reflect an expression of philosophy, and have been well established in representing the foundation on which the home operates upon. It presents an excellent description of the home’s aims and objectives, philosophy of care and terms and conditions. All the requirements prescribed in Schedule 1 are addressed. A review will be undertaken to accommodate changing environmental and organisational demands resulting from the extension work. Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 9 The contract document continues to reflect changed circumstances and conditions, including an identification of allocated bedroom agreed. The care manager continues to adhere to a strict admission policy of personal supervision of the pre-admission assessment. Case tracking demonstrated the presentation of a highly personal approach to prospective residents and their relatives on pre-admission. A very detailed assessment was examined and found to collect a full profile of physical and psychological needs, as well as social, cultural and environmental circumstances. An appraisal is made, and discussed, to ensure the home can satisfactorily meet those needs. Case tracking and discussion with service users confirmed that this standard continues to be well met. Following an assessment the senior carer assessor determines the suitability of the application in view of the facilities available, and at the capacity of the home, to manage the individual and any special needs. Likewise the applicants are informed of those facilities and are encouraged to seek clarification concerning the general and specific services available for the prospective service user. Case tracking confirmed that a valuable exchange between service users and assessor took place and resources made available. These resources were seen to be an appraisal of staffing skills, equipment and general environment. Prospective service users and their relatives are able to visit and assess the quality, facilities and suitability of Woodford House at any reasonable time, to meet with staff and management. At all times relatives are involved throughout the process. The home does not admit emergencies. Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 and 11 The pre-admission assessment is recognised as the foundation for a comprehensive care planning process. A profile of the service user’s social, physical and psychological status offers an individual plan of care to be implemented and reviewed. The policy of the home is to maintain service users own GP support wherever practical, otherwise local GPs covered on a regular basis. Service users spoken to were particularly pleased in the way their privacy and dignity was respected, not only by the care staff, but everyone connected to the running of the home. EVIDENCE: Case tracking records clearly showed that this standard continued to be well met, maintaining a high quality process of assessment. The pre-admission assessment represented the foundation for a well-considered and detailed care planning process. A profile of the service user’s social, physical and psychological status offered an individual plan of care, based upon a 12-point activities of daily living. Each service user’s health, personal and social care needs are carefully assessed in an individual plan of care that is reviewed monthly, including service users and relatives views, to reflect their changing Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 11 needs. That review is more frequent, dependant upon the individual’s needs and clinical condition. Each service user has a named carer (key-worker) who is responsible for maintaining an in-depth awareness of those service users, with a monthly key-worker report. There is also an excellent daily report structure. The policy of the home is to maintain service users own GP support wherever practical, otherwise local GPs covered on a regular basis. Case tracking confirmed a consistent medical input into the provision of health care to meet assessed needs. There was evidence of consultations from medical and nurse specialists, and other professional support services. Discussions with service users confirmed their acceptance and confidence in the overall standard of health care given. Documentation showed that service users had access to hearing and sight tests, and appropriate aids according to their assessed needs. It was pleasing to see that the administration of medicines continues to adhere to procedures to maximise protection to service users. The storage was secure with satisfactory added security for controlled drugs. A controlled drug register was examined and found to be in order. A trained member of staff completed MAR sheets accurately, with accountability recorded throughout the process. Residents who wished to self-medicate were encouraged to do so. At the time of inspection there was no one self-medicating, although policies were in place. It was advised to review procedures for handling new admission’s medicines through early medical review. The philosophy of promoting individuality and self-determination, as laid out in the Statement of Purpose, continues to be seen to be exercised in many aspects of care. The general atmosphere throughout the home was one of family, confidence, warmth and contentment. Staff were observed in addressing service users in a respectful and dignified way. As is consistent with the clinical management approach each service user is treated as a unique individual, and offered every courtesy. Service users and relatives spoken to were particularly pleased in