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Inspection on 03/05/07 for Woodland Court Nursing Home

Also see our care home review for Woodland Court Nursing Home for more information

This inspection was carried out on 3rd May 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

What the care home does well

The staff at Woodland Court are skilled at encouraging the people who live there to take part in the things that are happening within the home. They treat individual people with respect ensuring that they know what they are doing, when assistance is offered or given. The way individual people`s health, personal and social care needs are assessed ensures that their care can be planned in a way that meets their needs. The activities provided for the people at Woodland Court are arranged to fit in with people`s personal preferences and choices. The staff try hard to understand what is important to the individuals and what they enjoy.

What has improved since the last inspection?

Since last key inspection the way individual peoples care planning is recorded has improved. It clearly covers the health care needs of individual people living at home. Wound care planning is easy to follow and demonstrates wound healing pathways. A wound care policy and procedure has been provided for staff. The involvement of external professional health personnel to advise and support on the health care of individuals has increased. The rear garden of the home has been planted with a variety of shrubs and plants. A raised garden border area where people who use wheelchairs can participate in gardening if they wish has been established. One person was very pleased this had been provided as they really enjoyed gardening.

What the care home could do better:

The medication practices in the home need to improve to ensure the people who live at the home receive medication prescribed for them. The records of medication disposed of must be kept to reduce the risk of people receivingmedication they no longer need. Out of date medication must not be kept in the home. This practice could put people at risk of receiving out of date medication, which will not be effective. The evidence to support that the home manager has a safe recruitment practice that will protect people from unsuitable staff is incomplete. The staff records must include a copy of references, proof that qualifications have been checked and police checks carried out. With out clear recruitment information for staff employed the people who live at Woodland Court may not be protected from unsuitable staff. The way people`s individual care planning records are stored does not safeguard their confidential information. The arrangement for storing confidential information held must be reviewed to ensure this is securely stored and only available to the individual concerned and authorised personnel.

CARE HOMES FOR OLDER PEOPLE Woodland Court Nursing Home 56 Marldon Road Shiphay Torquay Devon TQ2 7EJ Lead Inspector Rachel Proctor Key Unannounced Inspection 10:00 3rd May 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodland Court Nursing Home Address 56 Marldon Road Shiphay Torquay Devon TQ2 7EJ 01803 613162 01803 615192 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) Woodland Healthcare Ltd Vacancy Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (3), Physical disability over 65 years of age (39) of places Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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 14th December 2006 Brief Description of the Service: Woodland Court has been a nursing home for just 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 with easy access to the Torbay ring road, which is half a mile away. 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 configuration has four of the double rooms 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 the less able bodied Service Users. There is one large lounge with dining space on the ground floor at the rear of the building. The terrace immediately outside the lounge that looks over the garden that has disabled and wheel chair access. The home has recently been redecoration throughout the communal areas and some bedroom areas, which included fitting good quality carpets in the communal areas and passageways. Some of the bedrooms have also been re-carpeted as part of the home’s redecoration program. The statement of purpose and the last inspection report were displayed in the reception area of the home. The fees charged on 03.05.07 were stated as from £317 to £527;the actual fee is dependant on the dependency of the person using the service and the room occupied. Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection, which took place on 3rd May 2007. Four of the people living at the home had their care followed. Their care planning records, medication records and their personal rooms were viewed. Two hours were spent in the lounge/dining room using a short observational tool, which showed how staff interacted with the people who live there. Some records relating to the management of the home were viewed. A tour of the home was completed. People who live at the home, visiting relatives and staff were spoken to during the visit. Prior to the inspection some comment cards were received from relatives. Some of the comments made in these and comments made on the day have been incorporated into this inspection report. What the service does well: What has improved since the last inspection? What they could do better: The medication practices in the home need to improve to ensure the people who live at the home receive medication prescribed for them. The records of medication disposed of must be kept to reduce the risk of people receiving Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 6 medication they no longer need. Out of date medication must not be kept in the home. This practice could put people at risk of receiving out of date medication, which will not be effective. The evidence to support that the home manager has a safe recruitment practice that will protect people from unsuitable staff is incomplete. The staff records must include a copy of references, proof that qualifications have been checked and police checks carried out. With out clear recruitment information for staff employed the people who live at Woodland Court may not be protected from unsuitable staff. The way people’s individual care planning records are stored does not safeguard their confidential information. The arrangement for storing confidential information held must be reviewed to ensure this is securely stored and only available to the individual concerned and authorised personnel. 