Inspection on 07/01/08 for Woodham Grange

This inspection was carried out on 7th January 2008.

CSCI found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Woodham Grange 02/05/07

Woodham Grange 15/05/06

Woodham Grange 07/12/05

Woodham Grange 02/02/05

Woodham Grange 03/09/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Woodham Grange Burn Lane Newton Aycliffe Durham DL5 4PJ Lead Inspector Glynis Gaffney Key Unannounced Inspection 7, 11, 12 and 15 January & 18 February 15:00 Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 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 Woodham Grange DS0000007523.V357338.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 Adults 18-65. 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. Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodham Grange Address Burn Lane Newton Aycliffe Durham DL5 4PJ 01325 310493 P/F No E-mail www.milburycare.com Milbury Care Services Ltd 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) Deborah Elizabeth Saunders Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Learning disability - Code LD, maximum number of places: 8 2. The maximum number of service users who can be accommodated is: 8 2nd May 2007 Date of last inspection Brief Description of the Service: Woodham Grange is a large two-storey property, situated in its own grounds. The home is in the Woodham area of Newton Aycliffe, within walking distance of the town centre and local amenities. The home is owned by Voyage. It is registered to provide care for up to eight adults who have learning disabilities, complex needs, and/or a physical disability. Woodham Grange is purpose built to accommodate people who use wheelchairs. From information provided by the home, the current scale of charges ranges from £863 to £1,100 per week. Additional charges, between £10 and £25 per week, are made as a contribution towards the home’s wheelchair adapted mini-bus. The home’s statement of purpose and latest inspection report are available on request. Each person living at the home has access to their own individual service user guide. Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means that the people who use this service experience poor quality outcomes. How the inspection was carried out: Before the visit: We looked at: • • • • • Information we have received since the last key inspection visit on the 2 May 2007; How the service dealt with any complaints and concerns since the last visit; Any changes to how the home is run; The manager’s view of how well they care for people; The views of people who use the service and their relatives, staff and other professionals. The Visit: An unannounced visit was made on the 08 January 2008. inspection we: • • • • • • • During the Talked with some of the staff, the manager and her line manager; Formal interviews were not carried out, as the people living at home are unable to comment on the quality of services and facilities provided. However, time was spent observing the care and support they receive; Looked at information about the people who use the service and how well their needs are met; Looked at other records which must be kept; Checked that staff have the knowledge, skills and training to meet the needs of the people they care for; Looked around the building to make sure it was clean, safe and comfortable; Checked what improvements had been made since the last visit. We told the manager what we found. What the service does well: The provider’s representative and the home’s manager provided every assistance during the inspection process and were willing to engage in a constructive debate about the outcome of the inspection. Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 6 Key policies and procedures, and the home’s statement of purpose and service user, have been made available in easy to read versions. Individual service user guides have been prepared for each person. The service has developed a detailed personal evacuation plan for each person to ensure his or her safety in the event of a fire. The food served during meal times looked tasty and nutritious. It was nicely served and presented. Staff involved in the meal were kind and patient and the mealtime was unrushed. One healthcare professional said ‘the environment has improved a lot in the home. Individual rooms have been personalised. There is much better attendance at clinics. A better welcome on arrival. There is better feedback and more co-operation.’ One family member said that they were very happy with the way that their family member is cared for. The provider has devised a quality assurance framework within which it can reach judgements about what is happening within the home. Documentation has been devised to support the implementation of the quality assurance cycle. What has improved since the last inspection? What they could do better: Provide people with a more informative contract that sets out what they can expect when they move into the home. Ensure that the contract is in suitable formats for the individuals who live at Woodham Grange. Ensure that staff complete training in person centred planning. This will help staff to build upon the skills and knowledge they already have and use it to implement the new person centred planning documentation that is currently being introduced. Ensure that people’s support plans clearly outline their needs and how they are to be met. Complete nationally recognised preventative health care risk assessments for each person. Support plans should include desired outcomes and be reviewed six monthly. This will help staff to be clear about what help and support people require and how this is to be done. Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 7 Staff should receive regular formal supervision and an annual appraisal. This will help ensure that staff are well supported, appropriately supervised and aware of their responsibilities in promoting and protecting the welfare of people living at the home. All care staff should complete person centred planning training. This will help ensure that staff have the knowledge and skills required to prepare person centred plans. Where relevant, ensure that people’s moving and handling support plans clearly specify the actual techniques to be used by staff when assisting them to mobilise. This will help to ensure that people are transferred safely by staff that are clear about how to do this. Address the medication related concerns identified in the body of this report. This will help to ensure that people’s health and safety is protected and promoted. Address the financial related concerns identified in the body of this report. This will help to ensure that people’s financial rights are protected and that good financial practices are followed within the home. Ensure that the kitchen is clean and maintained in a satisfactory condition. This will help to ensure that people are protected from poor kitchen hygiene and inadequate food rotation practices that have the potential to affect their health and well-being. Carry out an immediate staffing review to determine what levels of staff are required to satisfactorily meet people’s needs. Carry out a risk assessment of the dangers posed to each person by inadequate staffing levels. This will help to ensure that there are sufficient staff on duty to meet each person’s assessed needs and implement their support plans. Address the health and safety concerns referred to in the body of this report. This will help to ensure that people live in a safe home where health and safety issues are treated seriously. 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. Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are given a written contract that provides them with adequate information about what they can expect once they move into Woodham Grange. EVIDENCE: People and their families are provided with a copy of the home’s contract. There is a copy in each person’s care record. The contracts looked at during the inspection do not include all of the required information such as: • • • Which bedroom the person will occupy; Details of the fees that will be charged, what they will cover, when they must be paid and by whom, and the cost of facilities or services not covered by the fees; Who is liable if there is a breach of contract. In addition, the contract incorrectly refers to the Care Standards Commission as being the present regulatory body. The contract is not available in an easy to understand version. A key therapeutic service offered by the provider is not referred to in its contract. The inspector was told that home’s contract is currently under revision and that each person will be given a new contract following this process. Of the six staff who returned surveys, five said that Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 10 they are given up to date information about the needs of the people they support. One person said that this is usually the case. Admissions into the home do not take place until people have had their needs fully assessed. There have been no admissions into Woodham Grange since the last inspection. Compliance with this standard was not checked. Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s support plans do not provide staff with satisfactory guidance about how their needs are to be met. This could mean that staff are not clear about what steps need to be taken to ensure that people’s assessed needs are met. EVIDENCE: The provider is in the process of introducing a new person centred planning format that they hope will lead to further improvements in the way in which people’s care is delivered. The new format has been agreed with a representative from the Commission for Social Care Inspection. At the time of the inspection, the new format had been completed for one person. The manager expressed concerns that delays in receiving requested assessment and care plan information from the local social services department has impacted upon the home’s capacity to bring some people’s care records up to date. Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 12 A sample of care records was examined. Each person has a care record that contains a range of valuable information such as: • A care plan summary that provides staff with basic information about how people’s needs are to be met. A senior support worker said that the summary is especially helpful when new staff have to cover shifts at short notice. The summary contains helpful pictures and provides guidance in clear, simple language; Support plans that describe how the home will meet people’s needs. Some of those examined are written in plain English and are easy to understand; A document entitled ‘Getting to Know Me’ which provides staff with information about people’s daily routines and their likes and dislikes. • • Staff are familiar with people’s needs and some have long standing relationships with the individuals they care for. Some staff were better at engaging and communicating with people living at the home. People’s care records contain good information about their communication skills and needs. However, a support plan has not been devised for one person with identified communication needs. An audit of people’s care records revealed the following concerns: • • The ‘Getting to Know Me’ booklet for one person includes inappropriate comments; People’s support plans do not include reference to equality and diversity. For example, in the care records examined, there was no reference to how people will be encouraged to mix with people who do not have a disability; People’s support plans are not available in easy to understand versions; Generally, people’s support plans focus on how staff will meet their assessed physical, health and social care needs. There is limited emphasis on skill development; A file containing care summaries and other important personal information is kept in a bookcase in the lounge area; Some support plans have not been reviewed during the previous six months; People’s support plans do not always clearly identify desired outcomes; People living at Woodham Grange are unable to assist with the development of their support plans and other care related records. However, there is no evidence that demonstrates how the home has consulted with people’s representatives about the content of their support plans; Staff are expected to keep a daily activity report for each person. This is a useful record for the home and enables Social Services to monitor the quality of care provided. However, the quality of information recorded on some of the daily activity reports is poor. For example, staff had DS0000007523.V357338.R01.S.doc Version 5.2 Page 13 • • • • • • • Woodham Grange failed to record the times during which one person took ‘bed rest.’ In the same activity report, staff had recorded concerns about the condition of the person’s skin. But, there was no mention of what action staff had taken about this concern. Another person’s care record contains guidance from the provider’s behavioural support team outlining the strategies that should be adopted by staff to help them better manage the challenging behaviours displayed. Although the guidance was produced in 2006, the inspector was told that it is still relevant. However, a number of concerns were identified: i) ii) iii) The support plan devised to manage this person’s behaviour does not fully reflect the guidance issued to staff by the behavioural support team; The person’s needs are not clearly defined in their behavioural support plan; The support plan states that if the person’s challenging behaviour continues for longer than five minutes despite staff following the guidance given, they are to be given an ‘as and when required’ sedative. This strategy is not referred to in the guidance supplied by the behavioural support team; Some staff did not follow the guidance given by the behaviour support in relation to one element of this person’s challenging behaviour; The daily activity logs completed by staff refer to the display of challenging behaviours but not how they have dealt with them and whether this has been successful or not; The risk assessment conducted in relation to challenging behaviours occurring when visitors attend the home had not been reviewed in over 17 months. It had however been reviewed in January 2008; iv) v) vi) • In one person’s care records it is not clear how, and on what basis, staff have made the decision to ignore their behaviour when taking them for ‘bed rest’. The person’s support plan states that when the person is not happy with anything they will ‘…make noises, shout, shake their head and fling their arms.’ It goes on to say that the person behaves in this way when they do not want ‘bed rest’. Whilst the professionals involved have agreed that ‘bed rest’ is an important tool in helping to prevent the development of pressure sores, the support plan fails to provide staff with guidance on how they should manage this person’s resistance to the care they are providing. Staff have not completed training in devising and implementing person centred plans. The provider said that training in this area would be delivered as soon as possible. Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 14 Steps have been taken to minimise the risks experienced by people living at Woodham Grange. For example, in one person’s care records the risks associated with bathing, the use of bedside rails and their nighttime care had been assessed. However, the assessments had not been reviewed during the previous 6 months. Bedside rails are used to prevent this person falling out of bed. Although a detailed moving and handling risk assessment has been completed for this person, the management plan does not describe the actual techniques to be used by staff when assisting them to transfer. Peoples’ care records contain information about their likes and dislikes. Information detailing the choices and decisions they are able to make for themselves is less detailed. There is no active involvement of advocates for people who have no family support or contact. This is of concern as all of the people living at the home experience significant difficulty expressing their views and opinions. Observations made during the inspection showed that staff tried to treat people in a dignified manner. However, concerns about one person’s dignity were identified. For example, whilst preparing to take a bath one person appeared naked in the corridor area on four separate occasions. Each time a member of staff quietly escorted this person back into the bathroom area. Other concerns relating to this person’s dignity were also identified. A support plan providing staff with guidance on how to promote this person’s dignity was not in place. Of the four healthcare professionals who returned surveys: • • Two said that the care service ‘usually’ responds to the different needs of people living at the home. One said that this is only ‘sometimes’ the case. One person chose not to provide a response; Three said that the care service ‘usually’ respects individuals privacy and dignity. One person chose not to provide a response. One healthcare professional also said that ‘I dislike finding residents with food from their last meal still evident on their teeth, faces and clothes. Some clothes have barely covered residents’ modesty. Privacy seems to have been respected. Handling has, at times, been undignified.’ One of the healthcare professionals said ‘the package of care needs to be carefully examined for each client (to make sure that) they are getting what was offered. This should be monitored closely and problems shared so that there is an air of co-operation, not confrontation.’ Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 15 Of the two relatives who returned surveys: • • • • • One said that they ‘always’ get enough information from the care home to help them make decisions. One person said that this is ‘usually’ the case; One said that the care home ‘always’ meets the needs of their relative. One person said that this is ‘usually’ the case; One said that the care home ‘always’ helps their relative to keep in touch with them. One person said that this is ‘usually’ the case; One person said that they are ‘always’ kept up to date with important issues affecting their family member. One person said that this is only ‘sometimes’ the case; One person said that the care home ‘always’ gives their relative the support and care they thought would be provided. One person said that is ‘usually’ the case. Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, and 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for supporting people to eat and drink, and have access to structured in-house activities, are not fully satisfactory. This may mean that people are not being supported to benefit from activities and stimulation that may help them to develop their social, emotional, communication, and independent living skills. EVIDENCE: As people living at Woodham Grange are unable take up paid employment, it is crucial that opportunities for sufficient stimulation and activity are created. The home has put a framework in place to achieve this goal. The inspector observed some examples of good practice such as staff enabling a person to join them in the kitchen whilst they prepared the evening meal. Staff assisted another person to spend time in the home’s conservatory listening to music accompanied by multi-sensory stimulation. Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 17 People’s records contain important information about how they like to spend their time. An assessment has been completed for each person which provides staff with a range of information including the most important people in their lives and what activities they enjoy most. Over the next three months, arrangements have been put in place to help one person go on holiday and four others attend various musical events. Staff have access to a mini-bus that can be used to help people living at the home to access their local community. However, a senior member of staff said that the home often experiences difficulties using the bus due to the lack of available drivers. This is of concern as people are paying a weekly contribution for their use of the bus. It was also said that one person pays a contribution even though they do not use the bus. The relevant commissioning authority is currently reviewing this matter. A number of concerns regarding the provision of activities and appropriate stimulation were identified: • • • In one of the assessments examined staff have recorded what sorts of activities the person enjoyed participating in. However, the weekly activity timetable had not been completed; One person does not have a support plan that outlines how their need for stimulation and activity is to be met; In another person’s daily activity log staff have recorded that during both the morning and afternoon periods, the person had relaxed ‘with music and sensory lights.’ However, no information had been recorded about where this activity took place or at what time, and what role staff had played in setting up and monitoring the sessions. Staff had recorded that they had checked the person’s well being during these activity sessions, but the activity log did not show who had carried out the checks, at what times and with what outcomes; The mini-bus was used on several occasions during the inspection. However, in one instance, although some people were taken out in the mini-bus, this was to visit another Voyage service to pick up continence aids; With the exception of approximately 15 minutes, a music TV channel played constantly throughout the period during which the first inspection visit took place. The television music channel was not switched off during the other teatime meals observed. In addition, two people were placed directly in front of the television for approximately two hours. There was limited interaction with staff during these periods. Some people’s records did contain reference to them enjoying the music channel and to another person becoming distressed if the music channel was switched off. • • A healthcare professional that returned a survey said that they did not think that ‘…people had access to a broad range of activities.’ This person also said Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 18 that ‘boredom is an ever present issue. Choices seem to have been rather limited beyond the home, and even there it has been difficult due to space, numbers and organisation.’ However, it was also said that some improvements have been made recently. Of the relatives who returned surveys, one said that the care service ‘always’ supports people to live the life they choose. One person said that this is ‘sometimes’ the case. The home has a four-week menu, which sets out what food will be served at each mealtime. The food served during the meals observed looked tasty and nutritious. It was nicely served and presented. Staff were kind and patient and the mealtime was unrushed. It is evident that staff try to make people’s mealtimes a social event that can be enjoyed by all. However, a number of concerns were identified: • • The menus are not in format that would be more easily understood by any of the people living at the home; On the day of the inspection the teatime meal was to consist of Toad-inthe-Hole, roast potatoes, cabbage, and cauliflower. However, a sausage casserole was served with cabbage and carrots. A record of the change made to the tea-time menu had not been kept; The menus did not include details of the range of foods available at the suppertime meal. • During the meal times observed, staff did their best to bring each person to sit around the two dining tables. Some people are able to make their own way to the dining tables with encouragement from staff. Others need assistance. Two people using wheelchairs were positioned in such a way as to enable staff to also sit at the tables and support them to eat and drink. At first, only one member of staff was available to feed both these people. The member of staff concerned did this by giving one person a spoonful of food and then the other person a spoonful. They did this for a short period until another member of staff came to assist. Another member of staff was observed trying to manoeuvre a third person to sit around the table. This person was in a large postural wheelchair and because of this, and the lack of space available, the member of staff was unable to do so. Finally, the staff member concerned sat on the sofa in the lounge to feed this person. The space available for dining is limited given the needs of the people living at Woodham Grange. At mid-afternoon, a member of staff provided some people with drinks as they sat at the dining tables. During this period, the member of staff concerned did not ask people what they wanted before the drinks were delivered to the dining table. Although this was a busy period, another member of staff in the same room spent their time watching the television. At no time did this individual offer to help their colleague with preparing the drinks or serving them. This person watched television for almost 30 minutes. The person Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 19 concerned is not a permanent member of staff. This is clearly unacceptable. After people had drunk their beverages, a member of staff cleaned one person’s face using a paper hand towel. The manager said that normally ‘baby wipes’ would be used. Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 20 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The arrangements for meeting the personal and healthcare support needs of people using the service are not fully satisfactory. This may lead to people’s assessed personal and healthcare needs not being fully met. EVIDENCE: None of the care records examined contain a ‘Health Action Plan’. Ms Saunders said that the social services care manager had prepared ‘Action Plans’ for each person approximately ten months ago but the completed documents had never been returned to the home. The home intends to pursue this matter. There is evidence that shows that people are supported to access local health care services. For example, one person had seen a dietician, a hospital consultant, and their community nurse, within the previous 12 months. This person had also received optical and dental care in the last 18 months and had had their weight checked on a regular basis. However, it is concerning to note that when staff asked for guidance about how to manage this person’s Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 21 challenging behaviours, they had to wait approximately 18 months to receive advice from the provider’s behavioural management team. The same person also has assessed nutritional care needs. The home has devised a support plan that describes how their needs are to be met in this area. The action plan advises staff when to involve the person’s dietician and GP. However, it was identified that: • • • A nationally recognised nutritional risk assessment tool is not used; The support plan does not reflect all of the advice given to the home by the person’s dietician about the frequency of food supplements; The support plan does not provide detailed guidance on the interventions to be carried out by staff to meet the person’s need for assistance with eating and drinking. Staff assist some people to take ‘bed rest’ in the afternoon to help prevent the development of pressure sores. In one person’s care plan staff are instructed to: change the person’s position to prevent pressure sores developing; assist the person to take ‘bed rest’ for short periods of time. However, the care plan does not advise staff how much ‘bed rest’ time the person should have. There is also no guidance on when the ‘bed rest’ should normally start and finish or, about how to re-position the person. A nationally recognised pressure care assessment tool is not in use. A senior support worker said that a multi-disciplinary team meeting has been held to agree a consistent approach to managing this person’s pressure care needs. However, the relevant support plan has not been updated to reflect the outcome of this meeting. In addition, a senior manager had said that staff are to carry out ‘transfers’ for this person every 30 to 60 minutes. However, staff have not recorded that this had happened in the daily activity log. In the person’s continence support plan, it was recorded that staff should use a commode chair if they showed signs of wishing to use the toilet. The support plan was last reviewed in September 2007 where it was identified that there had been no changes in the person’s needs. However, a senior support worker said that this intervention had not been carried out for some time as the person’s needs had changed. The home has a medication policy that was last reviewed in March 2007. All medication is stored in a wall mounted locked cabinet and is appropriately labelled. Photos to identify each person have been placed within their medication records. Records covering the receipt, administration and disposal of medicines are in place. Generally, these records are well completed. None of the people living at the home administer their own medication. Controlled drugs are not in use. The home carries out its own internal pharmacy audit to ensure that staff are complying with the provider’s policies and procedures. The majority of staff have completed a 12-week distance-learning course on medication awareness. Staffs’ competency to administer medication has been Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 22 assessed. There is evidence that some staff have received specialised training in the administration of emergency medication for people with epilepsy. However, a number of concerns were identified: • • • • • • The medication cabinet is not clean. The plastic basket in which liquid medicines are stored, and the bottom surface of the cabinet are unclean. Some medication bottles had drips which had not been cleaned; Checks of the air temperature of the room in which medications are stored have not been undertaken; The home’s medication practices and procedures have not recently been inspected by an experienced pharmacist; The medication reference book is out of date; The directions for administering some items of medication are not always clearly indicated on people’s Medication Administration Records (MARs); People using the service are generally unable to consent to staff administering their medication. However, people’s records do not contain evidence which demonstrates how staff have made ‘best interests’ decisions to administer their medication in the absence of informed consent; Medications for external application are not kept separately from those intended for internal use; Fortifresh Liquid Supplement has been prescribed for one person and included