the way their privacy and dignity was respected, not only by the care staff, but everyone connected to the running of the home. Individual freedom was seen to be extended to providing for visitors to come freely, and be involved in the daily activities, encouraging continued social contact. Service users wishes were documented at assessment and care plan review stages, with families and friends become involved as much as possible. The service user’s spiritual needs are attended to with respect. Policy and procedure concerning the care of the dying and death are adhered to within the home at all times, and the staff were fully aware of their duties. Relatives are involved and have free access at all times as desired by the service user. The staff ensure that the service user has the appropriate care and prescribed pain relief. Palliative care and bereavement training has been given to the Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 12 staff, with a firm, yet sensitive policy issued to all staff. The care manager hopes to have 3/4 trained staff with McMillan accreditation by the year-end. The Home has been officially approved to receive up to 4 palliative care residents on completion of the extension. It was noted that an appraisal of any special preferences or observances is recorded on admission, and is regarded as integral in the assessment process. Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15 Woodford House main objective is to respect the individual, thus delivering care in a relaxed and easy environment, with routine flexible to accommodate needs, and not dictate daily life of service users. Personal choice and relative self-determination are respected in policy and action. Those who wish to bring in personal possessions are encouraged to do so. These policies are designed to match expectations and to achieve a harmonious relationship throughout. The Home offers an excellent service, to which all service users spoken to were highly complimentary of all aspects of quality. Staff were seen to offer discreet assistance to those who required it. The choice of dining room, lounge or bedroom was at the discretion of service users. EVIDENCE: Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 14 The Statement of Purpose and Guide indicate a flexible routine, established to meet the preferences of service users. The policy was evidenced in admission assessment, care plans examined, and talking to service users and relatives, a policy much appreciated and freely expressed. Routine is seen as flexible to acknowledge individuality, yet maintain a focal point for service users to latch on to without dictating events. Staff were observed to hold a friendly, sympathetic and confident interaction with service users and family, in lounge areas and at lunchtime in helping those who required assistance. Service users’ life-styles and interests are recorded in their care plans, discussed with their relatives prior to admission, and documented as far as possible to enhance a position of supported independence. The recording of social activities was seen to be a valuable part of care reporting and planning. It is planned to engage a social activities co-ordinator on completion of the extension. Links with the local community were seen in planned events and the enthusiasm of some residents and members of staff in getting involved. Plans for 4 residents to take a short break in Torquay were perused. The local church and village hall figured largely with those service users talked to, in maintaining outside links and enriching daily life. The care manager demonstrated the strength of protecting service user’s rights, which was secured through the robustness of the procedures in place. This was confirmed on examination of records. The tour of the Home demonstrated a high degree of expressed individuality in each of the bedrooms inspected. A varied menu is available for service users on a four-week cycle and represent a wholesome, appealing and varied balanced diet. Lunch was served during inspection and meals seen to be wholesome and nutritious with service users enthusiastically agreeing on the quality of preparation and serving. Special dietary needs are catered for and monitored as was evidenced through case tracking. Some service users choose to have their meals in their bedrooms. The dining areas were very pleasant, offering conducive ambience for a social meal. The kitchen was seen to be clean, well organised and with modern equipment. An effective cleaning schedule was seen to be in operation. Fridges/freezers and food temperature records were seen to be up to date and accurate. It was advised that access to the kitchen area be controlled and that protective over-garments be made available. Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17 and 18 The home had a meaningful complaints policy, clearly identifying the CSCI as a resource to approach with a complaint or grievance. On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. Service users’ legal rights are protected by the systems in place in the home to safeguard them, including their contract, the continual assessment of care planning and policies in place. Staff induction and in-house training programmes clarified the responsibilities of all staff in their daily contact with service users, especially their privileged position in protecting service users from abuse, of all natures. EVIDENCE: The complaints policy was seen and records examined. There were few complaints, none recent, to assess. All service users had received information on the procedure to complain, including reference to the CSCI. On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. Case tracking confirmed the effectiveness of a care manager and staff sensitive to service users needs and readiness to test the robustness of their information and report structures. As part of the process of encouraging self-determination a policy exists to be able to offer advocacy services should they be required. Family involvement has been the usual means of representation in the past. Service users’ legal rights are protected by the systems in place in the home to safeguard them, including their contract, the continual assessment of care Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 16 planning and policies in place i.e. the complaints procedure. This process was evidenced on examination, and case tracking as previously reported upon. The care manager showed satisfactory evidence of a protocol and response to anyone reporting any form of abuse, to ensure effective handling of such an incident. Staff induction and in-house training programmes clarified the responsibilities of all staff in their daily contact with service users, especially their privileged position in protecting service users from abuse, of all natures. It was recognised that a contact with the local Adult Protection office had been established. The care manager includes a routine address to abuse issues in staff training and development to complement work set out in induction. Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25 and 26 The home is well appointed to meet the needs of an elderly population of service users in providing a safe and comfortable environment. Bedrooms were well maintained to meet service user’s personal preferences; the outcome is a comfortable and familiar private domain that reflects the service user’s preferences. Work is under way on extending the Home to 40 beds. The care manager and staff have managed to contain disturbance to a minimum. The work is hoped to be completed by the end of the year. There are plans for an extensive redecoration and refurbishment throughout on building completion. There is evidence of an awareness of health and safety issues being high on training and supervision priorities. Individual rooms are presented as highly personalised and inviting individual domains. The Home continues to present a clean and pleasant, odour-free atmosphere, much to the credit of staff. Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 18 EVIDENCE: Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 19 External access is satisfactory for visitors, although building work is restrictive. Service users take advantage of attractive gardens and grounds; pathways were safe and recently attended to. Building work is evident but represent no overt risk to service users. CSCI will be involved at various stages during the work. On admission a trained nurse assesses each individual service users needs for equipment and necessary adaptations. Internal access was facilitated with ample fittings of hand and grab rails, in adequate, well-lit and airy corridors. Wheelchair access was satisfactory throughout all areas of the home. Bedrooms were well maintained to meet service user’s personal preferences. It was evident that there were examples of minor maintenance to décor that was awaiting a full redecoration following the extension work. There are 3 variable height beds available for use, with 2 more on order. On inspection most bedrooms were personalised, with some displaying service user’s own furniture, and most with personal belongings. It is the policy that on bedrooms becoming vacant that each room is reappraised for redecoration. There is generally a good standard of furnishing complimented with a variety of personal belongings. Some of the Home’s furniture needs varying levels of attention to maintain the existing high standards. All communal areas are of a high standard, offering social as well as private reflection, as the mood takes. A large lounge space allows activities to be presented in a very pleasant, animated area of the home with furniture and fittings of good quality. The dining area was adequate, and corridors wide enough for wheelchair access, well lit and with sufficient handrails. Service users have the provision of sufficient and suitable lavatories and washing facilities within the home. The standard and presentation of all the toilets and bathrooms were of a high quality, clean, uncluttered and odourfree. Adequate attention has been given to ensure maximum privacy within risk-assessed boundaries. 17 rooms have en suite facilities of a good standard. There are adequate sluice facilities, each having suitable arrangements to assist in control of infection. The areas that store chemicals displayed appropriate COSHH posters and information charts. It was acknowledged that the care manager has reviewed environmental risk assessments, to establish an impressive foundation for maintenance management. A recent Fire officer’s report was received in regard to essential remedial work on a fire escape at the rear during the extension work. A further, full fire inspection will take place on completion. It was noted that several storage areas had faulty locks. An effective nurse call system is installed; care staff reacted speedily to tests. The care manager expressed a willingness to meet any reasonable demand for special needs. Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 20 There is an adequate lighting, and bedside lamps are available where risk assessed. Radiators are protected; smoke detectors fitted and adequate electrical sockets available. A locked facility and lockable bedroom doors were made available on request, following suitable risk assessment. The evidence seen on inspection of service user’s rooms, and on discussion with the individual service users and family, assured that this standard was well met. Several service users spoken to expressed a sense of belonging and satisfaction in the quality and presentation of their living areas. The standard of cleanliness continues to be seen to be excellent throughout; there were no offensive odours in any of the rooms inspected. Sluices, bathrooms and toilets were cleaned on a routine basis presenting a hygienic environment. Kitchen presentation showed good standards of cleanliness and evidence of sound food hygiene practices. The laundry was well organised and equipped to a good standard. COSHH regulations were clearly displayed and relevant to solutions in use. Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 21 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30 Staffing had maintained consistent levels to ensure equilibrium between numbers, skills and qualifications, with a strong presence of long serving experienced staff. The home employs a full complement of support staff, including maintenance, part-time administrator, laundry staff and adequate domestic and catering staffing levels. The provider has established a high profile in the management process, offering a detailed knowledgeable and helpful contribution. The care manager informed the inspector of routine staff induction programmes, well established and well designed on which formed the base upon which in-service supervision and training are planned and achieved. Formal staff clinical supervision has been established, which needs to be extended to encompass general working standards and be part of the cascaded package involving all the staff. EVIDENCE: Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 22 There were 26 residents in the home on the day of the inspection, 10 assessed as residential and 16 as needing nursing care. Off-duties for weeks commencing 29/06/05 through to 17/07/05 were provided and examined; staffing levels were seen to be exceeding recommended minimum levels. The daily care staffing rota showed adequate balance between skills, qualifications and numbers to provide a good standard of care. The staffing establishments were examined and found to be satisfactory in meeting the staffing notice. At the time of inspection there were no vacancies. There were 12 RGNs working 248 hours a week and 15 care staff working 635 hours a week. An average coverage was seen to be: 07.00 – 14.00 - 2 RGN 4 carers 14.00 – 21.00 - 1 RGN 4 carers 21.00 – 07.00 - 1 RGN 2 carers There is spasmodic use of trained and untrained agency staff, and an established nurse bank in use. Flexible rostering and overtime are used when necessary. Activities and socialisation is presently organised by the care staff, but it is expected to appoint a part-time Activity Co-ordinator working 30 hours per week in the near future following the extension completion. There was 3 domestic staff working the early shift on a routine basis, i.e. 180 hours, and a 49-hour laundry services. There are 5 catering staff working within 102 hours, a 40-hour maintenance man and a 30-hour administrative support. It was noted that the care manager worked 25 of her working week as a clinical team leader, 75 as the home manager. Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 23 The care manager emphasised the home’s commitment to training and to achieving the 2005 targets for NVQ level 2. There are 10 staff with NVQ level II and level III, 6 staff working towards level 2, and 6 member of staff due to commence. The care manager has a DMS qualification and the NVQ level IV managers course. It is worth noting that the Home has established an in-house foundation course (based on NVQ), which is seeking accreditation from Wolverhampton College. There are 10 certificated first-aiders in the home’s staffing establishment. Three staff files were sampled and found to be well organised and up to date, following a review of procedures. It was evidenced that CRB checks have been made and contracts of employment are up to date. Ongoing personal and training records were kept secure in accordance of the Data Protection Act 1998. Policy clearly states an equal opportunity position. Woodford House has developed an extensive training plan, evidenced by a 2005 schedule, a significant and impressive commitment to staff training and education, conducted on a professional footing. Records show a very broad spectrum of clinical and allied subjects covered, ensuring that staff fulfil the aims of the home and meet the changing needs of service users. Consideration is being given to seek student nurse allocations. The care manager and deputy lead from the front as facilitators and mentors, and are actively seeking new horizons for their personal portfolio of training. All staff receive training in care issues within the home from registered nurses and trainers. Evidence showed a diligent attention to clinical supervised training, involving a shared aspect of responsibility between staff and trainer, with the involvement of mentor trained staff. However there is a need to extend this process by involving general working arrangements to offer a more substantial commitment to the supervision and appraisal process. Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36,37 and 38 The care manager Juliet McDonagh offers a considerable resource of experience and skills, which are reflected in the high standing in which Woodford House is held by residents, their relatives and the community alike. The style of management was seen as by direct observation, and by discussion with service users, relatives and staff, and that a very open and positive attitude prevails, enhancing the home’s ‘family feel’ and homeliness. There was strong evidence of openness and honesty in speaking with service users, relatives and staff in which day to day events and episodes were freely discussed. On-site inspections offers evidence of a management firmly in control, well organised and prepared to facilitate meaningful, delegated responsibilities to an efficient care management team. EVIDENCE: Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 25 The care manager has demonstrated competence in running Woodford House in establishing a solid Statement of Purpose and policy portfolio that has been implemented, to achieve a high standard of set aims and objectives. A qualified general nurse with a BSc (Hon), a professional portfolio of practical and managerial experience, including a newly acquired NVQ level IV manager’s award is well suited to her present position. Staff meetings are held fortnightly in which staff are encouraged to participate fully in the management and direction within the home. The inspector observed at first hand the confident interrelationship that exist not only between management and staff, but also between staff and residents. The care manager has reinforced the presence of quality assurance with a monthly audit of standards, and regular review of risk assessments. There was strong evidence of openness and honesty in speaking with service users, relatives and staff in which day to day events and episodes are freely discussed. Evidence was secured to confirm a quality monitoring system has been introduced, based upon audit of standards, care plans and feed back from service users and relatives. Standards are discussed at staff meetings, daily reports, direct observation and involvement and one to one staff meetings. The procedures manual was randomly examined and found to offer a very comprehensive reference, although these policies are in need of review to reflect changing circumstances and contemporary issues. A report from a fire prevention inspection had been completed to accommodate arrangements during the extension work. Fire safety remains high priority for all staff evidenced in routine maintenance checks, regular fire drills and frequent staff training sessions organised by a member of staff recognised as a fire safety officer. Suitable accounting and financial procedures were found to be satisfactory. The appropriate insurance cover was in place. Records were kept of all transactions entered into by the registered person and made available for inspection. Small amounts of service users’ pocket monies were accounted for, and kept secure in the office safe by the administrator. Records were made available and seen to be accurate and up to date. Those residents who wished, and were able, kept control over their own finances. Discussion with the care manager indicated that supervision sessions and individual training programmes are areas that with continuing improvements, will enhance the desired impact on quality of service. The Statement of Purpose is clearly recognised as the foundation for providing a high standard of care through effective quality assurance and adherence to working policies, procedures and practices. Each service users has a personal file containing contractual, financial and personal information. Several files Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 26 inspected evidenced a satisfactory standard of maintenance and security of these files. An extensive sample of administrative, maintenance and care records were examined and found to offer an accurate reflection of a service committed to providing a safe and comfortable environment for elderly service users. The Regulations, Standards and Schedules as provided in the Care Standards Act 2000 are recognised and implemented. Records were seen to be generally well maintained, accurate and up to date in accordance with the Data Protection Act 1998. Accidents were seen to be addressed, risk assessed, actioned and recorded in an effective way, with access to Riddor if needed. No serious accidents have been recently reported. The administration and management of the home is efficient, uncomplicated and sensitive to the needs of service users. Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 27 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 4 4 4 4 x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 4 3 3 3 2 4 STAFFING Standard No Score 27 4 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 4 4 4 4 4 4 3 3 3 3 3 Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 28 no Are there any outstanding requirements from the last inspection? 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 Regulation No Requirement Timescale for action 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 OP19.5 Good Practice Recommendations Protective over-garments be provided for access to kitchen area. Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 29 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Woodford House Nursing Home E51-E09 S22384 Woodford House V231318 060705 Stage 4 Version 1.40 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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