Inspection on 29/10/08 for Woodland Court Nursing Home

This inspection was carried out on 29th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Woodland Court Nursing Home 06/12/07

Woodland Court Nursing Home 03/05/07

Woodland Court Nursing Home 25/05/06

Woodland Court Nursing Home 06/01/06

Woodland Court Nursing Home 22/10/05

Woodland Court Nursing Home 14/12/04

Woodland Court Nursing Home 26/05/04

Woodland Court Nursing Home 15/01/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Woodland Court Nursing Home 56 Marldon Road Shiphay Torquay Devon TQ2 7EJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Clare Medlock     Date: 2 9 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Woodland Court Nursing Home 56 Marldon Road Shiphay Torquay Devon TQ2 7EJ 01803613162 01803615192 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Woodland Healthcare Ltd care home 39 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: One named service user under the age of 60 years with mild learning difficulties may reside at the home Registered for max PD(E) 39 service users over the age of 65 Date of last inspection Brief description of the care home Woodland Court has been a nursing home for over 14 years. The home is part of a group of homes providing personal and nursing care. It is sited in a residential area on the outskirts of Torquay. This home provides personal and general nursing care to people over the age of retirement. It is registered to care for up to 39 people mainly in single room accommodation. There are 25 single rooms all with en-suite facilities and 7 double rooms, mostly with en-suite facilities. The present use is that four of the double rooms are used as singles; therefore there are 29 singles and 3 double rooms. The home has a shaft lift, centrally located, making access between the ground and first floor easy for people with mobility and access problems. There is one large lounge with Care Homes for Older People Page 4 of 35 Over 65 3 39 0 0 Brief description of the care home dining space on the ground floor at the rear of the building. The terrace immediately outside the lounge has wheel chair access and enables people to overlook the garden. The home has recently been redecorated in the communal areas and some bedroom areas. This has included fitting good quality carpets in the communal areas and passageways. Some of the bedroom carpets have also been replaced as part of the homes redecoration programme. The statement of purpose and the last inspection report were displayed in the reception area of the home. The fees charged are calculated according to the dependency of the person using the service and the room occupied. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was unannounced and took place instead of an annual service review of the home. This was because of an increased number of complaints the commission for social care inspection had receivedabout the service. After receiving the complaint we performed a short random inspection where we found some, but not all, of the issues in the complaint upheld. Prior to this inspection we sent out questionnaires to ten people who use the service and ten members of staff. We received five surveys from people at the home and seven surveys from staff. We also requested an Annual Quality Assurance Assessment from the Registered Manager. The AQAA is a self assessment record that focuses on Care Homes for Older People Page 6 of 35 how well outcomes are being met for people using the service. It also gave us some numerical information about the service. This key inspection consisted of a visit to the home commencing at 09.30 on the 29th of October 2008 and finishing at 16.30. A CSCI pharmacy inspector also attended the inspection to look at the management of medications in the home. During our visit we spoke to the acting manager, clinical nurse lead, 5 people who live in the home, 2 visitors, and 5 staff members. We case tracked three people who use the service. Case tracking means we looked in detail at the care three people receive. We spoke to staff about their care, looked at records that related to them, spoke with their relatives and made observations if they were unable to speak to us. We looked at three staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the systems work and what this means for people who use the service. All this information helps us to develop a picture of how the home is managed and what it is like to live at Woodland Court nursing home. What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 35 The storage of records has improved since the last key inspection, ensuring care plans and confidential records are securely stored. The Statement of Purpose has been updated to reflect the service that is given. Since the random inspection in September staff now ensure people are able to reach their call bell and have access to drinks, people are also offered a choice of the meal at lunch time. Toilets and commodes are now maintained and cleaned to a satisfactory standard to reduce the spread of infection. Staffing has also stabilised since this inspection to ensure there are sufficient staff on duty to meet the assessed needs of people who use the service. The home tell us that care plans have been improved, the number of complaints they have recieved has reduced and staff morale has improved. The AQAA also told us that new specialist equipment has been purchased and carpets replaced throughout the home. What they could do better: People must be able