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. Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. 1,3, This judgement has been made using available evidence including a visit to this service. The information provided in the statement of purpose for Woodland Court will enable people to make an informed choice about whether the home can meet their needs. The way individual assessments of care needs for people who live at Woodland Court are carried out will enable their care needs to be met. EVIDENCE: The statement of purpose had been up dated since the last inspection to reflect the changes in the management structure of the home. The new manager advised that she was in the process of making this accessible for the people who live and the home, their representatives and professional visitors to the home. The statement of purpose gave information for people who use the service. Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 9 Four people who live at the home had their care followed. Each had an assessment of their care needs, which had been used to plan their care. The manager advised that the care plans had been reviewed and up dated since the last inspection and now included more information. The assessments seen contained information about the person’s health, personal and social care needs. The manager confirmed that each of the people living at the home had an assessment by an NHS nurse to determine the registered nurse input they needed. One relative visiting during the inspection said” staff worked with them to help care”. They also said that staff had discussed what was important and they had been able to influence their relative’s plan of care. This person’s assessment and care plan contained a record of their likes and dislikes. Risk assessment for manual handling, risk of falls and pressure sore risk had been completed. This person had a pressure sore and they had been provided with a pressure-relieving mattress for their bed. Regular wound care reviews and assessments had been recorded. Involvement of the tissue viably nurse specialist for assessment and treatment planning had been recorded. Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. 7,8,9,10 This judgement has been made using available evidence including a visit to this service. The care plan records give a clear picture about the individual persons care needs and how the staff should meet these. The involvement of other health care professionals in the health care management of people should ensure they receive health care, which meets their assessed needs. The management of medication no longer required by people isn’t clear. This may put people at risk of receiving treatments and/or medication, which are out of date. The staff team appear to have an excellent, understanding caring attitude towards the people who live at Woodland Court. This means that people who live at Woodland Court are treated with dignity and respect by the staff team who care for them. EVIDENCE: Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 11 The people whose care was followed all had comprehensive care plans completed, which identified their care needs. These had been further improved since the last inspection. Two people spoken to said they had discussed their care needs and what was important to them with the staff. One commenting that the staff tried to ensure that they had all they needed. The care plans seen had a record of the person’s personal preferences for food and the type of activities they enjoyed as well as their personal care and health care needs. These plans of care gave staff sufficient information to meet the needs of the people they were caring for. The four people’s whose care was followed had their plans of care reviewed at least monthly or sooner if their care needs had changed. One person advised that the staff regularly talk to them about their care to make sure they are happy. One relative commented that staff listen to them and they felt able to discuss any aspect of care. The people seen in their own rooms looked well cared for. Their personal hygiene had been maintained, their hair had been brushed and their oral hygiene had been attended to. They were all wearing clean clothing and their rooms had been kept clean and fresh. Falls risk assessments had been completed for all four people whose care was followed. Where risk had been identified a plan of care provided guidance for staff how to reduce this risk. One person who had bed guards fitted to their bed advised that they had discussed this with the nurse. They also said they had agreed that they felt safer in bed with the guards in place because they had fallen out of bed in the past. A risk assessment for the use of bed guards had been completed for this person, which they had signed. Three of the people whose care was followed were unable to maintain their own person and oral hygiene with out assistance from the staff. One of these people said that staff come and see them regularly to make sure they were comfortable. This person looked clean and fresh and their oral hygiene had been taken care of. One relative said the staff help their relative to maintain their