Inspection on 15/10/07 for Woodhouse Hall

This inspection was carried out on 15th October 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Woodhouse Hall 14/04/08

Woodhouse Hall 22/05/07

Woodhouse Hall 28/11/06

Woodhouse Hall 16/03/06

Woodhouse Hall 01/12/05

Woodhouse Hall 27/01/05

Woodhouse Hall 20/04/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Snydale Care Home

Whitwood House

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

CARE HOME ADULTS 18-65 Woodhouse Hall 14 Woodhouse Lane East Ardsley Wakefield West Yorkshire WF3 2JS Lead Inspector Carol Haj-Najafi Key Unannounced Inspection 15th October 2007 07:30 Woodhouse Hall DS0000001523.V352882.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 Woodhouse Hall DS0000001523.V352882.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. Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodhouse Hall Address 14 Woodhouse Lane East Ardsley Wakefield West Yorkshire WF3 2JS 01924 870601 01924 820939 woodhouse.hall@craegmoor.co.uk www.craegmoor.co.uk J C Care 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) Mrs Vikki Harratt Care Home 13 Category(ies) of Learning disability (13), Physical disability (13) registration, with number of places Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd May 2007 Brief Description of the Service: Woodhouse Hall is owned by J C Care, which is a subsidiary of Craegmoor Health Care. The service is registered to provide care and accommodation for up to thirteen adults who have a learning disability. So as not to have people sharing a bedroom, the maximum number of people being cared for is eleven. At the time of the inspection only ten people were living at the home. Woodhouse Hall is a semi-detached property. It is joined to another care home, owned by the same company. The home is situated in its own grounds and ample parking is available to the front of the building. The home is on two levels. On the ground floor there are two bedrooms, a kitchen area, a lounge and separate dining room, a shower room, bathroom and two offices. On the second floor are the remaining bedrooms, bathrooms and a second lounge area. There is a main staircase; there is no passenger or stair lift. There is a concrete ramp to the front of the building. The home is on Wakefield Road in East Ardsley, an area of Wakefield. It is within easy walking distance of the main road and is well served by public transport. There are a number of local amenities, which are well utilised by people who use the service. The fees charged by the home range between £438.61 and £1501.87 per week. This information was provided on 15 October 2007, during the inspection. Information about the home including a Statement of Purpose, Service User Guide and previous inspection reports are available at the home. Up to date information about fees can be obtained directly from the home. Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out a site visit. One inspector was at the home between 7.30am and 6.00pm; the other inspector was at the home between 7.30am and 10.00am. During the inspection process all of the key standards were looked at to try and find out what it was like to live at the home. The last key inspection was carried out in May 2007. An annual quality assurance assessment (AQAA) was completed by the home and this information was used as part of the inspection. Survey forms were sent out to people living at the home, their relatives and health and social care professionals. Two surveys were returned at the time of writing this report. Comments from the surveys have been included in the 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, which included how staff interact with people at the home. Comparisons with the observations were made with the home’s records and the knowledge of the care staff. Feedback was given to the registered manager and acting business support manager at the end of the visit. During the visit the inspector looked around the home, spoke to three people who live at the home, two staff, an agency staff, the registered manager and business support manager. Care plans, risk assessments, healthcare records, meeting minutes, and staff recruitment and training records were looked at. What the service does well: Some people enjoy going into the kitchen to make drinks and are supported to make snacks. One person who lives at the home said the staff were good at cooking and she liked helping out in the kitchen. The majority of people attend external day services. Two people talked about external day services and said they enjoyed going. Staff said people benefit from going out during the day. Daily records confirmed that people regularly receive support to have baths and showers, and they see healthcare professionals which makes sure their healthcare needs are met. Bedrooms are personalised and each room has a lot of items that reflect individual preferences. Posters, pictures and photographs were mounted on walls. This is good practice and demonstrates that everyone is encouraged to make their rooms homely. Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The general culture and attitude of the staff must change. There were several examples of poor practice. These included staff ignoring people at the home and not talking to them for long periods. Staff were abrupt in their responses and did not always explain things. They must provide better care that meets people’s needs and takes into account their wishes and feelings. They need to give people more choice and make sure they are getting the type of care they want. They need a better care planning process to make sure people’s needs are met. They need to be able to provide better support to people who challenge the service and challenge others. They need to make sure people are properly supervised to make sure their needs are met and they are safe. They need to make sure people get food and drink when they want it so people’s wishes and nutritional needs are met. They need to make sure people’s privacy and dignity is respected. Important information about people living at the home must be recorded and the information must be accurate. Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 7 The registered provider and registered manager must improve the management of the home and make sure people who are living at the home receive a service that meets their needs. Requirements and recommendations that were identified at this and at previous inspections are at the end of this report. 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. Woodhouse Hall DS0000001523.V352882.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 Woodhouse Hall DS0000001523.V352882.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): 1&2 People who use the service experience adequate quality outcomes in this area. There is now a better understanding of how an admission process should be carried out. This will make sure the home can meet people’s needs. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The inspection in November 2006 identified that the admission process was not satisfactory and the needs of people who had moved into the home had not been properly assessed. There have been no new admissions to the home since this inspection so there was very little evidence for many aspects of this outcome group. It was not possible to assess whether the requirements which relate to the admission process made at the last inspection had been met. These standards will be checked at the next inspection. After the inspection in May 2007 the manager said she was clear that each person must be fully assessed before they move into the home and the necessary documentation must be available at the home. Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 10 The Statement of Purpose has been amended since the last inspection. Details about the number and gender of people who use the service and staff members had been very specific so every time there were changes the Statement of Purpose had to be updated. The information is now more generalised, which makes it easier to keep the document up to date. Woodhouse Hall DS0000001523.V352882.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 People who use the service experience poor quality outcomes in this area. People’s care needs are not properly met and people cannot make choices about the care they receive. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The inspection in May 2007 identified that some information was missing from the care plans and staff had not followed some guidance that was available. Since the last inspection, the registered provider has told CSCI that they were introducing new person centred care plans, which focus on individual needs. They also said staff had received care plan training. The timescale for completing the introduction of new care plans was September 2007. Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 12 At this inspection three people’s care records were looked at. They were all in the new ‘person centred’ format. Each care plan had inaccuracies, poor information and did not meet the minimum standard. It was also evident that guidance in the plans was not being followed. For example, one care plan stated that the person must only go out when accompanied by two staff. Daily records confirmed that the person had gone out with one female staff. A risk assessment stated, ‘razors to be locked away’, ‘staff are not to leave out’. In the person’s en-suite 5 razors were on the shelf. One plan stated under the mental health section: Anxiety- ‘I go really down, I feel down.’ There was no other information and it stated an additional plan was not needed. Another person’s plan stated under the communication section ‘talking in Welsh- although I understand most short words.’ The manager confirmed the person did not speak Welsh and the information in the plan was incorrect. It was evident from observing the person they spoke several words and were able to communicate with staff, although this was not reflected in the plan. A person who lives at the home talked to the inspector and spoke about lots of different things and it was clear the person could make very valuable contributions to the contents of their person centred plan. This person’s care plan was looked at. They had not signed the plan and said they had not seen it before. The staff member who completed the plan confirmed the person had not been involved. The staff member said they were going to write to the GP to get confirmation they could not give consent, and then they were going to forward the care plan to the person’s relative. This is not a person centred approach and goes against guidance for providing person centred care. One staff member said the new plans were based on the old plans and generally staff had not had time to read all the new plans. There was some good guidance in the care plans. One plan had very good step by step guidance to support a person with a personal care task. Another plan had details to make sure the person contacted their relative. Two plans had sections on ‘people who are important to me’ and ‘my life story’. These sections were blank in one plan. It was evident at this inspection and the last inspection that people were not appropriately supported when they displayed behaviour that challenges the service. Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 13 During this inspection, a person living at the home came into the manager’s office and refused to leave. The person eventually left the office but then slapped three people on their backs, albeit there was no real force behind the slaps. A staff member then invited the person back into the office to ring their relative. After the phone call staff chatted to the person as though the event had not taken place. This was poor management of a situation and very confusing for the person living at the home. One person raised concerns that staff support her differently, when completing a certain task. She alleged there were inconsistencies in how staff supported her, and specifically raised concerns that one staff member would not let her follow the usual procedure. She repeated the allegation to the manager and acting business support manager. During the site visit the inspectors saw examples when people living at the home were not properly supervised and they did not receive appropriate care to meet their needs. There are examples of this throughout the report. In the AQAA the manager said, ‘we have service users meetings; Craegmoor have recently introduced ‘your voice’ where each month the service users decide on any changes they would like to make to the home.’ The AQAA also said ‘we have a key worker system in place, the service users have as much choice as possible to choose their key worker.’ Under the ‘how we have improved’ section the AQAA said ‘person centred care plans have been introduced’. Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 14 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, 14, 15, 16 & 17 People who use the service experience poor quality outcomes in this area. Sometimes people are hungry because they do not get food and drink at the appropriate time or when they request it. Staff interaction is poor and people who live at the home are often ignored. People are given opportunities to engage in recreational activities and go out into the community although there is room for development in this area. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: Throughout the report there is evidence that poor practice was seen on the day of the inspection and this is clearly unacceptable. Good practice was also observed and must also be acknowledged. One person who lives at the home entered the upstairs lounge when one staff member was talking to the inspector. The person was very relaxed and although they had limited verbal Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 15 communication, the staff member responded in a very positive way and encouraged the person to engage. When inspectors arrived, one person offered to make a cup of tea. The person was relaxed and obviously felt comfortable going into the kitchen without asking permission. People who live at the home chatted with staff and management. They were relaxed when talking and at times there was a good atmosphere with some lively banter. One person was organising a shopping trip for the following day and talked to the manager about going out for a meal after shopping. The person was very comfortable when she was talking about what she wanted to do. People who wanted to prepare snacks were supported to make their packed lunch for daycare and their evening meal. In the AQAA the manager said ‘most people who live at the home have keys to their rooms and mail is given to the service user un-opened.’ At the inspection staff confirmed four out of ten people have keys to their room. In the AQAA the manager also said, ‘people’s interests and hobbies are documented in the care plan and there is an activity programme displayed in the small office.’ Care plans had details of what people like to do and there were some good programmes of activity, however, daily records did not reflect the programmes of activity. For example, an activity programme said one person should go to McDonalds on Saturday, Shopping on Sunday, and a walk on Tuesday and Thursday. Daily records stated that over a period of three weekends, the person had been out for a ride on the minibus on one Sunday. Daily records for three people, covering a four-week period, were looked at. They had all been out on the minibus at least once. One person had been out shopping and for lunch, had a reflexology session and had received telephone calls from family members. Another person had been out for walks with staff, had played darts, and had watched TV. Another person, who receives twelve hours a day 1-1 support had been out several times for rides on the minibus, for lunch and for walks. On the day of the inspection four people who live at the home and two staff went shopping, bowling and had lunch out. It should have been the manager’s day off but she worked because the inspection was taking place. The manager said an outing would have been organised but accepted that her additional presence had enabled two staff to take out four people. Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 16 Under the ‘what we could do better’ section, the AQAA stated ‘we could get more involved in the community and could have more day trips.’ Staff and management said it would be good to increase the level of activity. This was also said at the inspection in May 2007. Daily records had details of times people had gone to bed. These were varied. For example one evening a person had gone to bed at 6.30pm, another evening they had gone to bed at 10.30pm. In addition to daily notes, an activity record was also maintained. However, it was unclear if all the information was accurate. For example, an activity record stated the person had joined in a drawing session and had been supported to ring a relative. The daily record said they had a reflexology session and had been chatting to staff and laughing until supper. The majority of people attend external day services. Two people talked about external day services and said they enjoyed going. Staff said people benefit from going out during the day and they were exploring options for one person who did not receive any form of day care. One relative survey was returned. Under the what do you feel the care home does well it stated ‘copes with a very mixed group of people with greatly differing needs.’ It also stated; • • • • • The care home usually helps their relative to keep in touch The care home sometimes gives the support they expect Staff usually have the skills and experience The care home sometimes meets the needs of their relative The care home usually supports people to live the life they choose During the site visit the inspectors saw examples when people living at the home did not get food and drink at the appropriate time or when they requested it. One person asked for their breakfast and was either ignored or told ‘after your medication’. A staff member was not available until after 8.20am to administer medication. The person’s mouth looked very dry. Another person who got up at 6.00am was not given a drink until 8.40am and did not have breakfast until 9.05am. He was told several times that he was going to have breakfast but did not receive it until 45 minutes after he was first told. The person’s care plan stated he has issues with food and they regularly take food from others. A staff member said ‘he gets agitated when he is hungry, he eats a lot and drinks a lot’. Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 17 Staff interaction was observed and some very poor practice was seen. Several examples have been written under the complaints and protection section. There was sufficient evidence to conclude that people’s rights are not respected and staff do not interact well with people living at the home. Menus were looked at and these were varied and nutritionally balanced. A food record sheet was in the kitchen and this had any variations to the menu. This is good practice and means that diet can be properly monitored. One person who lives at the home said the staff were good at cooking and she liked helping out in the kitchen. Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 18 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 & 20 People who use the service experience adequate quality outcomes in this area. People’s privacy and dignity is not always respected. People’s healthcare needs are met. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: Daily records confirmed that people had regularly received support to have baths and showers. There were also details of healthcare appointments. One person had recently seen a GP and a nurse. Another person had their eyes tested, and another person had seen a dentist, a nurse and a chiropodist. Individual weight records were also maintained. One person had been unwell and had spent a period in hospital. The nature of the illness was still unknown and they were awaiting test results. The care plan Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 19 stated a different suspected diagnosis to the one that had been reported to CSCI. This shows that accurate records are not always maintained. The last inspection identified that people at the home had specialist care needs, which includes mental health and epilepsy but only a small percentage of the staff team had received training in these areas. Since the last inspection staff have received ‘epilepsy’ and ‘bi-polar’ (mental health) training. Several practices were observed at the inspection that did not respect the privacy and dignity of the people living at the home. A person started asking for a shower at 7.35am and asked for a shower several times and was told soon. A female staff was not on duty until 8.00am but a female was required to support the person. This resulted in the person coming naked, out of the shower room into the lounge. The same person could not find their dentures and told staff of this. Staff made no attempt to help the person look for their teeth and subsequently they went to their day care placement without their dentures. It was not recorded that the person could not find their teeth. After breakfast, a person living at the home got up from his seat and his trousers kept coming down and you could see his bottom. Staff spoke to him but only to tell him to pull his trousers up. It was obvious his trousers did not fit but staff did not advise or encourage the person to change them. Later in the day staff took the person bowling and he was still wearing the same trousers. A healthcare survey was returned. It said; • • • • • The staff team are welcoming in their manner In my experience, the staff team welcome advice and act on this appropriately The care service sometimes seeks advice; staff sometimes do not recognise the need for further advice Individual’s health care needs are sometimes met; health care needs are not always recognised The care service sometimes respects individual’s privacy and dignity; privacy is maintained as far as I’m aware although dignity is compromised by the way staff speak to people. I believe this to be lack of education around dignity rather than deliberate. The care service usually supports individual’s to live the life they choose Care staff sometimes have the right skills and experience; staff appear to lack essential skills in communicating effectively, mental health care skills, preventing and managing behaviours which can challenge • • Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 20 Medication administration was observed. The staff member giving out medication watched the person who self-administers as she drank the medicine from the bottle. The staff member did not comment that medication should be properly measured. Medication and medication records were looked at and the amount of medication and the records corresponded. Medication storage was looked at and the medication was well organised. Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 21 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 & 23 People who use the service experience poor quality outcomes in this area. People are not safeguarded because staff practices and attitudes put them at risk. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: In the AQAA the manager said, ‘we have a complaint’s procedure and a whistle blowing policy displayed on the wall in the main entrance and offices. We have a record of all complaints,outcomes and investigations.’ The procedures were seen during the inspection. In the AQAA the manager also said, ‘all staff have been given a copy of the whistle blowing policy in the recent staff meeting and all staff have also undergone POVA (protection of vulnerable adults) training and CPI (crisis prevention intervention- non violent) training and are aware of company’s policy on restraints.’ Staff said they were fully aware of the whistle blowing policy and reporting any allegations of abuse. Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 22 At this inspection, and the two previous inspections poor practice was observed. There were times when staff did not treat people with respect. On occasions staff were abrupt in their responses. For example, “Sit down …(name of person)”. Staff did not always explain things. For example, one person kept asking when he was going home, responses ranged from “end of the month”, “soon” or not answering him at all. He was also told he would be having a shower, putting new trousers on, none of which happened. One staff used the term “boy” when speaking to a person living at the home. This did not feel respectful and no other staff used the term so it did not seem to be an agreed nickname or term of endearment. Staff also said things like “watch ..(name of person), don’t let him run away”. This felt like staff were talking about him as if he wasn’t there. One person was not spoken to or acknowledged by staff from 7.30am to 9.30am, although he went to his room for approximately 1 hour during this period. Staff were in the lounge he was in, one staff was putting make-up on and getting ready for their morning shift. They did not speak to him at all. Another staff member entered his bedroom to see if he was asleep, he knocked on the door, entered and came straight back out again. The staff member said he was awake. The person was given his breakfast by a staff member who just handed it to him without speaking or acknowledging him. When he wasn’t eating it, the staff member told another staff member that he needed sugar on it. The sugar was sprinkled on the breakfast without a word. There was no warmth shown to the person. Another person was observed while having his breakfast. Staff were in the dining room or passed through on a number of occasions and did not speak to him or acknowledge him. The CSCI has received regular notifications about incidents involving people who live at the home which sometimes result in people hitting other people who live at the home. It is recognised that there are tensions between certain people and this causes a lot upset. This has made some people unhappy. It is important their placements are looked at and management look at how the tensions and fall outs are managed. One person spoke to the inspector and said she was very unhappy living at the home. She said, ‘I am out of here as soon as I can.’ She talked about falling out with other people at the home. Another person talked about the ‘fall outs’ and ‘fighting’ and described an incident the day before the inspection. The incident involved two people Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 23 shouting at each other and getting upset. Daily records were looked at, and the incident had not been recorded. The person told the inspector they did not like living at the home because it was too big and too noisy. They said ‘I’m fed up, we’re always falling out, my head is pounding all the time.’ This is the third inspection that the person has consistently said they are not happy and do not want to live at the home. Staff confirmed conflict between some people living at the home was a daily event. During the inspection two incidents occurred when people living at the home had a fall out, which resulted in people getting upset and crying. Personal allowance records were looked at. All financial transactions were recorded. Two people’s monies were counted and the amount corresponded with the amount on the balance sheet. Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 24 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, 26, 27, 28 & 30 People who use the service experience good quality outcomes in this area. The home is generally pleasant, well maintained and people who use the service are comfortable in their surroundings. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: A tour of the building was carried out. All communal areas and bathrooms were visited and several bedrooms were seen. The home was clean and tidy. Decoration, furniture and furnishings were of a reasonable standard. A new settee has been purchased for the conservatory. The manager said new dining room furniture and a new TV had been ordered. The office has been reorganised and is more spacious. Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 25 The garden is enclosed and this is an area that people who use the service freely access. New fencing has been erected. Additional ventilation is needed in the ground floor toilet/shower room. The manager said the request had been approved and they were waiting for the work to be done. An en-suite extractor fan was not working; the manager said this links to the extractor system that was being replaced. All bathrooms and toilets had toilet rolls and paper hand towels. This is an improvement because they were not stocked at the last inspection. Bedrooms were personalised and each room had a lot of items that reflected individual preferences. Posters, pictures and photographs had been mounted on walls. This is good practice and demonstrates that everyone is encouraged to make their rooms homely. Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 26 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 People who use the service experience poor quality outcomes in this area. The home will not improve the service or succeed in providing person centred care unless they address the staffing problems and change the general culture. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: At this inspection poor practice was observed and there were insufficient staff to meet the needs of the people living at the home. The inspection commenced at 7.30am. There was only one staff member on duty until 8.00am. The sleep in person was in the building but did not start until 8.00am. Four people were up, one person should have had 1-1 staff support. This did not commence until 8.20am. At times, staff did not always know his whereabouts. At one point, he was found in another person’s bedroom. Another person couldn’t have a shower because there was not sufficient staff or a female staff to support her. Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 27 An agency worker started at 8.00am. They had limited knowledge about the home and the people who live there because they had only worked at the home on three previous occasions. It was evident the agency worker did not know what to do and appeared very uncomfortable. Staff waited nearly 30 minutes before they gave any direction to the agency worker about what he should do. Regular staff were heard to say in a negative tone, ‘where is he?’ ‘I don’t know what he’s doing.’ One person who lived at the home talked about staffing levels, she said ‘we do not have enough staff, we need more staff.’ Recruitment records were looked at for two people who recently started working at the home. All the information that is required before a person can start work had been obtained. Over recent months there has been a high turnover of staff. The manager said they were waiting for employment checks for two new staff and were interviewing others. The manager said two staff were still completing their induction programme. The induction training folders were not available in the home therefore it was not possible to establish how much of the induction had been completed. Staff training records were looked at for two staff. Both staff had attended several training courses in the last twelve months. The manager said existing staff had attended ‘intensive interaction training’, which focuses on care practices. Two new staff still had to attend the training. Staff meeting minutes were looked at. At a meeting after the inspection in May 2007, management had gone through the issues that were raised. The minutes confirmed they had spoken about treating people with respect, and how to speak to people who live at the home. All staff had been given a ‘code of practice’ booklet. Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 28 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, 38, 39, 41 & 42 People who use the service experience poor quality outcomes in this area. Ongoing problems at the home have not been addressed and people’s needs are still not being met. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The manager was completing her Registered Manager’s Award and said she hopes to achieve this by the target date of December 2007. Interaction between people who live at the home and the manager was observed. They were happy to see her and were comfortable in her presence, Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 29 and were seen to chat about what they had been doing and what they wanted to do. The inspection highlighted key areas where the home was failing to provide a satisfactory service and meet people’s needs. This is the third inspection where similar problems have been highlighted. The registered provider and registered manager have legal responsibilities to make sure the home meets the Care Homes Regulations and they are consistently failing to do this. Since the last inspection, the CSCI has received regular information from the organisation to demonstrate they have been monitoring the quality of the service. This includes monthly reports. The reports have information about the home, any issues and action they have taken to put things right. The reports were detailed and indicated that problems were being properly addressed. However, it is evident from the findings of this inspection that the home continues to fail to meet the needs of the people living at the home. Hence, quality assurance systems cannot be effective. Accident and incident records were looked at. These contained good details of events and identified any action that should be taken to prevent a similar incident occuring again. Daily records provided details of what people had been doing. However, they did not always provide a full picture because it was evident that some information was not recorded. For example, arguments between people living at the home were not always recorded, the person going to the daycentre without their dentures and going into communal areas naked, and the person drinking medication from the bottle was not written in their notes. Failure to record significant information does not enable a person’s health and welfare to be properly monitored. Some wording to describe people at the home was inappropriate. Terms such as ‘demanding towards staff’, ‘very loud and demanding’, ‘demanding but in a good mood’ were used. The manager said this had been picked up by the area manager during a visit to the home. The AQAA provided details of how the home met health and safety standards. It stated ‘all staff have completed their statutory training and have regular updates. Monthly accidents and incident forms are completed. Internal audits are completed and action plans are set for any issues that arise from these. i.e. infection control audit for the home.’ Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 30 Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 31 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 3 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 1 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 X 1 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 1 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 3 2 X 2 2 2 X 2 3 X Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 32 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 YA6 Regulation 12 (1) (a) (b) 15 Requirement People must have a care plan that identifies how their needs should be met. This will make sure their health and welfare needs are identified properly and met. Timescale for action 22/11/07 2 YA6 12 (1) (a) (b) 18 12 (3) Staff must follow care plan 22/11/07 guidance to make sure people’s needs are met and they are safe. People who live at the home or their representatives must be involved in the care planning process and consulted about the care to make sure they are getting the type of care they want. People who live at the home must be involved in making everyday decisions and staff must take into account the wishes and feelings of the people who live at the home. Risks to people living at the home must be properly assessed to make sure they are safe. Staff must speak to people who DS0000001523.V352882.R01.S.doc 3 YA7 22/11/07 4 YA7 12 (2) 22/11/07 5 6 YA9 YA16 13 (4) 12 (1) (a) 22/11/07 22/11/07 Page 33 Woodhouse Hall Version 5.2 (b) 18 (1) (a) 7 YA17 12 (1) (a) (b) 12 (4) live at the home in a respectful manner and interact appropriately to make sure the rights of the people who live at the home are respected. People must be given the right to 22/11/07 make decisions about when they eat and drink. People must be given food and drink when they request it. People who cannot request food and drink must receive it at appropriate times. This will make sure people’s wishes and nutritional needs are met. People must be able to receive 22/11/07 appropriate support with personal care at appropriate times to make sure their privacy and dignity is respected and their wishes and feelings are respected. People must receive the right 22/11/07 support so when they go out into the community, their appearance is to their personal satisfaction, and their dignity is maintained. People who live at the home 22/11/07 must be properly supported when they self administer medication to make sure they take the correct dosage. The placement of people who are 22/11/07 regularly involved in incidents with other people living at the home and clearly state they are unhappy living at the home must be reviewed. This will make sure people are living in an environment that safeguards them and respects their wishes and feelings. People who use the service must 22/11/07 DS0000001523.V352882.R01.S.doc Version 5.2 Page 34 8 YA18 12 (4) (a) 12 (3) 9 YA18 12 (4) (a) 10 YA20 12 (1) (a) (b) 11 YA23 12 (3) 12 YA23 12 (1) (a) Woodhouse Hall (b) 18 (1) (a) be safeguarded from abuse by ensuring staff treat people with respect. (Timescale of 30/06/07 not met) The ground floor bathroom must be appropriately ventilated to make sure people can have a shower in a pleasant environment. (Timescale of 31/07/07 not met) Staff must have the competencies and qualities to meet the needs of people who use the service. (Timescale of 28/02/07 & 31/08/07 not met) This must include the skills and knowledge to work with people that challenge the service. This must include the skills to deal with conflict amongst people living at the home and take action to prevent further conflict. 30/11/07 13 YA24 23 14 YA32 18 (1) (a) 22/11/07 15 YA33 18 There must be a sufficient number and skill mix of staff working at the home to meet the needs of the people who use the service. (Timescale of 31/07/07 not met) People who live at the home must be properly supervised to make sure their needs are met and they are safe. All new staff must complete the induction programme to make sure they have the skills and knowledge to meet the needs of DS0000001523.V352882.R01.S.doc 30/11/07 16 YA33 12 (1) (a) (b) 22/11/07 17 YA35 18 30/11/07 Woodhouse Hall Version 5.2 Page 35 the people living at the home, and the home’s aims and objectives. (Timescale of 31/08/07 not met) 18 YA37 9 The registered manager must complete a relevant management qualification. (Timescale of 30/04/07 not met) 19 YA38 10 The registered provider must provide adequate support to ensure the management of the service is satisfactory. (Timescale of 31/07/07 not met) 20 YA41 17 Care records must contain sufficient information to make sure people’s health and welfare needs can be properly monitored. 22/11/07 22/11/07 31/12/07 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 YA14 Good Practice Recommendations There should be more opportunities for people using the service to engage in recreational and social activities. Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Woodhouse Hall DS0000001523.V352882.R01.S.doc Version 5.2 Page 37 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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