to make decisions about the care they receive. Staff must ensure they do not restrict these wishes and feelings because of their work routines and must understand the importance of people being able to have a choice in their care. They must ensure the attitude of staff does not have a negative impact on people who use the service and that staff treat people and refer to them with respect at all times. It is recommended that the current administration practice be reviewed and to further develop the auditing of medicines to promote best practice in the home. The manager should continue with the planned introduction of activities programme at the home to provide people with stimulation in their day. Routines should be flexible and take into consideration to the wishes and feelings of people who use the service. Food should be reviewed with systems introduced to ensure drink and food reaches people upstairs whilst it is still hot. Those requiring a pureed meal should also be offered a choice where possible. The Manager must ensure she reports allegations to the local safeguarding team and discusses issues with the safeguarding team to ensure correct guidance is followed. Staff should also be aware of the correct local reporting procedures, to ensure investigations are not affected and people are kept safe at all times. When bed rails are used staff should ensure all good practice guidelines are followed and include external professionals for advice. There must be a system introduced to maintain the cleanliness and hygiene of the kitchen. Food should be correctly labelled when stored and freezers repaired to ensure food storage is safe. The manager should continue with the introduction of adjustable beds for people who require nursing care. Care Homes for Older People Page 9 of 35 Systems should be in place to keep up to date records of Nursing and Midwifery Council PIN numbers to show registered nurses are on the professional register of nurses. The manager should also ensure references are from a suitable source. The manager should also keep staffing levels under review to ensure the needs of people are met at all times. Quality Assurance systems should be in place to ensure standard of care is not affected in the managers absence. The manager should also continue with her application to become registered manager with the Commission for Social Care Inspection. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information provided means that people have accurate information about Woodland Court, before they come to the home. The admission procedure is good and means that staff have enough information to decide whether they are able to meet the needs of the person. Evidence: The Statement of Purpose and Service User guide have been updated to include the information that is needed for people to decide whether the home is the right place for them to be. Each document reflects the services that are provided and includes information on fees, staff, room sizes, services that are provided and how to make a complaint. Surveys told us that people thinking of moving to the home are given information. One Care Homes for Older People Page 12 of 35 Evidence: person wrote We were given sufficient information on our visit to the home to enable us to make our decision. Each person is admitted following an in depth assessment performed by nursing staff at the home. This assessment is used alongside assessments made by other health care professionals. Together this information is used to make an initial plan of care. Evidence was also seen of involvement of the person and their family. One person who lives at the home told us they were aware of the decision to move to the home but it was managed by their family because of ill health. Another person said they knew which room they were coming to and staff kept their promise to change rooms when one became available. Each person is given a contract when they move to the home. The majority also had a contract through the NHS or social services. Care Homes for Older People Page 13 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care people receive is good but not always provided in a respectful way. The care planning systems and documentation at the home are good and mean people have their health needs identified and met in a safe way. The management of medicines is adequate but some practice has the potential to place people and staff at risk. Evidence: People living at Woodland Court have access to a range of health care services both at the home and in the community. People have access to NHS services and routine screening programmes. Each person has a GP who attends when staff request a visit. Some consultations are performed by telephone. During the inspection people looked cared for, with the finer details, such as eye care, Care Homes for Older People Page 14 of 35 Evidence: nail care and appropriate foot wear present. Health care needs are monitored in well written care plans. Each person has a care plan, which sets out his or her specific needs. The AQAA told us that that care plans have been improved since the last inspection. Each plan contains assessments for such issues as falls, nutrition, moving and handling and more general risks. These assessments are then reviewed each month or more frequently where a change occurs. Plans of care are written and explain how care needs for each person will be met. One plan had not been updated to include a recent change in care, but the majority were well written and had been