on their medication administration record. However, staff have not signed the record following administration. Ms Saunders agreed to address this matter following the inspection; The keys to the medication cabinet had been left on the table in the office. The door into the office was unlocked and left open. The keys were returned to the senior support worker. • • • Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 23 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for protecting people from harm or abuse are not fully adequate. This could lead to people feeling unsafe and unprotected in their own home. EVIDENCE: The home’s complaints procedure provides staff with guidance about how to handle complaints. People are unable to comment on how complaints are handled. There is evidence in people’s care records that staff have attempted to share an easy to read version of the provider’s complaints procedure with them. Neither the home, nor the Commission, has received any complaints since the last inspection. Of the two relatives who returned surveys, both said that they knew how to make a complaint if they needed to. Both also said that the care service ‘always’ responds appropriately if they raise concerns. Six staff that returned surveys said they knew what to do if they received a complaint. The home’s safeguarding policy provides staff with guidance about how to handle adult protection concerns. There has been one safeguarding concern raised with both the Commission and relevant commissioning authorities. Following the concerns raised, the provider produced an Action Plan to rectify Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 24 shortfalls in the home’s practice. In addition, within the last 12 months, the conduct of a current member of staff compromised the health and well being of people living at the home. The concerns identified were handled through the provider’s disciplinary procedures. However, there was no contact with, or advice taken from, the relevant safeguarding team. Another potential safeguarding concern was identified during the inspection. Staff had recorded that following an ‘assault’ on another person living at the home and a member of staff, that ‘as and when required’ medication to calm the behaviour of the person concerned was given. There was no evidence that an incident audit had been carried out to determine what action could be taken to prevent this happening again. Neither had a referral been made to the local safeguarding team. Ms Saunders agreed to look at this matter further and provide the Commission with feedback. Although staff have received training in the protection of vulnerable adults, not everyone has received training in the use of physical intervention. Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 25 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the home is comfortable, has a programme to improve the decoration, fixtures and fittings, and appropriate aids and adaptations are provided, the premises are not fully adequate. This means that the people living at Woodham Grange do not have access to accommodation that is clean and maintained to a high standard. EVIDENCE: At the time of the inspection, a number of people’s bedrooms were being decorated. Staff have purchased bed linen, curtains and other decorative furnishings to provide people with a homely private space in which they can relax. Staff have tried to ensure that each bedroom is different and reflects the needs and personalities of the occupant. There are no shared bedrooms. The layout and design of the home enables people to live together in a domestic environment. The home has a range of facilities, including a large Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 26 kitchen, a lounge/dining area, and a conservatory. The corridors are wide giving a feeling of space that allows people to move around the home in a safe environment. The home is well lit, warm, and tidy. There are no unpleasant odours. A considerable amount of money has been spent in the last financial year on improving the premises. However, a number of premises related concerns remain: • The kitchen area: i) ii) iii) iv) v) vi) • The cupboards contain items of food, which have exceeded their ‘best before’ date. During the inspection, staff were asked to ensure that all food items are within the ‘best before’ date; Some of the kitchen cupboards are untidy and in a poor condition; The handle on the fridge is broken; The trays used to store the cutlery are unclean; The cooker hood is unclean; Staff did not put on protective clothing when entering the kitchen whilst food preparation and cooking was underway; The laundry: i) ii) iii) A bookcase is being used as shelving to store clothes and other laundered items; The sink unit is in a poor condition; A senior member of staff said that the size of the home’s domestic dryer makes it ‘almost impossible’ to fit in quilts which need regular laundering due to people’s continence care needs. • • • • • • Bedroom 1: the bottom drawer of the wardrobe is broken; Bedroom 2: the wardrobe door is broken. A senior member of staff said that the room’s occupant had done this by ‘back kicking’ the door; Doors and woodwork throughout the building are damaged and in a poor state of decoration. The corridor walls are marked and look unsightly; Bedroom 8: the bedside rails are damaged because of the room’s occupant chewing the external covering. A senior member of staff said that new bedside rail coverings are being purchased; There are no aids provided in the ground floor toilet for people who may need them; First floor bathroom: the inspector was told that people using this facility would benefit if a changing table could be made available in the room. The home has been purpose built to meet the needs of the people living there. A range of specialist aids and equipment has been provided. For example: • • Bathrooms had been fitted with grab rails; There are two mobile hoists which enable people to be safely transferred; DS0000007523.V357338.R01.S.doc Version 5.2 Page 27 Woodham Grange • • • One bathroom has a changing table; Overhead hoisting equipment is available in both bathrooms; There is a sit-on weighing scale, which enables staff to weigh those people who are unable to weight bear. A senior said that the provider is very good at making sure that staff have access to the aids and adaptations they need to move people safely. Staff have received training in the control of infection. Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 28 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are not sufficient to meet the range of needs of the people using the service. This means that people do not have access to the level of staff support that will allow them to engage in structured in-house and community based activities that require one to one support. EVIDENCE: There is a rota that sets out what shifts have been worked by which staff. The Commission has previously said that between four and five staff should be scheduled on duty throughout the working day. Although generally this level of staffing has been provided throughout the working day, there are times when it has not. Between 10 pm and 8 am, there is one waking support worker and a member of staff sleeping over in the building. Support workers carry out domestic and catering duties. The rotas contain the required information. A senior support worker is rostered on duty to cover each shift. Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 29 However, a number of concerns were identified: • The rotas show that there are occasions when the staffing levels reduce to only three support workers. This usually happens between 3 pm and 4 pm and 8 pm and 10 pm. The manager said that with the number of hours she has been given, the rotas take account of people’s needs and routines, and the busier times of the working day. During discussions held with the manager and her line manager, it became clear that the home has insufficient hours to meet all of the needs that people living at the home have. It was said that: ‘more staff are needed but we can’t afford it…people require a re-assessment of their needs…some people require support all of the time, but we can’t do this…we can meet people’s day to day physical needs, but we are struggling with everything else…the level of funding has not changed for 13 years.’ Concerns about staffing levels have also been expressed by professionals involved with the home. For example, a healthcare professional said ‘the intention to support is there but capacity and consistency varies due to a reduction in staff/resident ratio since the capacity of the home was enlarged without additional carers being recruited…I remain convinced that staff to resident ratios need to be restored to the same levels as a decade ago. (In connection with the person I support), I accept that the exact cause of the more extreme behaviours over the past two or more years is difficult to identify. But when a home takes in more residents and fails to maintain high staff ratios standards must surely suffer as a result.’ Of the six staff that returned surveys, one person said that there are ‘always’ enough staff on duty to meet people’s needs. Three said that this is ‘usually’ the case and two others said that this only happened ‘sometimes.’ A member of staff said that ‘staffing levels are not always met due to such things as sickness and holidays’; • To cover shortfalls in the rotas, staff have occasionally worked 70 hours per week and over. On occasions, staff are also working long shifts. For example, in one week, a support worker worked two 15 hour shifts, two 14 hour shifts and two other shifts, one of seven hours and one of seven and a half hours. The manager has recently capped the number of hours that staff can work in one week. Staff can no longer work in excess of 56 hours a week; The manager has been allocated 20 hours in which to carry out her management duties. The remainder of her hours are used to the cover the home’s care shifts. Ms Saunders indicated that she struggled to complete all of her management duties during the allocated hours; • Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 30 • • In July 2007, due to unforeseen staff absences, only two support workers covered the majority of a shift. Given that four people require assistance with moving and handling, and other people require support and supervision to remain safe, this was an unsafe situation. However, on the final day of the inspection, a similar situation occurred. A senior manager arrived at the home and staff cover was immediately arranged. In addition, the manager who was holiday at the time of the inspection also came in to cover the shift; Due to circumstances arising within the home, there are only two staff qualified to drive the home’s mini-bus. Although the home tries to borrow drivers from other services, this limits the capacity of staff to get people out into the local community. A range of pre-employment checks is carried out before people can commence working at the home. For example, each applicant completes an application form, provides two written references and evidence of identity. However, a member of staff has been employed at the home with only a ‘standard’ Criminal Records Bureau (CRB) disclosure check. Ms Saunders said that this situation applied to two other staff members. Applications have now been made to obtain an ‘Enhanced’ CRB disclosure check for the staff concerned. A signed copy of each person’s job description has not been placed in their staff file. The files do not contain evidence that staff have been provided with a copy of the General Social Care Council’s Code of Conduct. The majority of staff have obtained a relevant qualification in care. 13 staff have obtained a National Vocational Qualification (NVQ) in Care at either Levels 2 or 3. The majority of staff have updated their training in key statutory areas such as infection control and first aid. Certificates providing documentary evidence of qualifications obtained, and training completed, are not always available. Some staff have undertaken specialist training that is relevant to the specific needs of the people using the service. For example, one support worker has completed training in administering emergency medication to people who experience seizures. This person has also undertaken training in working with people whose behaviours challenge the service. Another support worker has completed training in using non-violent interventions to deal with difficult and complex situations. All of the people living at the home have varying degrees of difficulty with understanding and expressing their own views and opinions. However, the manager said that none of the staff team have been trained in alternative methods of communication. The home has a formal training plan that identifies which staff need to undertake what training over the next 12 months. The manager is aware of gaps in staffs’ training and is taking action to address this. Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 31 Generally, people’s relatives and staff themselves felt that they have the right skills and competencies to meet the needs of those individuals living at the home. Of the two relatives who returned surveys: • • One said that care staff ‘always’ have the right skills and experience to look after people properly. One person said that this is ‘usually’ the case; One said that the care service ‘always’ meets the different needs of people living at the home. One person said that this is ‘usually’ the case. Of the six staff who returned surveys: • • • • • Four said that their induction covered everything they needed to know to do the job ‘very well’. Two said that their induction training ‘mostly’ did this; Six said that the training they have received is ‘relevant’ to their job; Six said that the training they have received has helped them to understand people’s needs and keep them up to date with new ways of working’ Three said that the ways in which information about people who live at the home is shared between staff ‘always’ work well. Three said that this is ‘usually’ the case; Three said that they felt they have the right support, experience and knowledge to meet the different needs of people living at the home. Three said this is ‘usually’ the case. One of the healthcare professionals who returned a survey said that there is now ‘better awareness of the role of outside agencies and better engagement with them.’ The manager and her deputy carry out formal staff supervision. A standardised format is used to record the outcome of staff supervision. Staff have not received formal supervision at the frequency stipulated in the National Minimum Standards, or undergone a yearly appraisal. Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 32 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 41 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People benefit from a service where there are adequate arrangements for monitoring and reviewing how the home is run and for promoting and protecting the health and safety of people. EVIDENCE: There is a registered manager who has worked at the home for approximately two years. The manager has obtained the Registered Manager’s Award and a National Vocational Qualification at Level 4 in Care. Ms Saunders has extensive experience of working in a residential setting with adults with learning disabilities. The manager regularly updates her statutory training. Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 33 A range of policies and procedures are available all of which have been reviewed during the last 12 months. In one person’s care records, staff refer to this individual as needing ‘active management’ to help them look after their own financial affairs. However, a plan providing staff with guidance on how to manage this person’s needs in this area has not been devised. For some people, the records show that the manager and her deputy act as ‘Appointees.’ People’s records do not show how the decisions to take responsibility for the day-to-day management of people’s money have been made. In addition, the commissioning authority has identified that some people’s bank accounts appear to be in staffs’ names and that the status of these accounts is not clear. A financial profile has not been developed for each person. Some of the people who live at the home pay for their individual aids and adaptations as well as covering the costs of any maintenance and service contracts. The manager always seeks the agreement of people’s care mangers before any expenditure takes place. The commissioning authority is carrying out a review of this practice. Internal systems have been developed to monitor the quality of care and facilities provided in the home. For example, a service review is completed each year and an annual development plan prepared. The review covers such areas as the quality of the environment and people’s satisfaction with the way in which support is provided. As part of the review, people’s relatives and professionals who have regular contact with the home are consulted about the quality of care and facilities provided at Woodham Grange. Planned improvements to the premises as set out in the 2007 development plan have been implemented. However, although the provider carries out regular monitoring visits, the information contained within these reports is limited, and one of those most recently produced failed to identify the concerns referred to in this report. Steps have been taken to protect people living and working at the home from harm. For example: the fire alarms are tested weekly; the emergency lighting and fire extinguishers are checked visually at least once every month. There is an up to date and detailed fire risk assessment. Personal evacuation plans have been devised for each person. Monthly health and safety audits, checks of the safety of bedside rails and hot water temperatures are now being carried out each week. The home’s lifting and hoisting equipment has been serviced on at least two occasions in 2007. A number of concerns were also identified: • • During an inspection of the laundry, a member of staff placed their cigarette packet on top of the laundry storage shelves. This is a potential fire hazard; The fire door leading into the kitchen is sometimes propped open to facilitate access for people living at the home; Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 34 • • • • Not all staff have signed people’s personal evacuation plans as requested. The manager agreed to rectify this matter following the feedback session; Guidance given to staff states that they should not re-enter the building in the event of a fire. However, the home’s night time evacuation plan advises staff wherever feasible to evacuate four of the people living at the home to another service on the same site. Staff are then told to reenter the building to evacuate the remaining people to a place of safety; A night support worker has only participated in one fire drill in the last 12 months; Two night support workers have not received fire instruction at the recommended frequency. Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 35 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 2 26 X 27 X 28 X 29 2 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 3 X 2 2 2 2 X Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 36 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 YA5 Regulation 5 Timescale for action Ensure that the home’s 01/06/08 residency contract includes the required information. This will help people to know what they can expect when they move into the home. 2. YA6 YA18 YA19 15 Ensure that each person’s: • • Needs are clearly outlined in their support plans; Support plans consider what interventions staff can make to help people develop new skills and maintain existing ones; Support plans contain desired outcomes; Support plans are updated, without delay, to reflect changes in their assessed needs; Support plans are reviewed six-monthly. 01/06/08 Requirement • • • This will help staff to be clear about what help and support people require and how this is to be done. Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 37 3. YA6 15 Ensure that: • Support plans clearly identify how staff manage situations where people are resistant to the care that they require; Where people resist the care being provided, an assessment is carried out which identifies the benefits and risks associated with the care being given; Where people have assessed communication needs, a support plan is put in place. 01/06/08 • • This will help people to receive more individualised support and care delivered by staff who are clear about how to meet their needs. 4. YA9 13(5) Ensure that people’s moving and 01/06/08 handling management plans clearly describe the actual techniques to be used by staff when assisting them to move. This will help to ensure that people are transferred safely by staff that are clear about how to do this. 5. YA19 YA16 12 Ensure that: • The nutritional risk assessment recommended by the Commission, i.e. MUST, is used wherever concerns about an individual’s nutritional status are identified; People’s support plans clearly describe in detail the actions that need to Version 5.2 Page 38 01/06/08 • Woodham Grange DS0000007523.V357338.R01.S.doc • be undertaken to assist people to eat and drink; People’s support plans are updated to reflect advice given by specialist professionals such as dieticians. This will help people to receive more individualised support and care that takes account of the guidance provided by relevant professionals. 6. YA19 12 Ensure that: 01/03/08 • A nationally recognised and standardised tool is used to assess each person’s susceptibility to developing pressure sores; • Where a support plan identifies the need for regular re-positioning or ‘bed rest’, the regularity of re-positioning, and the approximate start and finish times, are specified. This will help staff to be clear about what help and support people require and how this is to be done. 7. YA20 13(2) Ensure that: • • The home’s medication cabinet is kept clean at all times; Clear directions for the administration of ‘as and when required’ medications are recorded in people’s medication administration records; The keys to the medication cabinet are kept secure at all times. 01/03/08 • Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 39 This will help to protect people’s health and well-being. 8. YA23 YA16 Schedule 4 Ensure that: • The home follows the financial advice given by the commissioning authority concerning the way in which people’s bank accounts are held and managed; The guidance outlined in the Commission’s policy ‘Monies Held on Service Users’ Behalf By Corporate Appointees’ is followed. 01/06/08 • This will help to ensure that people’s financial rights are protected and that good financial practices are followed within the home. 9. YA24 YA30 23(2) Ensure that: • • • • The kitchen is kept clean and hygienic at all times; The kitchen cupboards are tidy and in a good condition; The fridgerator handle is repaired; Food stocks are rotated to prevent the ‘best before date’ being exceeded. 