personal hygiene including keeping their mouth fresh. Another person whose care was followed who was unable to express their concerns and wishes easily was having their care monitored. The monitoring form included drinks given, personal hygiene for continence care and oral hygiene and the times they were turned in bed to reduce the risk of pressure sore development. The monitoring form had been completed for all care listed apart from oral hygiene, which had only been recorded once in a 12-hour period. One of the carers spoken to said the night staff attend to the peoples oral hygiene and the day staff do this if there is a need. They did say they did not always record this on the monitoring sheets when this was completed during the day. One dependant person whose care was followed had a clean hydrated month when seen in their own room. The clinical nurse leader was spoken to after the visit to the home. They advised that the very dependant people living at the home have their oral hygiene attended to throughout the day as needed. Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 12 During a tour of the home several high dependency airflow pressure relief mattresses were being used for people being cared for in bed. A record of discussion with the tissue viability nurse specialist had been recorded in one person whose care was followed. The clinical lead nurse for the home advised that they regularly speak to the tissue viability nurse and registered nurses had attended a training day for tissue viability at the local hospital. The people whose care was followed had a nutritional risk assessment completed. One person identified as being at risk said their GP had prescribed nutritional supplement drinks for them. They were drinking one of these when they were seen in their own room. This person went on to say that the staff had asked them which flavours they preferred. Another person who required their drinks thickened had thickening powder in their room for use with their drinks. The person’s medication sheet had a record of prescribed drinks thickener, which was the same as the one being used. One dressing being used and one thickener for a person’s drinks had been prescribed for another person in the home. This may mean that the person whose prescribed thickener or dressing was being used for another person may not have their thickener or dressing available for them when they need it. The nurse in charge should ensure that prescribed medication/treatment is available for individual people to ensure they receive the medication/treatment they need. The controlled drug record was checked against the stock for one persons record as correct. Medication records for those people whose care was followed had been completed and signed as expected. However one dressing being used for a person did not have this listed on their medication record sheet. The clinical lead nurse advised that this person had had this dressing prescribed for them. They acknowledged that this had not been recorded on this person’s medication record. A record of medication that had been disposed of was not available. Although a drug disposal company had been arranged to dispose of unwanted medication and disposal bins had been provided for this. The recently appointed clinical lead nurse advised that they were not sure where the drug disposal record was but felt sure drug disposal had been recorded. If records are not being kept of disposed of medication this may put people who are receiving medication at risk. A look at storage areas for people’s medication revealed that two out of date medication/treatments were still being stored. These included wound dressings and an injection. Two of the people spoken to advised that they had been able to see their GP when they wanted to. One relative said that their relative had seen their GP when staff had let the GP know they were unwell. Another relative commented that when their relative had been really poorly the nurse at the home had Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 13 spoken to the doctor and got treatment for them quickly. A record of GP contact details was recorded in the individual plans of care viewed. The short observation tool used during the inspection showed the staff treated people with respect and valued them as people. Staff observed speaking to people were using their preferred form of address. They were giving them time to answer any questions they asked. People were being asked what they would like to drink or eat. Four different drinks were being offered during the period of observation. All the people seen during the inspection were wearing their own clothes, which looked clean and well pressed. Four people spoken to said that the staff are always polite and friendly to them. Staff were observed involving people in general discussion about topical subjects such as the news, what was on television or the improvements to the garden. The manager advised that she felt it important to make people feel at home and respected. Peoples individual rooms entered during the inspection had been personalised with items of their choice. Screening had been provided for people using shared rooms. Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. 