reviewed. Each person has a monthly health check including weight, pulse and blood pressure. Wound care is well managed at the home with the use of body maps, photographs and daily diaries to record healing. Specialist health care professionals are sought for advice and guidance. Examples seen at the inspection included continence adviser, wound care specialist and health protection agency. We saw that medicines are stored securely and that records are made of all receipts and disposals. However the record made relating to the administration is not always clear about what dose has actually been administered. This means that it is not always possible to monitor the persons response to treatment. We saw that records of administration are made but that they were signed for when the medicine was prepared rather than administered. This may mean that if the person giving out the medicines was distracted for any reason that the person may not receive the medicine as prescribed. During the inspection we observed the giving out of the morning medicines. During the round we saw that medicines were not always handled in accordance with best practice, medicines were popped out into the persons hand and then placed into pots, pots were prepared for more than one person at a time. These issues are considered poor practice and may lead to errors in administration occurring or contamination of medicines occurring. We also observed a person administered one medicine that the manufacturer stated should be administered on its own at least 30 minutes before food or other medicines being given with their other medicines. This may mean that the medicine does not work as effectively as expected and also that the person does not get the beneficial effect of taking it. We saw that there had been an audit of the administration records and some notes had been left for other members of staff to action. However on discussion with the Nurse in Charge and the Acting Manager we were told that no other record of the audit was made. This means that they are not able to track if the same errors are being made by the same people. Care Homes for Older People Page 15 of 35 Evidence: We found that one of the medicines cupboards is used to store other valuables in. This is not considered good practice as it increases the number of times that the cupboard is accessed so increasing the risk of items going missing. One relative wrote in a survey She has made a major recovery since she was admitted to Woodland Court, and we believe this is substantially attributable to the efforts of the team there. Other people were less complimentary. One person commented I usually receive the care and support I need, but not always. Feedback about the individual staff at the home was good but feedback about care practices was more critical. People who use the service said that staff were kind and worked extremely hard. However comments from people showed that staff often had routines that were sometimes missed or could not be changed, especially when the manager or clinical nurse was not present. One person told us that a lot of their routines and preferences had to be changed when they moved to the home and getting some staff to change the routine was difficult at times. One person said sometimes they had to let what they wanted go, otherwise they would get frustrated. We were told that the manager and some of the nurses were kindness themselves, but when they are not there it falls apart. We were told response times to the call bell was generally good but that sometimes they had to wait if staff were busy. Each person had a call bell within reach, which had improved since the last random inspection. One member of staff was heard going in to a vulnerable person as they were passing their room. There was no purpose for this visit but a very positive interaction was heard, resulting in laughter from the person. We saw thank you cards from relatives. Comments included thank yous for such things as loving care, kindness, dedication and hard work. Staff are trained in induction about how to treat people with respect. Examples were seen of very good interactions but one or two interactions were less positive. The way some staff referred to people at the home was less respectful and were fed back to the acting manager at the time of inspection. People who are at the end of life are treated very well at the home. Staff have received training and use a nationally recognised multidisciplinary plan of care. This care pathway is used to control symptoms and meet the needs of a person in a sensitive yet effective way. People are asked about how they wish to be cared for at the end of their life and evidence was seen of relatives being treated with respect and sensitivity during this time. Care Homes for Older People Page 16 of 35 Care Homes for Older People Page 17 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines within the home sometimes mean that people do not have a choice and control over their lives. The planned improvements will mean that people have access to a more varied activity programme. People who use the service are provided with a wholesome appetising diet. However improvements are needed to the way this is sometimes served. Evidence: All staff are aware of the need for people to have more activities and stimulation to keep them occupied. The acting manager told us they were in the process of employing an activities person to organise less formal events and arrange one to one person centred events. Staff