01/09/08 This will help to ensure that people’s health and well-being is protected. 10. YA24 YA25 23(2) Ensure that: • • The wardrobes in bedrooms 1 and 2 are repaired; Communal doors and woodwork are repainted; Version 5.2 Page 40 01/06/08 Woodham Grange DS0000007523.V357338.R01.S.doc • 11. YA34 Schedule 2 The bedside rail cover in bedroom 8 is replaced. Ensure that an ‘Enhanced’ 01/02/08 Criminal Records Bureau disclosure check is obtained for each member of staff. This will help to ensure that only suitable staff are employed at the home. 12. YA33 18 In conjunction with Care 01/06/08 Management and the relevant commissioning authorities, carry out an immediate staffing review to determine what levels of staff are required to satisfactorily meet people’s needs. The suitability of the number of management hours allocated to the manager to carry out her duties should also be reviewed. Take action to implement the findings of the review. Carry out a risk assessment of the dangers posed to each person by inadequate staffing levels. Ensure that the completed risk assessments are shared with Care Management and the relevant commissioning authorities. This will help to ensure that there are sufficient staff on duty to meet each person’s assessed needs and implement their support plans. 13. YA36 18 Ensure that staff: • • Receive formal structured supervision at least six times a year; Receive an annual 31/12/08 Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 41 appraisal. This will help ensure that staff are well supported, appropriately supervised and aware of their responsibilities in promoting and protecting the welfare of people living at the home. 14. YA42 13(2) Ensure that: • Staff do not place their cigarette packets in the home’s laundry for safekeeping; The home’s fire officer is consulted and their advice followed concerning the practice of propping open the fire door leading into the kitchen; The guidance given to staff about how best to evacuate people living at the home in the event of a fire is reviewed; Night staff receive fire training and participate in fire drills in line with the guidance issued by the local fire service. 01/09/08 • • • Compliance with this requirement will help to ensure that people live in a home where health and safety issues are treated robustly. Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 42 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. Refer to Standard YA5 YA6 YA10 Good Practice Recommendations Ensure that the home’s contract is available in suitable formats for the people who live at Woodham Grange. Ensure that people’s: • • 3. YA6 Personal information is kept secure at all times; Support plans cover the ways in which their equality and diversity needs will be met by the home. Ensure that: • • People’s support plans are made available in easy to understand versions; Wherever people are unable to participate in the development of their own support plans, their representatives are consulted about the content. 4. YA6 YA41 Ensure that entries made in people’s activity reports and other care related records: • • State exactly what the person has done, where they have done it, at what time, and with whose assistance; Use positive and non-judgemental language. 5. 6. 7. YA7 YA9 YA16 Consider involving advocates for people who do not have families to act on their behalf. Carry out monthly reviews of people’s risk assessments. Devise a dignity support plan wherever staff experience difficulties providing care for someone whose behaviour challenges their right to dignity. Consider how the space available within the home could be better used to provide people with an improved dining experience. DS0000007523.V357338.R01.S.doc Version 5.2 Page 43 8. YA17 Woodham Grange Ensure that all staff are clear about people should be helped to clean themselves following meal times. Look at ways of presenting the home’s menus in ways that will be more easily understood by the people living at the home. Ensure that the home’s menus cover the range of foods that are available at the suppertime meal. Ensure that people are consulted about beverage choices before drinks are served. Ensure that staff sign people’s medication administration records following the administration of Fortifresh Liquid Supplements. 9. YA19 Ensure that any referral made to obtain behavioural management advice is monitored to ensure that the home receives the guidance it needs within a reasonable timescale. Request the supplying pharmacist to carry out regular inspections of the home’s medication policy, practices, and systems. Obtain a more up to date medication reference book. Carry out regular checks of the ambient air temperature of the room in which medications are kept. Ensure that medications for external use are stored separately from those intended for internal use only. Review the home’s medication policy to ensure that it complies with the latest guidance issued by the Royal Pharmaceutical Society of Great Britain. 11. YA29 Consider providing a changing bed facility in the first floor bathroom. Consider providing aids in the ground floor toilet. 12. YA32 Ensure that the staff team undertakes training in the implementation of the Mental Capacity Act and its Code of Practice. Ensure that staff files contain: DS0000007523.V357338.R01.S.doc Version 5.2 Page 44 10. YA20 13. YA34 Woodham Grange • • • 14. 15. YA35 YA39 Documentary evidence of any relevant training they have completed; Evidence that staff have been supplied with a copy of the General Social Care Council’s Code of Practice; A signed copy of each person’s job description. Ensure that all staff receive training in person centred planning and record keeping. Devise surveys which can be used to seek the views of professionals involved with the service. Use the format suggested by the Commission to inform the way in which you carry out and record your provider monitoring visits. 16. YA41 Purchase a copy of the Mental Capacity Act Code of Practice. Devise documentation that will enable the home to record how they have reached ‘best interest’ decisions on each person’s behalf. The documentation should address each of the following points: • • • • • Has the two stage test of capacity been considered and the outcome recorded; Can the person understand information relevant to the decision that needs to be made; Can the person remember that information long enough to make the decision; Can the person weigh up information relevant to the decision; Can the person communicate their decision by talking, using sign language, or by any other means. Any ‘best interest’ decisions reached by the home should be considered at each Care Management review. 17. YA41 Develop a financial profile for each person that covers the following areas: • • • • Woodham Grange What the person needs to pay for; A risk assessment of the person’s money management skills; How their money and valuables will be made secure; Documentation of the informal and formal financial DS0000007523.V357338.R01.S.doc Version 5.2 Page 45 • • 18. YA42 support arrangements; Arrangements for contacting relevant people with regards to the management of their money; A money management action plan. staff sign each person’s personal Ensure that all evacuation plan. Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 46 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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. Extracts may not be used or reproduced without the express permission of CSCI Woodham Grange DS0000007523.V357338.R01.S.doc Version 5.2 Page 47 - 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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