12,13,14,15. This judgement has been made using available evidence including a visit to this service. The residents engage in apropriate activities, the personal preferences of people living in the home are facilitated by the staff where possible. Meal times are a peasant experience for the people living at Wodland Court. EVIDENCE: Discussion with the four of the people in the lounge during the inspection took place. They said they have regular activities provided for them. One person said they were looking forward to going into the garden as they used to really enjoy gardening. Some raised flowerbeds had been set up since the last inspection, which would enable wheel chair users to participate in the gardening with the gardener if they wished. Another person said they enjoyed the company in the lounge and liked to see people coming and going. They were watching a popular TV programme. Staff were over heard discussing the programme with this person, who appeared to enjoy the conversation with the staff member. The manager advised that a call bell is given to one of the people in the lounge so if there is a need to call a member of staff they can. The staff were checking on the people in the lounge every 15minutes during Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 15 the time of the two-hour observation. They were asking them if they were Ok or if they wanted a drink or use the toilet and generally passing the time of day with the people who wanted to talk to them. Staff spoke to one person who had memory problems and did not remember where they were. The staff member did their best to reassure them by acknowledging what they were saying and what was concerning them, offering them a cup of tea while they were waiting. Visitors were coming and going throughout the inspection. Some were seeing their relatives in their own rooms, others in the lounge. The visitors spoken to during the inspection said that staff were helpful, friendly and kept them informed. One relative commented that the staff had been really supportive when their relative was first admitted to the home very poorly. They went on to say that the staff made them feel welcome when they visited their relative. Two of the people spoken to said they had chosen to stay in their own rooms. One said they liked to watch certain programmes on the televisions that they knew others might not be interested in. The other said they liked their own company as they had lived alone before coming to the home. Both said staff had enabled them to chose where they had their meals and if they wanted to join in. Both said they joined in with some of the activities arranged by the home staff. Each person’s room entered during the inspection had been personalised with items of that person’s choice. These included pictures, ornaments and soft furnishings. The lunch time meal observed was unhurried, with the people eating their meals at their own pace. Those that needed assistance to cut up or eat their meals were being given this by staff. They were providing help in a friendly supportive way. Staff were chatting to people about their meal and making general conversation with them as they helped them. The observation showed that people who live at the home have their opinions about meals valued and are encouraged to make decisions. Very little wastage was seen at this meal. The manager advised that the menus are reviewed regularly and the people who live in the home have opportunity to influence the meals provided for them. All those spoken to said they usually enjoyed the meals provided. Two said that the food had improved recently, although one said sometimes the hot food isn’t as hot as it could be. One comment card received from a person living at the home indicated that they ‘sometimes’ enjoyed the meals provided. Specialist diets were being catered for. Those people that required a soft or pureed diet had this prepared in a way that enabled them to taste the different foods. One person who needed meal supplements to help them gain weight was being given flavours they enjoyed. Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate 16,18 This judgement has been made using available evidence including a visit to this service. The residents are cared for by a staff team who are approachable and friendly and have their best interests at heart. However by not ensuring all empoyment checks are carried out and available prior to a staff member starting work, the manager could potentially be putting people who live at Woodland Court at risk from unsuitable staff. EVIDENCE: The Commission has received two complaints since the last key inspection. Both related to the quality of care, the availability of staff and call bells. One of these was not substantiated the other was still being investigated at the time of this report. During the inspection there appeared to be sufficient staff to meet the needs of the current people living at Woodland Court. The way health and personal care is provided and managed has been discussed in a previous section of this report. A tour of the home revealed that all the people in their own rooms who required access to a call bell had one with in easy reach. One person living at the home said “staff always make sure I have my call bell handy before they leave me”. The security of the home and the open front door without staff around to greet visitors every time was raised as a concern by both complaints. The manager advised that they were looking into providing a lockable door beyond the porch entry. The complaints procedure continues to be displayed in the reception area of the home. Feedback from relatives on the day was positive all saying that Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 17 staff were very helpful and responsive and they did not have any concerns about raising issues with the staff or their concerns not being listened to. One commented that the staff had been “most helpful during their relative’s illness”. The manager and staff spoken to during the inspection said they had received adult protection training. Polices and procedures for adult protection and prevention of abuse have been seen at previous inspections. The pre inspection information provided prior to this visit indicated that these were still available. The recruitment practices in the home do not always follow best practice to protect people from unsuitable staff. Records to support that all pre employment checks had been completed prior to the person starting were not available in the home to verify these checks were happening. Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. 