surveys also highlighted a need for this. Staff comments included comments such as There are enough staff to meet their needs but not enough for 1 to 1 care and we need more staff to be able to sit and talk with the residents. Surveys from people who use the service also reflected this view. One person wrote that more activities would be welcome if this could be arranged. The Care Homes for Older People Page 18 of 35 Evidence: activities, which are arranged, are greatly appreciated and enjoyed. One relative wrote She would benefit from more help to pass the time. An external activity organisation visits the home four times a month to provide activities. People told us these were good. Other people said they preferred their own company and passed the day by watching TV or listening to the radio. One person said they received visits from their religious minister and knew staff would arrange this if they chose. People also told us staff are very helpful if they need help to get ready for a specific event, such as a hospital visit or going out for the day. People also told us that staff were less helpful if their requests were more to do with everyday routines. Requests to change bath times and breakfast times has been met with some resistance. One person said they had been told that a daily bath request had been agreed by the manager and clinical lead, but later, care staff had been told that it was not possible. The person told us that an agreement had now been reached. People told us they never felt rushed, but some staff seemed more efficient than others which sometimes made them feel too slow. People who were more able said staff encouraged them to do as much as they could themselves rather than taking over. One person told us they had to let what they wanted go or else they would get too frustrated. One person said staff have their routines, which some staff will change but others wont. One person said they had noticed that some staff make comments as they leave the room, which makes them feel frustrated, as they are not sure what is being said. People described the food as good and not bad. People on the upper floor said they regularly were served luke warm tea and meals quite often. One person said pudding was always cold. People told us the portion sizes were good and too big at times. Although one person said the gap between teatime and breakfast was too long and a request for an earlier breakfast had been made. Some people told us they had a choice of main meal each day but other people said they were not offered a choice. On the day of inspection people were heard being offered a choice of meal, although those receiving a soft diet were not offered a choice. The food appeared appetising and fresh vegetables were served. Those receiving a pureed diet were given mash, corned beef hash and vegetables. A sample of this was tasted. The corned beef hash tasted meaty and savoury, the vegetables were sweet but the taste of what vegetables was unclear and the mash tasted powdery. The chef gave assurances that nothing had been added to the mash but potatoes, cream and butter. Pudding was a freshly made fruit pie. Meal times were a sociable affair for those in the dining area. The dining area was attractive with table coverings being coordinated with the decor in the lounge. People who needed help eating their meals were assisted in a sensitive and unhurried way. Care Homes for Older People Page 19 of 35 Evidence: Soft diets were presented attractively and extra gravy was offered. Care Homes for Older People Page 20 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that complaints would be dealt with appropriately. Improvements are needed to ensure poor practice is addressed appropriately and information provided so staff know how to correctly report allegations of abuse. Evidence: Complaints are well managed at the home. There is a complaints procedure within the Statement of Purpose and Service User Guide. These showed how people could complain at the home. Up to date details were listed about how people could contact the CSCI if the home did not deal with the complaint to their satisfaction. The AQAA told us that the number of complaints have reduced since the last inspection. A complaints folder was securely stored within the office. The acting manager told us she had received three complaints in the last year. One complaint was regarding loss of property, which was resolved. Another was partially upheld and the third was following information given to a nurse on duty. The manager explained that she had written to the person who gave the information offering an apology and requesting further information. This complaint is still open. The manager explained that elements had been upheld, whilst others were still being investigated. All records showed that the manager had dealt complaints with well. Care Homes for Older People Page 21 of 35 Evidence: CSCI have received two complaints regarding the home. The first complaint led to a random inspection being performed where some elements of the complaint resulted in Requirements being issued to the home. The second more recent complaint, mirrored findings found at the random inspection. People we spoke with said they would feel able to complain to the manager and felt very confident that she would deal with the situation. One relative told us they had not needed to complain because the manager deals with issues effectively. People said they felt safe living at the home and that staff were generally kind. People