Inspection on 13/10/05 for Woodland Hall

This inspection was carried out on 13th October 2005.

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.

Other inspections for this house

Woodland Hall 22/08/07

Woodland Hall 04/07/06

Woodland Hall 07/02/06

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOMES FOR OLDER PEOPLE Woodland Hall Woodland Hall Clamp Hill Stanmore Middlesex HA7 3BG Lead Inspector Clive Heidrich Unannounced Inspection 13th October 2005 09:30 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 Hall DS0000063588.V258477.R01.S.doc Version 5.0 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 Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Woodland Hall Address Woodland Hall Clamp Hill Stanmore Middlesex HA7 3BG 020 8954 7720 020 8954 5582 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) Care UK Mr Martin John Tully Care Home 72 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (55), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (12) Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15/2/05 by the Healthcare Commission Brief Description of the Service: Woodland Hall is a continuing care/respite facility that is owned and managed by Care UK. It has been registered as an independent hospital since it opened in 1995, but voluntarily changed its registration to that of a care home with nursing during the summer of 2005. This inspection represents the home’s first by the CSCI since the home’s successful registration. Woodland Hall is a purpose-built, two storey building that is currently registered to accommodate 72 patients aged 65 years and older, 5 of whom may have dementia and be 59 years or over. The service provided is contracted to Harrow Primary Care Trust. The hospital is located in attractive and peaceful grounds in-between Harrow Weald and Stanmore. It is close to some local shops and facilities. Ample parking is available in the front of the hospital. All bedrooms are single rooms with en-suite toilet and sink facilities. There are numerous communal toilets and bathing facilities on the wards although the latter are kept locked at all times unless requested for use. Laundry and catering services are located centrally on the site. Woodland Hall is divided into six separate units: Greenview Unit (1) – accommodates 12 female patients. Bluebell Unit (2) – accommodates 12 female patients. Cedar Unit (3) – accommodates 12 patients of both genders. Parkview Unit (4) – accommodates 12 female patients. Sunshine Unit (5) – accommodates 12 male patients. Hillside Unit (6) – accommodates 12 male patients. There was one vacancy at the time of the inspection. Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This home was first registered by the CSCI in July 2005 following the Care UK organisation’s decision to cancel the home’s registration as an independent hospital and apply for registration as a care home with nursing. The home must now be inspected at least twice during this inspection year against the national minimum standards for care homes for older people. As this is the first such inspection against the national minimum standards, the number of requirements is expected to be slightly greater than usual. Consequent inspections should find that the identified shortfalls against the standards have been addressed. This inspection took place across a cool day in mid-October. It lasted until 6:25pm. As the first CSCI inspection of the home, it aimed to audit the home against all the core national minimum standards. The lead inspector was supported with this by both the local CSCI area’s pharmacy and nursing inspectors (Mrs Shaw and Mr Sooriah respectively). The pharmacy inspector audited the home’s medication systems and has produced a more detailed but separate report for this. The nursing inspector attended throughout the day, and focussed most specifically on service users’ social and health care. The inspectors attempted to meet with a number of service users from all units during the visit. Communication difficulties, or refusals to discuss matters, prevented relevant feedback from being gained however in most cases. Independent feedback was gained from meeting with any family members and with healthcare professionals who were visiting. Issues were also discussed with a number of staff. A number of records were checked, care practices were observed, and the home’s communal areas and some bedrooms were inspected. The home’s deputy manager and administrator made themselves fully available in support of the inspection process. The home’s manager was away at a meeting throughout this unannounced visit, but returned in time for feedback during the last half-hour of the visit. The lead inspector also met with the home’s manager on an arranged basis during the morning of 18th October, to finish information gathering and to provide more detailed feedback. The inspectors thank all at the home for their patience and helpfulness throughout the inspection. What the service does well: Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 6 Service users benefit from a comprehensive range of regularly monitored risk assessments, and from the input of a wide variety of visiting health professionals, in addition to the skills and experience of the staff team. There is a strong emphasis by staff and management on monitoring service users’ healthcare. Service users are supported to stay in touch with friends and family particularly through receiving visits and phone calls. Feedback from visitors about the home was entirely positive. Visitors’ feedback included comments such as “the home is good enough for me to want to place members of my family in it”, and “I’d recommend this home.” Service users are protected from abuse through appropriate recruitment and staff-training practices. The home is purpose-built and is hence spacious and functional. The home was being kept clean and hygienic during the visit. Staff are provided with appropriate