19,26 This judgement has been made using available evidence including a visit to this service. The people who live at Woodland Court have a clean fresh homely environment to live in, which helps them to settle into the routines and way of life at the home. 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 lift between the floors where people have their accommodation. A staircase provides access to an office on the second floor. The people who live in the home do not have access to this area. The Regulation 26 reports have indicated that repairs and renewals have continued. The vacant rooms entered during the inspection had been redecorated and carpets cleaned. The maintenance man spoken to Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 19 during the inspection said that individual rooms are redecorated as they become vacant; they also advised that they had started to plant out the garden with summer plants. The garden pond, which had been filled in at the last inspection, was being used as raised flower border that people could work with if they wished. Two people spoken to said how much they enjoyed the garden in the summer and were looking forward to seeing the summer plants. One person said that they were looking forward to helping out in the garden even if it was just to give directions. The home was fresh and clean in all areas entered during the inspection. The domestic staff working in the home advised that they took pride in the way the home looked for the people who lived there. The bathrooms and en-suite facilities entered were clean and smelt fresh. The people who lived at the home spoken to said their rooms are kept fresh and clean by the staff on a daily basis. Information about infection control was provided in the treatment room for staff use. Staff observed providing care were using gloves and aprons provided and were washing their hands as they cared for people in the home. The laundry area is separate from the home. The people seen in the home during the inspection had their own clean well-pressed clothes to wear. One of the staff said that the personal cloths for people who live at the home are cared for in a way that keeps them looking good for them. Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. 27,28,29,30 This judgement has been made using available evidence including a visit to this service. The way staffing levels are organised may mean that on occasions staff are unable to respond to calls for help from the people in a timely manner. Evidence to support that staff have pre employment checks completed before they start work was incomplete. Without this people are at risk of being cared for by unsuitable staff. Without training staff will not be able to build on their knowledge skills and abilities in a way that reflects the needs of the people who live at Woodland Court. EVIDENCE: A duty rota is provided which shows the number of staff on duty each shift and in what capacity they are employed. The rota showed that more staff are on duty at peak times during the day. The lunchtime observed during the inspection appeared to have sufficient staff provided to assist those people who needed assistance to eat their meals. The manager was unable to confirm that staffing is linked to the dependency needs of the people who live in the home. She advised that the current dependency of the people who lived at the home and the staffing numbers deployed were meeting needs. However she did comment that when a person becomes ill and needs more staff time this is Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 21 sometimes difficult as it means less time is available for other people who live in the home. The home employs domestic staff, a cook and maintenance man in addition to staff who provide personal care for the people. Of the 10 health care assistants employed 2 have a National Vocational Qualification (NVQ) level 2 or above in care. This is below the 50 recommended in the Standards. Three staff files were viewed during the inspection. Two of these did not have references on file and none of the three had a record of the police check being returned before they started work. Although the pre inspection information received indicated that a police check had been completed for all staff. One registered nurse employed whose staff file was viewed did not have a record of their NMC (Nurses and Midwifery Council) registration being verified with NMC. The new manager advised that she was receiving help and support from another home manager in the group close by and thought some of the information may have been left there. The way staff records are currently being managed does not evidence safe recruitment practices. This may put people at risk of being cared for by unsuitable staff. The pre inspection information indicated that staff had received mandatory training in the last 12 months. This included manual handling, fire, adult protection, health and safety and food hygiene. Three staff spoken to during the inspection confirmed they had received manual handling, fire and health and safety training. None of the staff files viewed had a training and development plan provided. Although training had been identified in the supervision records seen for two members of staff, the manager advised that she had not yet completed supervision and appraisals for all staff since starting in post in March 07. She further commented that the clinical lead would be completing supervision and appraisals for the registered nurses employed in the home. A dated checklist was being used to indicate which staff had received supervision and when this was due. When this is completed it should ensure that staff have the support they need to care for the people who live at Woodland Court. Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. 