told us all staff were OK but some were better than others. Staff said they had received training on abuse, and this training had been organised by the training manager within the Woodland Group organisation. Staff told us an update for this training was due in November. The staff we spoke to told us they would have no hesitation in reporting any allegations of abuse. However, these staff were unclear of the correct local reporting procedures. This could mean that any investigations are affected by poor handling or people are placed at risk by staff not reporting promptly to the local safeguarding adults team. Contact numbers for the safeguarding team were not easily accessible during the inspection. One specific safeguarding incident was highlighted during the inspection, which should have resulted in the manager discussing with the safeguarding team for guidance. Action had been taken within the organisation, but lack of referral and discussion with the safeguarding team does have the potential to place people at risk. People told us their families care for their financial affairs. Where this is not possible power of attorneys and court of protection systems are in place. People have a locked drawer in their rooms for storage of valuable items. Staff have CRB Criminal record bureau police checks and Protection of Vulnerable adults pre employment checks performed before they work with people in the home, to show that they are appropriate to work with vulnerable people. Some people were being cared for using bed rails. Detailed risk assessments were completed for these people, however the assessments did not follow the good practice guidelines, which state that opinions of a suitably qualified person outside of the home are sought. Domestic style non adjustable beds used were in some cases not adequate. This is reported upon later in this report. Care Homes for Older People Page 22 of 35 Care Homes for Older People Page 23 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in the cleaning programme mean that people now have a cleaner home to live in. However, changes are needed to improve kitchen hygiene and cleanliness. Minor improvements to medication practices would reduce the risk of infection. The planned introduction of adjustable beds would mean that people and staff are prevented from injury when moving people and caring for people in bed. Evidence: Woodland Court is a large house, which has been adapted for use as a care home with nursing. Disabled access bathrooms and toilets have been provided for the people who live in the home. There is a passenger shaft lift between the floors to give level access to the accommodation. A staircase provides access to an office, bathroom and storage area on the second floor. People who live in the home do not have access to this area. The lounge area was arranged in a way that allows small groups of people to sit together. The dining area was attractively presented and all communal areas were clean, tidy and domestic in style. The AQAA told us that new carpets have been fitted throughout the home. One survey said that the garden is a great asset. There is a well maintained garden area to the rear of the home, which people said is used during finer Care Homes for Older People Page 24 of 35 Evidence: weather. Specialist equipment is provided where appropriate. The AQAA told us that new specialist equipment has been purchased. Pressure relieving mattresses and cushions, hoists and lifting equipment was present and being used appropriately during the inspection. The manager told us that she has been agreed two adjustable beds per month. This will enable staff to move and transfer people safely using the hoist and means that people who require care in bed can be provided that care whilst minimising the risk of back injury to staff. Staff providing care were using gloves and aprons provided and were washing their hands as they cared for people in the home. Infection control training is provided in house and the training matrix showed that updates for this training was due. The laundry area is separate from the home thus minimising cross contamination risks. Creams and lotions within peoples rooms did not contain a date of opening on the lid, which is recommended to prevent use after a period where infection may start to spread. The standard of bathroom and toilet hygiene had improved since the random inspection in September. Worn toilet seats had been replaced and toilets and commodes were free from stains and dirt. The majority of other areas of the home were also clean and tidy. However, the kitchen was less clean. The cook uses the safer food better business programme to record checks are done, however, some areas of the kitchen were stained, dirty and even unhygienic in places. Discussion with the cook showed that she works on her own, to provide meals for up to 35 people and often only has time for basic cleaning. Extra assistance was discussed with the acting manager. The manager told us that a refurbishment of the kitchen has been requested. One freezer seal was faulty causing a build up of ice in one freezer, preventing accurate food storage. This had not been reported to the manager. Some foodstuffs prepared that morning had been covered but not labelled. Care Homes for Older People Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current staffing levels mean people have their basic care needs met but do not have time to receive one to one care. Not all staff have had robust pre employment checks