Inspection on 24/07/08 for Woodhill House HFE

This inspection was carried out on 24th July 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Woodhill House HFE 05/09/07

Woodhill House HFE 28/06/06

Woodhill House HFE 05/01/06

Woodhill House HFE 02/08/05

Woodhill House HFE 24/01/05

Woodhill House HFE 09/08/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOMES FOR OLDER PEOPLE Woodhill House HFE 60 Woodhill Lane Morecambe Lancashire LA4 4NN Lead Inspector Ms Jenny Hughes Key Unannounced Inspection 24th July 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodhill House HFE Address 60 Woodhill Lane Morecambe Lancashire LA4 4NN 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) 01524 423588 01524 832981 julie.bagger@careservices.lancscc.gov.uk Lancashire County Care Services Julie Peirson Hagger Care Home 44 Category(ies) of Dementia (28), Old age, not falling within any registration, with number other category (16) of places Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home with nursing - Code N, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places 16) Dementia - Code DE (maximum number of places: 28) The maximum number of people who can be accommodated is: 44 Date of last inspection 5th September 2007 Brief Description of the Service: Woodhill House is a purpose built two storey home, located a short distance from the centre of Morecambe, with its shops and the seafront. It is at the end of a quiet cul-de-sac, overlooking the local cricket ground. There is space to park cars both at the front of the building, and in the car park provided at the side of the home. An attractive central courtyard provides seating and tables for residents, and other smaller outdoor areas provide the same. The home provides personal care for older people, including people with dementia, and also provides nursing care to people with dementia. It is equipped to suit the needs of its residents. For example, there is a passenger lift to the upper floor, grab rails, raised toilet seats, assisted baths, and ramps for easy access. All of the rooms are single rooms, and toilets and bathrooms are conveniently situated, with some rooms being ensuite. There is ample communal space, with dining and lounge areas in each section of the home, some overlooking the cricket ground through the large windows. Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 5 A designated area is provided for people with dementia, with sufficient communal areas within this, and access to outside space. There is also a designated area for those people with dementia who require nursing care, again with communal areas, and access to outside space. Staffing is provided over 24 hours, every day of the year. As at 24th July 2008, the fee scale ranges from £342.50 to £507, with additional charges for hairdresser visits, and extra newspapers and toiletries requested. More information regarding fees is available from the manager. Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of this service is 1 star. This means that people using this service experience adequate quality outcomes. This was an unannounced site visit to the home, in that the owners were not aware that it was to take place. The site visit was part of the key inspection of the home. A key inspection takes place over a period of time, and involves gathering and analysing written information, as well as visiting the home. The length of the visit was for 7 hours. Every year the registered persons are asked to provide us (CSCI) with written information about the quality of the service they provide, and to make an assessment of the quality of their service. We use this information, in part, to focus our assessment activity. This document is called the Annual Quality Assurance Assessment (AQAA) Surveys were sent and received from residents, and staff from the home. Reports have been received from the provider every month, following their monitoring visit to the home, giving information on how they think the home is performing. During the site visit, staff records and resident care records were viewed, alongside the policies and procedures of the home. The manager, residents and care staff were spoken to, along with visitors who called during the day. Their responses are reflected in the body of this report. Two hours were spent observing the care being given to a small group of people. The care of four people was looked at in depth, and then comparisons with those observations were made with the homes’ records, and the knowledge of the care staff. A tour of the home was made, viewing lounges, dining rooms, bedrooms and bathrooms. Everyone was friendly and cooperative during the visit. Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? Communication issues are being addressed with the use of a Communication Book for staff in each unit. Problems in its use have been identified by management, and there is constant monitoring to make sure staff are confident in what they need to do. Infection control has been addressed for staff working in the kitchen, laundry, and providing care as well, by the use of protective clothing and instruction in hand washing. There have been some improvements in activities in the home, and plans are available for the units, although they do not always take place due to time constraints. Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 8 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. The summary of this inspection report can be made available in other formats on request. Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a clear assessment procedure, which is carried out for all residents. This means that the service provided is tailored to an individual’s needs and preferences. EVIDENCE: Individual records are kept for each of the service users, with a set procedure for admitting someone to the home. Four selected files showed assessments had been received from social services or the health authority. These are needed so that the manager can confirm that the staff in the home are able to give the appropriate care, before it is decided that the home is the right place for the person to be admitted to. Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 11 These prospective service users are then visited at home or hospital by the manager, when pre-admission assessments and preliminary care plans are developed along with the person and their family. The assessments we viewed held comprehensive and detailed information, but not all were signed and dated as required and the manager should make sure this is done so that all records can be linked. The manager needs to ensure that staff can meet all of the health and social care needs of the individual before the decision to admit them is made. A key worker is allocated to each service user. A social history to find out what sort of activities or hobbies the person enjoys is developed during their stay at the home. Any new information is passed to staff at the shift handover sessions, and through use of the Communication Book in each unit, which they read as soon as they start their shift. They are also able to view care plans. Staff confirmed, “Care plans and information are up to date”. Some staff felt the handover session between shifts was sometimes rushed, and the information passed on was then not always complete. This also sometimes happened due to staff working different shifts and not being at the formal ‘handover’. The supervisory staff on duty at the time of the visit said that to make sure they had full information staff were instructed to always look at the Communication Book, which would direct them to care plans if necessary. The minutes from the Management Team meeting showed that issues about communication generally were being with. Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff have a very good understanding of the service users’ individual health and personal care needs, but lack of staff numbers may cause these to not be fully met. Errors in medication records could place the health and wellbeing of residents at risk. EVIDENCE: There is a standard format for the care plans on each unit which clearly identify the needs of each individual so staff know how best to look after people. Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 13 Monthly reviews are carried out by the keyworker for each service user. We noted that some of the reviews were overdue, but this had already been identified by the manager who had raised the issue at a team meeting. The reviews and care plans need to be dated clearly so that information can be linked. Staff surveys were positive regarding the standard of care and commitment of staff, but negative comments were given about the numbers of staff, and about not fully managing care needs with the staff numbers in place. A survey comment was “The service we provide couldn’t be better. I have never worked with people who care so much about the residents and staff. I just feel we are let down by staff numbers” We carried out an observation over about two hours in the nursing area of the home, focusing on selected service users. During this time staff gave minimal contact to those service users less able to initiate conversation, as staff were busy attending to the tasks necessary in the unit. In general any staff engagement with service users was positive, but it was usually service users who initiated the contact, as staff did not appear to have time to initiate contact with them. Staff were seen to be having problems dealing with the needs of the people in the nursing unit. There is generally one nurse and two carers on duty throughout the day, and most of the service users need assistance from two carers at a time, either due to their moving and handling needs or behaviours. Meal times are a particular problem, as several either need help to eat, or prompting. It is not unusual for the nurse to have to leave the unit, for example to get medication, leaving only two people on the unit. We witnessed this during the observation when the nurse and student nurse left the unit and carers had to ask a member of the kitchen staff to watch the unit while they helped someone at the toilet. We were told that in general, people who live on the unit where nursing care is provided were not able to access their bedrooms throughout the day. This was because the majority of people’s bedrooms were on the first floor and their daily living area downstairs, and there were not enough staff to take them up to their rooms, which they were not able to access independently. At the visit all service users were in the downstairs area. Care staff transport trolley loads of pots to the kitchen and place them in the dishwasher, or manually wash and dry pots. They also make drinks and toast for service users. They also transport washing to the laundry and place it in the washers, returning to take it out and fold it to return it to service users. Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 14 Infection control issues raised at the last visit have been addressed by the use of protective clothing, and hand washing instructions. Some staff spoken to said they had not had any training in infection control, but dealt with laundry on a regular basis. These additional duties that staff have to carry out may mean that they are not available to meet people’s health and social care needs in a timely way. We also noted in the residential unit that staff had little time to spend with service users. A service user said, “Staff mostly listen but don’t always have the time when they are so busy”, although service users surveys responses said that they usually received the help they needed. The organisation has comprehensive medication procedures in place. Medication records were examined. We found a few omissions on the Medication Administration Records (MAR), with no explanation as to why people had not had their medication. Some entries on the MAR sheets are handwritten and not clear, so people are in danger of receiving wrong doses. These handwritten entries should be witnessed. Many of the MAR sheets held no photograph of the service user, which could lead to errors when administering. There is not enough information about medication to be taken ‘When required’, so that it is clear to staff when it should be given. The staff should ensure they are storing medication in line with instructions, as we noted some in the medication cupboard required storage in a fridge. Records of medication received are not being kept properly, so making audits impossible. Competency assessments should be carried out as routine before people give medication to service users. One of the staff on duty at this visit had not handled medication for four years, and although felt confident to do this again, and had been given the task, had not had an up to date competency assessment. These issues mean that people’s health could be at risk, as they may not be getting their medication as required. Care staff who administer medication attend training provided by Boots pharmacy. Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Activities have been planned, but due to lack of staff time are not always provided. EVIDENCE: There is information in the care plans about the social history of people, and what hobbies and activities they prefer. The manager told us that a wide range of activities are organised, although staff said there is little time for activities, and a senior staff member commented that activities do take place, but often staff lack motivation to do them due to the short amount of time available. Staff on the residential unit said they try to play dominoes or card games a few times a week. Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 16 The manager has plans for activities and what can be done to enable all service users to join in. She told us that a Tai Chi expert visits and assists with gentle exercise, leaders from different churches visit giving communion and short services, and hairdressers visit twice a week. She said it can be difficult to motivate some people to join in, and they try to vary activities to do this. One of the staff plans afternoon sessions of chairobics, reminiscence, and board games. Trips out have been planned. No activities were taking place at the time of the visit. We discussed activities with staff on the nursing unit, who commented “We don’t even get the chance to look at people’s care plans, let alone do activities.’’ The carers said they did not feel they were doing their jobs properly because they do not have time to spend with residents. Service users commented, “Staff mostly listen but don’t always have the time when they are so busy”, and “I would like to be taken for walks but there is not enough staff available to do this” The meals are planned on a 3-week menu, and the cook spoken to said that something different is offered if a resident doesn’t like the choice. The cook visits the service users to make sure they like what is on the menu, and a record of any special diets are kept in the kitchen. The dining areas in the units are pleasant, small and homely, using small tables for four or six people to sit at. Meals are transported from the main kitchen to these dining areas in heated trolleys, where they are served piping hot and fresh to the residents from the mini-kitchens based there. Service users are assisted with their meals when necessary, and staff commented this was a problem when there were six people in a unit who needed this help, and only three staff, who were also serving and clearing away as well. Survey responses from service users stated that usually meals were enjoyed. Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users and their families are generally confident their concerns will be listened to and acted upon, but lack of records could mean some issues are not addressed. EVIDENCE: There is a complaints procedure in place, which is clearly outlined in the service user guide, and which is on display in the home. The senior staff in charge at the time of the visit was not able to locate the record where any complaints received would be logged. The manager had informed us in the home’s self-assessment that they had received no complaints in the last 12 months, and that records are kept of formal and informal complaints. In discussion some staff had a lack of understanding of what should constitute a complaint from service users, which should be recorded and be used positively to improve the service provided. Any concerns appeared to have been informally dealt with, with no written record. Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 18 Later discussion with the manager confirmed her awareness of the need for the records, which she said she had developed following our last visit and our requirement for them. She agreed that they had been misplaced during this visit, and stated that she viewed the event as positive by showing the training needs of her staff regarding what should be recorded as a concern or complaint. The records will be viewed at the next visit. All of the service users spoken to, and responses on surveys, stated that they knew how to make a complaint, with comments such as “never had to” and “Just mention it”. The self-assessment told us that staff have mandatory training in Safeguarding procedures, and what to do if they had any concerns that a service user is being abused. This training is initiated during induction training for new staff, and the manager stated in the self-assessment that there is annual refresher training. Training records showed that most staff had received their training, and were due for refresher sessions. Most staff spoken to were able to discuss the procedures, but one new staff spoken to said that they had not had any information about safeguarding procedures, had no knowledge of safeguarding procedures, and was not aware of the organisation’s whistle-blowing policies. There was no evidence of this being covered during induction training for this person. Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a well-maintained environment, which generally provides aids and equipment to meet the care needs of the service users. It is a pleasant, safe, and homely place to live. EVIDENCE: Woodhill House is a purpose built 2-storey accommodation, divided into 3 large units. Bedrooms, lounges and dining rooms are on both floors. However, we were advised that due to current staffing levels, service users who have bedrooms on the upper floors do not get the opportunity to use them at will, as most would require staff support to make their way upstairs. Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 20 The home is modern, bright, airy, and a very pleasant environment to live in. There are various safe garden areas for residents to sit in the good weather, with the back of the home overlooking the local cricket pitch. Some service users enjoy watching the summer matches. The seating areas are gradually being developed with planters, and one area has a small vegetable patch. Corridors are light, with windows along the length, and large plants and strategically placed seating giving a comfortable feel to this building, which has its living units linked by these long corridors, and so is spread over a large area. The lounges in each unit are comfortable and welcoming. The bedrooms are also modern and bright, with new furniture and matching bedding and curtains. Service users are welcome to bring personal belongings, and small pieces of furniture if they wish, to help make their room their home. All of the service users spoken to said they liked their rooms very much. Random viewing of the rooms showed them all to be clean and tidy. There are toilets and bathrooms around the home, some with assisted baths. General aids such as hoists, raised toilet seats, ramps and handrails help people with mobility problems, although some of the aids cannot be used in a bathroom which is too small, and toilets which are arranged in such a way that staff have difficulty in helping some of the very dependent service users who now live at the home. Staff have brought these problems to the notice of management. The self-assessment document also raises this problem “We need to review the way the bathrooms are laid out on the nursing unit, as they are impossible to access with a hoist.” Over the last twelve months developments have been made in equipment purchased (sit on scales, hoists, hospital beds) and procedures improved. Further planned developments include a 24-hour sensory garden. The laundry area is away from the kitchen and dining areas, and the manager stated that the home has infection control guidelines for staff to follow. There are no designated laundry staff in this large home, and care staff are presently working in the laundry as well as providing care to service users, including serving meals. This raises infection control issues, which have been addressed with the use of protective clothing and instruction to hand wash. Two of the care staff spoken to said they both dealt with laundry on a regular basis, but neither had infection control training. Any maintenance needs are recorded and passed onto head office for them to allocate the work out. Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People receive their care from carefully recruited, trained and committed staff. Current staffing levels at the home do not enable carers to regularly provide support in areas such as social activities. EVIDENCE: We saw that staff files showed the necessary recruitment checks are made to ensure the protection of service users. References and Criminal Records Bureau checks were available, and notes of the interview were made. New care staff are required to have full induction training, so they are clear on what is expected of them when they are carrying out their work. A check list is used to ensure all areas are completed and understood by the staff. Not all new staff had these available, and even though they could state they had a short induction, they could not discuss some areas on that induction which would have been addressed. The manager must make sure staff are clear on what is expected of them, especially staff who are left in charge of areas of the home. Care staff confirmed they had an induction pack to work through with managers, which covered principles of care. Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 22 Some staff said staff had not attended manual handling training for quite a while after they started at the home. We viewed records that showed nearly all of the staff have had this training, and the manager must make sure it is provided as soon as possible after employment by the home. Staff spoken to said that they have attended dementia awareness training, and abuse awareness training. They were able to discuss the procedures to follow. Records showed that only one person had attended training in the support of people with challenging behaviour. All staff should be attending courses relevant to the people they care for. The self-assessment from the home stated that 60 of the staff are NVQ trained, with no-one at present working towards it. It stated that there are inhouse and distance learning options available, and training is organised locally to provide an equal opportunity for staff to attend. Staff comments were “Mandatory training is good and generally up to date”, “There is healthy mix of experienced long term staff and new staff to help broaden knowledge and share ideas”, “We seem to have good training”. One person commented, “ I feel there is not enough training for all staff. Only certain selected staff do courses”. The manager sent the training matrix to us following our visit, and it showed most mandatory training is attended by most staff. The record shows that several staff have not attended infection control, food hygiene, and health and safety courses. We saw staff going about their duties in an organised and professional manner, and the majority said that they met with and felt supported by managers. A few felt unsupported by some of the different levels of management within the home. A staff rota shows who is on duty at any time. However the rota does not state that care staff are also carrying out kitchen and laundry duties, when they were seen to leave the units where service users were then being monitored by one less carer. Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 23 A number of people we consulted told us that they did not think the staffing levels at the home were adequate. In general, people felt that current levels were just about enough to meet residents’ basic health and welfare needs, being particularly difficult to do this in the nursing unit, but didn’t allow staff to spend time with service users or support them in social activities. Staff we consulted confirmed that activities were not being provided on a regular basis because they simply didn’t have the time to do them. As raised at the last visit, due to time constraints the care appears to be task orientated rather than person orientated. Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has a vision for the home, which is not always realised. This means that planned developments in the standard of care provided to service users are often delayed. EVIDENCE: The manager has worked at the home for about a year and a half, and has been registered with CSCI since July 2007. She is a Registered Mental Nurse, having experience of working mainly with the elderly, with needs associated with different forms and levels of dementia. Her management experience has taken place mainly in the community. She is presently undertaking the Registered Managers Award. Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 25 Comments were received at the last visit from a relative about the good quality of the care provided by the staff who are on duty, but they queried whether there was any point in raising issues regarding low staffing levels, as she had done this over a few years and it seemed to be a paper exercise as there were never any improvements. This again is an issue and appears to underline the comments made by this relative. The home prides itself on quality assurance systems, and states in its AQAA: “We have started a relative support group that meets on a monthly basis. The care assistants run this group and are using it as a forum for getting to know the relatives more and also an opportunity to listen to concerns in a more informal and approachable manner.” The manager told us that there have been problems getting enough interest in this so far. She also told us that service user meetings are held on each unit, but no minutes have been taken from these. At the next visit we will view minutes and the outcomes of these meetings, and how issues have been addressed. The AQAA told us that service users complete surveys every six months. The results are made available and circulated to residents, staff and visitors. The latest surveys have only recently been sent to service users, and the manager said that the results would be sent to us when they have been collated. Very regular visits are made by the Area Manager of the organisation, who monitors the care provided. Management meetings are held with the area manager, manager and supervisory staff at least every month to address any problems, and the minutes we viewed clearly showed action plans and directions for how to address them. Areas covered include discussion on the training schedule, development of the sensory garden, communication within the home, activities, the relative support group and supervision and appraisal plans. Supervision records show most staff have had either an individual or team supervision. The cook had some health and safety concerns over care staff working in the kitchen when she is busy cooking, using hot pans etc. On the day of the visit we noted two care staff from different units in the kitchen at the same time, one preparing toast, and another filling the dish washer, while the cook was preparing lunch. The Area Manager said they tried to organise this so there is limited presence of staff during this time, but if service users have a late breakfast it still remains a problem. All accidents are recorded, and in a general file, which gives good opportunity for an overview of any patterns emerging. Risk assessments are done, and what action to take. Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 26 The self-assessment confirmed that general maintenance and standard checks of equipment are up to date. Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES 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 OP9 Regulation 13(2) Timescale for action Appropriate arrangements must 30/09/08 be made for the recording, handling, safekeeping and safe administration of medication. • All staff who administer medication must have their competency assessed prior to doing so. • Any omissions on the MAR sheets must have an explanation • There must be full information on ‘when required’ medication so it is clear when staff should administer it. The numbers of competent staff 31/01/09 on duty must be appropriate for the health and welfare of the residents (Timescale of 30/09/07 not met) Requirement 2. OP27 18(1)(a) Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 29 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 OP9 Good Practice Recommendations Handwritten medication records (MAR) must be clear, and witnessed by another staff member. • There must be evidence of regular audits of the medication and records, to identify errors, and amend them. • All MAR must hold a photograph of the service user it relates to. • Medication must be stored in a designated fridge when required. The Activities Plan for each unit should continue to take place and develop dependent on people’s choices, to enable them to live fulfilled lives. Staff training in complaints recording should be refreshed. The manager should achieve the Registered Managers Award Training for staff should be relevant to the people they care for and the tasks they carry out. For example the Support of people with Challenging Behaviour, and Infection Control. • 2. 3. 4. 5. OP12 OP16 OP31 OP30 Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North West Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Woodhill House HFE DS0000033118.V362747.R01.S.doc Version 5.2 Page 31 - 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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