31,33,35,37,38 This judgement has been made using available evidence including a visit to this service. The new manager is working towards ensuring the people who live at Woodland Court live in a well run home. The way people’s care planning information was being stored will not protect their confidentiality. Records held by the home for staff employed do not have sufficient information to prove people are protected from unsuitable staff by the homes recruitment practices. The training staff receive for manual handling, fire safety, food hygiene and infection control will help promote people’s health, safety and welfare. EVIDENCE: Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 23 The previous registered manager has left since the last inspection. A new manager has been appointed to lead the home. They are supported by a clinical nurse lead, who manages people’s health care. At the time of this inspection and application to register the manager had not been received. During the inspection it was clear that the lines of accountability between the manager, registered nurses and health care assistants was clear. The people living at the home who were asked knew who the new manager was. A system for monitoring quality and seeking the views of the people who live at the home is in place. The Commission receives regular reports from a senior nurse within the organisation about the home and its services. The manager advised that quality audits were in the process of being completed. Copies of audits completed for care plans and staff recruitment files had been provided at previous inspections. The manager confirmed that these would continue. She also advised that questionnaires had been prepared for the people who live in the home and their representatives to complete, which would allow them to give feedback on their satisfaction with the services provided the home. The manager advised that people who live in the home are encouraged to have an appointed person such as family or a solicitor to manage their financial affairs. Expenditures such as newspapers, hairdressing and chiropody are included in the billing system of the home. This means that the people who live at the home do not need to hold money to pay for these. Not all the records required by regulation for protection of service users and for the effective and efficient running of the business were provided for inspection. The records of medication disposed since January 07 were not available. One person who was no longer at the home did not have their medication record available. The manager commented that she did not know where this was. Staff records did not contain all the information required by the regulations. The care plans for the people who live in the home are kept in a treatment room on an open shelf. During the inspection the door to this treatment room was open. The treatment room is close to the main entrance doorway of the home. This main entrance door is not locked and visitors can come and go without seeing a member of staff. The way individual peoples personal care plans are stored does not ensure that records held are secure. The information provided showed that staff had received manual handling training. All staff spoken to during the inspection confirmed that they had received a manual handling training up date in the last 12 months. The manager confirmed that fire safety, fist aid and infection control training had also been provided for staff. A tour of the home revealed that cleaning chemicals used were securely stored. COSHH (Control of Substances Hazardous to Health) information was available in the office of the home for staff use. The dates for maintenance of Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 24 electrical equipment were provided with the preinspection questionnaire. The maintenance man spoken to during the inspection and advised that he took responsibility for regularly checking water temperatures and running water in vacant rooms, records were being kept of these checks. The organisation has provided a statement of the policy, organisation and arrangements for maintaining safe working practices at Woodland Court. This was available in the policy folder in the office of the home. Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 1 3 Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) 13(4(c) Requirement Prescribed medication and wound dressings must only be used for the person they are prescribed for. Out of date medication and prescribed medication no longer required by the individual must be disposed of. Records of medication disposed of must be recorded and signed for by the staff disposing of the medication. 2 OP29 19(4(b)(i) Staff records kept must evidence that all pre employment checks are carried out prior to their employment. Confidential information held must be securely stored. All the information listed in Schedule 4 must be available in staff files for inspection. Records must be kept for no less than three years from the date of the last entry Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 27 Timescale for action 03/06/07 03/07/07 3 OP37 17(1)(b) 17(1)(b) Schedule 4(6)(c) 03/06/07 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 OP27 Good Practice Recommendations The number of staff on duty should be decided by the care needs and dependency of the people who live at Woodland Court. The training staff receive should ensure that the service users are in safe hands at all times. 50 of care staff employed should be trained to (National Vocational Qualification) NVQ level 2 or above in care. The manager should register with the Commission The manager should make the results of quality assurance and questionnaires available to the Commission, people who live at Woodland Court and their representatives. 2. OP28 3. 4. OP31 OP33 Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Woodland Court Nursing Home DS0000028762.V333907.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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