performed. Evidence: The manager explained that staffing levels have been more stable in recent weeks. The manager explained that at the random inspection some staff had not turned up for duty and new staff had not completed the recruitment process, therefore staff were trying to manage on reduced staff numbers. On the day of inspection there were thirty people being cared for by one trained nurse, five care staff, the manager, two domestic staff, a laundry assistant, the cook and the maintenance person. The Manager explained that nursing and care staff levels remain constant. Domestic and ancillary staff are part time. Off duty records for the week before and the week after the inspection show that these staff levels are consistent. The rota also showed that more staff are on duty at peak times during the day. The overwhelming feedback from people who use the service, their relatives and the staff is that there is just enough staff to meet the needs of people at the home but not Care Homes for Older People Page 26 of 35 Evidence: enough to allow more time or one to one time with people. Staff said there are enough staff to meet their needs but not enough for 1 to 1 care. Another member of staff said I would like more time to spend with them to get to know them as individuals and another said we need more staff to be able to sit and talk with the residents. Staff told us that extra hours are being looked at for the activities programme and there are staff in mind for this role. Three staff records were looked at. These showed that the recruitment process is consistent and audit processes have just been introduced to show staff have had pre employment checks carried out. This audit was in process and had already highlighted some gaps. CRB and POVA checks are performed, but the information that is planned to be stored was insufficient. A discussion was held about how it was possible to show that CRB checks were enhanced and included a POVA check. References are sought, although some of these references were from work colleagues rather than employers. Work permit information is gathered for overseas staff. Registered nurses are asked for their Nursing and Midwifery Council PIN numbers. Although systems are not in place to ensure an up to date PIN number is maintained for all staff. People who use the service say they are looked after and that staff work very hard. Staff said they received a good induction. One staff survey said that their induction covered everything they needed including extra training and NVQ. The manager told us an initial induction is performed on the first few days which includes emergency procedures, on calls and contact numbers for senior managers. Then staff complete a skills for care common induction standard programme.The initial induction is in tick box form and the in depth induction involves a information booklet which is signed by the worker and manager. Staff told us they have access to many training events as well as the mandatory training programme. Examples of this training included use of the Liverpool Care Pathway end of life care package, information about Parkinson disease, nutrition and diet in the elderly, dementia and the mental capacity act. Training is sourced both within the organisation and externally via the NHS, Primary care trust and external training providers. The majority of care staff have done NVQ training. Staff say the manager supports them with extra training. Care Homes for Older People Page 27 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed, but systems are not in place to ensure the home maintains the same standards in the managers absence. People have their finances protected by the systems in place at the home. The health , safety and welfare of people, visitors and staff are protected at the home. Evidence: The manager is not a registered nurse. She is supported by a registered nurse who leads the nursing staff and manages health care needs in the home. At the time of this inspection an application to register the manager had not been received. However, the manager showed us the application pack, which was almost ready for submission to Commission for Social Care Inspection. The manager explained that her operations manager is in the process of organising a place on a management course. Care Homes for Older People Page 28 of 35 Evidence: The clinical lead has been in post since January 2008. Feedback about the manager and clinical lead was overwhelmingly positive. Staff surveys contained a comment that read I feel you should know that due to the hard work and dedication of our manager, standards have risen to the best I have known them at the Court. Credit where it is due, she has high standards and is not willing to let them slip. She leads by example and has raised morale and put together a good working group of people who are there for all the right reasons; to give the best care and standards to the clients. Surveys from people who use the service were also positive. One comment read The manager has a very positive and can do attitude which reflects throughout the home. However, people who use the service told us that when the manager or clinical lead are not there standards are not the same. We were told that the level of care is not as high with corners being cut. One person said when they (the manager and clinical lead) are not there everything falls apart. Another person told us that what the manager expects to happen does not always do so when she is absent. The manager explained that she intends to look at ways of improving this during staff meetings and supervision sessions. Staff said they have regular supervision sessions, which are very helpful. People said they see the manager and trained nurse daily when concerns or information can be shared. Relatives told us she has an open door policy and positive attitude, which makes her easy to approach. Regular visits by another manager in the organisation take place to check on well being of people within the home. The findings of these visits are sent to Commission for Social Care Inspection. People told us they felt safe at the home and told us either family or other representatives deal with their financial affairs when they are not able. Staff told us there is a safe in the home and each person has a lockable drawer for storage but most people have left valuables with their family for safekeeping. Insurance certificates were present and show adequate cover. Records within the home are well maintained. Accident records are recorded and reviewed monthly. However, these records are kept on loose sheets of paper which may get lost. Discussion was held regarding suitable accident recording tools. Maintenance records are kept to show regular risk assessments and checks on equipment such as wheelchairs, emergency lighting, fire equipment, hot water supplies, nurse call points, electrical testing, gas supplies, lift maintenance, and bed Care Homes for Older People Page 29 of 35 Evidence: rail checks. These records showed that portable electrical equipment testing was due. Staff said they had regular mandatory training and knew the training manager was due at the home in November to perform mandatory updates. The manager has a training matrix which shows which staff are due updates. The manager explained that purchase of equipment and major repairs is done by submitting a request to head office. She explained that if she puts a reason for the request, funding is granted. Care Homes for Older People Page 30 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 12 People in the home must 22/05/2009 have a choice about routines of daily living and staff must ensure work practices are flexible and varied to suit the needs of the person not the staff So people do not have to change their routines to fit in with the routines of the home, but staff have flexible work patterns that can meet the needs of the person 2 18 13 The Registered Provider should ensure all staff are aware of how to correctly report allegations of abuse This will mean that any investigations that need to take place are not affected by poor management or a delay in reporting 22/05/2009 3 18 13 The Registered Provider must ensure any relevant complaints or safeguarding alerts are dealt with 22/05/2009 Care Homes for Older People Page 32 of 35 according to locally agreed safeguarding procedures This is so that the decision whether to investigate is made by a multidisciplinary group rather than being dealt with within the organisation. This will also mean that any investigations that need to take place are not affected by poor management 4 19 13 Systems must be in place to ensure kitchen hygiene is maintained To prevent the spread of infection because of poor hygiene. 5 29 19 Staff working at the home must not work at the home unless the information listed in schedule 2 is obtained. This must include an up to date record of Nursing and midwifery council PIN number This will show that registered nurses at the home are on the nurses professional register 6 33 24 Systems must be in place to 22/05/2009 enable standards to be maintained even in the absence of the manager and clinical lead So people receive a constant good level of care and that some routines and care is not missed in their absence 22/05/2009 22/05/2009 Care Homes for Older People Page 33 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 It is recommended that the current administration practice be reviewed and further develop the auditing of medicines to promote best practice in the home. Staff should be made aware that the way they treat and speak to people who use the service and refer to them has an impact on the well being of people in the home. The Registered Person should continue with the planned improvement in activities programme The Registered person should ensure staff introduce a system to ensure people who are receiving a soft diet are offered a choice where possible, and a system to ensure all food and drink is served at a temperature favourable to the people in the home. Staff at the home should discuss the need to use bed rails with an appropriate professional who is independent to the home, as per good practice guidelines. Kitchen hygiene and food storage should be improved by Repairing replacing freezer seal and Ensuring food stuffs are labelled as well as being covered 2 10 3 4 12 15 5 18 6 19 7 26 Creams and lotions with a screw lid should be labelled with date of opening to ensure they are used within their best before date. The staffing levels should be kept under review to ensure people have all of their care needs met. Written references should be from a suitable source. The manager should submit her application to become registered with the CSCI and should continue with a suitable management course. The manager should ensure accident records are safely stored and easy to audit. 8 9 10 27 29 31 11 37 Care Homes for Older People Page 34 of 35 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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