support for working in the home, and they are appropriately supervised. What has improved since the last inspection? What they could do better: In the inspectors’ opinion, the biggest concern is that the home lacks sufficient staffing to easily meet all service users’ needs. The lack of sufficient staffing levels in certain units at certain times can put unsupervised service users at risk. It was evident that, following the departure of the activities co-ordinator recently, service users are not being kept sufficiently occupied. There was also evidence that some service users are being dressed and then put back to bed to save staff time in the mornings. Now that budgets for these staffing posts have been agreed, the manager must ensure that the posts are quickly filled with suitable new staff. The practice of dressing service users early in the morning, unless through clear choice, must cease regardless of staffing provision. Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 7 There are a number of minor improvements needed in care provision and monitoring. Comprehensive risk assessments, particularly about the service users as a group, also need to be set-up and actioned. Some areas of the home have not had refurbishment since the home opened around ten years ago. Consequently refurbishment needs to be planned and implemented, particularly in relation to some furnishings and the home’s carpets. Whilst there have been improvements in training provision, it must be ensured that all staff have received and understood all relevant training courses. This particularly includes emergency first aid, dementia care, and infection control. Additionally, the organisation must ensure that the home’s manager enrols on and completes the national care managers’ award. 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. Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 8 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 Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4. Prospective service users and their representatives are provided with detailed written information about the home in advance of making a choice about living there or not. Minor improvements are needed to reflect the home’s changed registration status. Service users have their needs assessed prior to and upon moving into the home. These assessments are very comprehensive in some areas, but need more attention to detail in a few other areas. Service users and their representatives can feel confident that the home will meet many of the service user’s needs. However a lack of sufficient staffing is preventing this from fully happening currently. EVIDENCE: The inspectors looked at six care plans. There was evidence that new service users have had a comprehensive assessment of their needs prior to admission in the home. The deputy manager stated that pre-admission assessments of prospective service users are carried out by the manager, the deputy manager, or a senior nurse who is always accompanied by a junior nurse. There was Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 10 evidence that a risk assessment is also carried out to ensure that the home is suitable place for the prospective service user. There was evidence that the assessment of the service user by the placement authority was also received as part of the pre-admission assessment. Once admitted to the home, service users’ needs are assessed for care planning purposes. These generally contained good information about the needs of the service users. They could however have been more comprehensive. For example the section on communication only addressed verbal communication and did not always clarify such things as ability for comprehension and expression, hearing, sight, and ability to read. The section on eating and drinking did not clarify the likes and dislikes of service users. As a result the registered person must ensure that all service users have a comprehensive assessment of their needs. The mental health needs of service users were however comprehensively assessed using the Clifton Assessment Procedures for the Elderly and a Mental Status Questionnaire. Service users presented on the main as clean, and as appropriately dressed and groomed. Most staff were familiar with the needs of the service users and could discuss these with the inspectors. The home is visited by a range of healthcare professionals including the GP who visits twice weekly, a consultant psychiatrist, a team of psychologists, and a dietician, who provide the necessary support as required to care for the service users. As a result the inspectors judged that the home is able to meet many of the needs of the service users who are admitted to the home. However, as per standards 12, 14, and 27, the lack of sufficient staffing levels leaves service users potentially at risk of accident or incident, and does not provide for a stimulating enough environment. The manager must ensure that this is addressed. The home has a Statement of Purpose and a brochure (Service User Guide). The manager explained that the brochure is supplied to prospective new service users and/or their representatives. It is recommended that the brochure also be available within the reception area for browsing purposes. Checks of the Statement of Purpose and the brochure found that they need minor updates, to reflect that the home is now registered with the CSCI and any consequences of this. Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. Service users’ needs are in the main set out well in an individual plan of care. There were however some individual needs that had been identified but for which documented care planning had not taken place. Service users benefit from a comprehensive range of regularly monitored risk assessments, and from the input of a wide variety of visiting health professionals, in addition to the skills and experience of the staff team. Some improvements must however be made with the documenting and reviewing of some ongoing health issues. Service users benefit from medication systems in the home that are in the main effective. The pharmacy inspectors separate report identifies a few areas for improvement. Service users are treated respectfully and knowledgably by staff in the home. There are suitable systems for handling the care of dying service users with appropriate sensitivity and respect. Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 12 EVIDENCE: Each service user has a care plan which was in good order and which was kept safely in the nurses’ offices. The inspectors were informed that there were sample care plans in place to guide staff with regard to completing the care plans. This is good practice. The inspectors found that some care plans are signed by the advocates of the service user, to show that they have been consulted. It is recommended that where unsuccessful attempts have been made to involve service users or their advocates in the care planning process when these are being drawn up, that a record be made of this. The deputy manager explained that the advocates are also able to attend review meetings. These meetings take place three months after the admission of a service user and then yearly after that. During the review meeting, which is also attended by the consultant psychiatrist and other healthcare professionals, the needs of the service user are discussed. Minutes of these meetings confirmed this. The care plans of service users at times contained some information about their wishes/instructions with regard to their funerals. Although the care records of service users inspected were found not to contain any information about the wishes and instruction of service users with regard to end of life care, particularly in relation to cultural practices and rites, the deputy manager was clear that these issues are discussed for service users who have reached this stage and that care plans are then put in place. There were leaflets available for relatives and friends of service users about bereavement. These provide the information that they may require about handling funeral arrangements and other issues with regard to the death of the service user, which is good practice. It is recommended that staff receive formal training in the care of the dying and of bereavement, so as to improve their skills in supporting service users and families with this process. The home uses a range of risk assessments to ensure the safety of service users. These were mostly reviewed monthly. There was evidence of further care planning in cases where needs have been identified. There were however a few cases where this was not evident despite clear needs being identified. For example the inspectors noted that there was no care planning in place where a service user was identified at very high risk of pressure sores. One service user with a chest infection and another with an infection of the lower legs did not have a care plans in place that reflected these identified needs. The inspectors also noted that the vital signs such as respiration rate, of service users with chest infections, were not being monitored regularly and comprehensively. The manager must ensure that comprehensive care plans are in place to address all identified needs of service users. There must also be comprehensive monitoring of the vital signs of service users as necessary. Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 13 The home uses the Waterlow score for the risk assessment of service users with regard to pressure sores. This is reviewed monthly, according to the care records of two service users with pressure sores that were inspected. There was evidence of the involvement of the tissue viability nurse in the management of the pressure sores. One service user had a care plan, wound chart, and regular wound assessments from when dressings were carried out. The other did not always have the wound assessments undertaken when the dressing was renewed, and had no wound mapping. The manager must address this. There was evidence of appropriate pressure care equipment being in place for applicable service users. The service users’ nutritional status is assessed in detail monthly. Weights are taken monthly or more often if required. The home has a visiting dietician to help the management of service users with nutritional problems. This is good practice. All service users have a continence assessment and a plan to manage incontinence. There was evidence that service users are supported to ensure continence in some cases where the assessment shows that this is possible. The management of incontinence is individualised and generally clear with regard to the incontinence aids to use and the frequency of changing the aids. As mentioned previously, service users are seen by a range of healthcare professionals depending on their needs. Records are kept of the outcome of the visits. While there were separate records for some healthcare professionals, the outcomes of other healthcare professional visits are made in the daily progress notes. It may therefore be difficult at times to extract the information with regard to the visits and outcomes. The use of separate records in all such cases should be considered. The pharmacy inspector’s findings, as detailed within a separate report, were of medication systems and practices being suitable in most areas. Her report contains four minor issues to be addressed. The inspectors found that all service users were clean and appropriately dressed during the visit. Staff addressed service users appropriately. Staff were aware of the behaviour of service users and used strategies to calm service users down where necessary whilst maintaining the dignity of the service user. Personal care was provided in private, in the bedrooms of service users or in the bathrooms/toilets. The clothes of service users were generally ironed appropriately. Checks found that service users’ clothing is kept labelled. Relatives fedback positively about clothing care. Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. Service users have their lifestyle needs assessed and planned for. Improvements are needed however with activity provision. Service users are supported to stay in touch with friends and family particularly through receiving visits and phone calls. Staff respect the choices made by service users in some areas, but improvements are needed with service users’ individual morning-rising routines. Service users receive a nutritional and sufficient diet in the home. Attention must be paid to active choice and presentation of meals, and to enabling service users to receive enough fluid throughout the day. EVIDENCE: There was information about the cultural and social needs of service users in their care records. All had a Lifestyle and Interests assessment that considers the service user’s individual history. Care plans were in place to address these needs. Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 15 The inspectors were informed that the home does not have an activity person in post, following the departure of the person in that post in September 2005. The inspectors also noted that there was not much activity with regard to occupying service users during the day. There was no activity programme on the units. There was however evidence that the visiting psychologists advise and organise sessions about activities for service users. Relatives said that there is currently a lack of activities for service users, but that the activities that used to be provided were very good. One service user was also able to state that there is currently nothing to do. The manager must ensure that a suitable activities co-ordinator is promptly recruited. A number of visitors were observed in the home. Service users could receive them either in their bedrooms or in communal areas. The visitors were received appropriately by staff in the home, according to observations and feedback. Visiting procedures minimise visiting restrictions. The home has a Friends of Woodland Hall group, composed mainly of relatives and volunteers. Minutes of their meetings showed that they undertake fundraising and provide service users with occasional garden parties and outings. In terms of phone calls to and from service users, the manager explained that the staff-phones or the payphone in reception may be used. Additionally, one service user has paid to have a separate line installed within their room. For service users that want more privacy, or who cannot easily leave their room, the manager agreed to consider alternative options such as a portable phone. Feedback from one staff member found that some service users are assisted to dress when supported with toileting at around 5am. They may then get up or go back to bed. Reasons for the practice were explained as so that the morning staff do not have such a heavy workload. The manager must ensure that service users are only dressed when they are ready to get up, and that there are enough staff in the mornings to support in key areas such as with getting up and dressed. The home has a four weekly food-menu cycle that was recently updated to reflect the change of seasons. The dietician has worked closely with the chef on the menus, to ensure appropriate nutritional content of the meals. Apart from the three meals of the day, snacks are also provided during the day and at night for service users. The inspectors were informed about attempts to help those service users who have been identified at risk of malnutrition by fortifying their meals at source. There was evidence that service users were offered appropriate crockery to promote independence while eating. Meal components were also seen to be blended where needed. Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 16 Food presentation and information to service users needs improvement. From the lunch serving seen in one unit, the staff there did not know what the meals were and so gave the wrong information to service users. Service users were not informed of, or shown, each available meal, although they were seen to be able to refuse the meal and have an alternative provided from the two main hot meals available. The manager must ensure that meals are served to service users in a manner that enhances their choice and enjoyment of the meals. A picture-based menu is additionally recommended. There was no agreement amongst service users about the standard of the food, but relatives spoke positively of the food provision and that it is generally eaten. The food itself, from the sample eaten, tasted fine. The inspectors explored the fluid intake of service users. They noted that service users generally receive drinks mostly at set times of the day, including at breakfast, mid-morning, lunch, tea, supper and perhaps before bed-time. As there were no jugs of water and glasses of water in the rooms of service users, the fluid intake of service users at night was not always clear. This all demonstrates that at times service users may only be getting about 1.2 litres of fluid per day, which is lower than the 1.5-2.0 litres of fluid recommended. The manager must therefore review the provision of fluid in the home to ensure that service users have adequate amount of fluid. Water jugs must also be provided in service users’ bedrooms unless risk-assessed as not appropriate for any individual. Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Service users and their representatives can be confident that any concerns or complaints will be appropriately acted on, including any allegations of abuse. Service users are protected from abuse through appropriate recruitment and staff-training practices. EVIDENCE: The complaint procedure was on display on the board in the entry corridor. It was in big characters allowing easy reading of the procedure. The complaint register contained one recent complaint, which was later removed by the complainant. There was evidence that the complaint was being handled appropriately. The complaint prior to that one was from July 2004. There was a suggestion box in the foyer of the home. This is good practice. Staff spoken to were familiar with the abuse procedure to follow in cases of allegations or suspicions of abuse. There were files in each nurses’ offices detailing the procedures for the home and the Harrow PoVA procedure. When some members of staff were questioned about the whistle-blowing policy, they were able to describe it. Training records showed that almost all staff have attended ‘protection of service users from abuse’ training. The manager noted that he checks staffs’ ability to follow the procedure. The manager was open about the one adult protection case that had happened since the last inspection. The investigation into this case involved the use of the organisation’s disciplinary procedure and the use of the national list of people deemed unsuitable to work with vulnerable adults (the POVA list). Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 18 The inspectors noted that service users with behaviour problems are referred to the consultant and to the psychologist for management. Staff spoken to, were clear that they do not physically restrain in cases where service users are behaving inappropriately. Care plans to manage the aggressive behaviour of some service users also confirmed this. In cases where special chairs were being used for the care of service users, appropriate risk assessments were in place. Staff stated that they very rarely use bed rails and that most of the time they use an additional mattress on the floor. They were clear that if bedrails were in use, appropriate risk assessment would be in place. Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. Service users live in a purpose-built environment that is spilt into six almostidentical units. Specialist equipment to support independence was reasonably evident, although improvements must be made to service users’ beds. Communal, toileting, and en-suite bedroom facilities are mostly sufficient for service users’ needs. Many of these areas need however some degree of refurbishment as much of the original furnishings and décor remains from when the home first opened ten years ago. The home was kept generally clean and hygienic during the visit. EVIDENCE: All communal areas, specialist areas, and some bedrooms were inspected during this visit. All areas of the home are purpose-built. Each unit is very similarly designed, with the only significant difference being that the upstairs and downstairs units to the right upon entry have main lounges that openly interconnect, so Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 20 providing more opportunities for social contact amongst service users. The outcome is a very regular and spacious design with long corridors. The lounges in each unit include comfortable seating mainly around a television, and dining tables that can accommodate most service users. A separate kitchenette is available next to each lounge, but these are generally not used by service users unless under supervision. Each unit has an additional smaller lounge that service users may use for quieter time, privacy, or to entertain visitors. Each unit has one accessible toilet, and an adapted bathroom that is kept locked for service users’ security. There are additionally two other adapted bathrooms in the home with much lower-lying baths, and two assisted shower rooms, that can be used if appropriate to service users’ needs. It was noted that all the communal toilets lacked toilet covers. Unless there is a good reason for this (written risk assessment), they must all have covers installed. Many of the communal living areas require refurbishment. Carpets, curtains, and some furnishings in particular were very worn, and some areas of carpet had ingrained staining that the home’s carpet cleaning machine is not able to fully rectify. There has been repainting and redecoration of some lounge and corridor areas this year, and the manager reported that this whole process will be ongoing as a significant amount of budget has been made available for the process. Staff feedback confirmed the need for further refurbishment, noting that much of the fabric of the home has not been changed since it opened ten years ago. Records confirmed that there are plans to address the issues. It is additionally highly recommended that Care UK and the manager discuss and establish a plan of rolling maintenance and refurbishment work, to help to ensure that no areas of the home are left to become overly worn out before their upgrading is identified and addressed. Checks of a sample of service users’ bedrooms were made. The bedrooms are uniform in design, each having most furniture recommended under the standards, including en-suite toilet, comfortable chair, raised electrical sockets, and window-restrictors. Most beds are not adjustable. The standard expects beds to be adjustable in nursing homes, and there was staff feedback about the difficulties of providing appropriate care with fixed-height beds. Care UK must provide adjustable beds to all service users unless the individual service user does not wish for, or would not gain from, such a bed (in which case, there needs to be records of this decision). Each bedroom has a staff-call alarm system that is fixed to a wall. Records showed that these are checked for faults weekly. The system needs to be switched on in each room for the alarm to work, which must necessitate a great deal of staff vigilance. Consideration should be given to upgrading the alarm system, so that it does not need switching on within each room to make it workable in that room. Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 21 There are no radiators in the home. All rooms have under-floor heating. Temperatures are controlled at the main outlet in the house, but can be adjusted within rooms only with the support of the maintenance worker. A system that allows service users or their representatives to adjust the heating in their rooms should be considered. There were no significant concerns with the laundry area and kitchen. Both areas were sufficiently clean and had suitably working facilities. It is recommended that, for reasons of health and safety and time management, peeling and cutting devices are invested in for the kitchen staff. Checks of a sample of hot taps during the visit were found to provide water that was not scalding. Boiler checks found them to be at a temperature that should prevent legionella. There have been professional checks of both the water and the boilers recently. There were no concerns about how the home operates infection-control procedures during this visit. Staff feedback explained how routine controls are followed. Equipment in support of this was available and being used. The home has an up-to-date contract for the disposal of clinical waste. An infection control audit was undertaken in March 2005 by a Clinical Governance Manager within Care UK. Findings were mainly positive but with a few action points. The floors of many of the kitchenettes were found to have crumbs and small food stains in a number of harder-to-reach areas. The floors also had a number of small paint marks, which helped to mask the crumbs in some cases, and the joins of the flooring to the wall were sometimes in a poor state of repair. For these reasons, the kitchenette floors must be replaced with flooring that supports good hygiene standards. The kitchenette floors must also be kept properly clean. Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. The home’s experienced and knowledgeable staff team attempt to meet service users’ needs conscientiously. There are reasonable standards of staff training provided in the home in general. Some areas for improvement have been identified, specifically in meeting the 50 standard of care staff trained in NVQ level 2. Some units lack sufficient staffing to meet service users’ care needs, and the home lacks activity workers to help meet service users’ recreational needs. There are plans to address this, which must be promptly actioned. The home’s recruitment practices protect and support service users. EVIDENCE: Feedback from visitors about staff abilities and how they treat service users was all positive. Key family members noted that they get immediate phone calls if there are concerns with their relative. Discussions with nursing and care staff found that they generally understood the needs of service users, both in general and in respect of individual needs. They were seen to work conscientiously to meet service users’ needs. Roster analysis of the week beginning 3/10/05 found that four or five nursing staff always work during the day with the support of 10 care assistants. This meets the staffing notice that previously applied under the home’s old registration. Night staffing levels were also suitable. For the weekend however, care assistant levels dropped to 9 for the late shifts. Combined with just four Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 23 nurses at that time, that is considered to be insufficient staffing relative to the previously agreed levels. The manager must address this, but it is noted that the levels were sufficient for the following weekend. There are no concerns with the levels of people working in the kitchen, or as domestics, despite slight vacancies in each area. The home also has full-time maintenance and administration workers. The inspectors are concerned about the agreed staffing levels, particularly in units where only two staff work during the day. The home’s policy of staff always supporting service users with personal care in pairs can, in these units, leave all other service users in the lounge with no staff support. This presents risks to those unsupervised service users, in terms of accidents and incidents. One visitor and one staff member also made comments that there can be times when service users are left alone in the lounges. The manager explained that there are currently vacancies of 2.5 nursing staff, 10 care-assistants, the activities person, a domestic, and a kitchen worker. Recruitment is ongoing. This takes into account that additional staffing has recently been agreed, of three extra care assistants working at night and of one further care assistant working in units 1 and 4 daily. The confirmed staffing levels increases must be recruited to promptly or else temporary or agency staff must be used. Staff and visiting professionals’ feedback about training was positive. The home has a detailed training plan. Staff training records show that most staff have attended many necessary courses relevant to the work in the home. The deputy manager explained that any gaps in course or refresher training should be addressed by the end of the year, with two exceptions. Infection control training is dependent on a designated management figure within Care UK prioritising the home for assessment and training (there were however no significant concerns with infection control procedures noted during this visit). The home is now also subject to a standard of ensuring that 50 of their care staff achieve the NVQ level-2 in care by the end of the year. As this is impractical for this newly-registered home, a plan to address the issue must be provided to the CSCI. The deputy noted that levels in this respect are currently around the 10-20 mark, with a number of other staff currently attending the training. The manager must additionally, relative to the training records supplied, ensure that all care staff have attended a basic emergency first aid course and a course about dementia care. There were a number of gaps in the staff team’s training progress in these areas. The deputy manager explained that new care staff start off supernumerary for a week before being asked to work fully on the roster. Records of Care UK’s Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 24 detailed induction and foundation processes, that tie-in with national induction standards, were seen to be used for new staff. The recruitment files of three inspector-selected staff were checked through. These included a number of recently-employed staff. All required recruitment checks were in place. For recent staff, most were working without completed Criminal record Bureau (CRB) checks being fully in place, but instead under supervision following a partial check being satisfactory. Checks of the qualified nursing staffs’ registration were seen to be undertaken suitably. Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 25 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38. The home is run by an experienced and qualified manager who is able to put service users at the forefront of the management approach of the home. Staff are provided with appropriate support for working in the home, and they are appropriately supervised. There are a number of systems in place to enable the home to be run in the best interests of service users. There were a few improvements needed to ensure that the health and safety of everyone in the home is appropriately maintained. EVIDENCE: The home has had a new manager in post since April 2005. He was registered with the CSCI as part of the changing registration process in July 2005. He has an up-to-date nursing qualification, and has been working in senior or Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 26 management positions in the care field for at least the last eleven years. He presented during the visit as open, knowledgeable, and with service users’ best interests at the forefront. He is also supported by an experienced and knowledgeable management team. He noted that he has signed a contract to undertake the registered managers’ nationally-recognised course, but that there has been no further progress on this. Care UK must address this. Feedback from staff about the support they receive in their work was positive. Many staff mentioned about team meetings, and some confirmed that they receive regular supervision from senior management. They also found training supportive. Records of staff meetings confirmed that they are used to guide staff and that staff can raise issues within them. Supervision records of a sample of staff, dating from September, were seen. A standard format is used to help to ensure that all aspects of the work and the staff member’s development are considered. Staff and the employer keep a signed copy of the notes from the meeting, and of the initial supervision contract. The home used to have Investors in People status (a national recognition of strong staff support) but it is now elapsed. Consideration should be given to re-acquiring the award. The inspectors were informed that the home has an annual audit, which is carried out by someone from the head office. The report following the latest audit carried out in January 2005 was available for inspection. The audit is based on 16 standards, which have been chosen within the quality system used by Care UK. The report was generally quite objective and has picked on areas of improvement, such as those that the inspectors have also noted for example with regard to the décor/environment of the home. There is a system of internal audit where the deputy manager audits a sample of care plans and medicines charts every month. Regulation 26 (senior management) visits also takes place on a monthly basis and reports are sent to the local CSCI office. It was noted through records, that the chemist who supplies the home also carries out quarterly audits. Overall the home has good quality systems in place to ensure that areas of improvements are identified and that good practice are built on. The administrator has primary responsibility for looking after service users’ money and financial records. He was able to explain clearly about how the systems operate, and about how individual service users access their money. Minimal amounts are kept on behalf of the service users within the home. Checks of a sample of service users’ finances found no discrepancies and clear record-keeping. There was evidence of auditing of some service users’ records by senior figures within Care UK. Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 27 A number of health and safety systems were checked during this inspection. In terms of external professional checks, up-to-date records were in place for such things as gas safety, portable electrical appliances, fire systems, and mobile hoists. There were a few gaps which the manager must provide copies to the CSCI for. These were in the areas of electrical wiring and passenger lift inspection. In terms of internal checks, each unit has twice-daily general safety checks. Temperature checks of hot food were seen at both the kitchen and serving areas. There was a recently-dated fire safety audit and evacuation plan. The deputy manager explained clearly as to how it would work. There are fire doors at the entrance of each unit, and in a number of other areas of the home. There were suitable internal fire safety checks. The fire drill records in particular showed very good attention to what worked and how to rectify things that did not work. The local fire authority’s visit of the home in the summer of 2005 found standards to also be satisfactory. Checks of the accident and incident records were undertaken. Care UK have very detailed forms for both scenarios. All forms are numbered for auditing purposes. Accident records are always signed off by the GP. They include areas for investigation of the accident and for planning to minimise the chances of re-occurrence. The whole system represented very good practice. An external consultant also checked the health and safety standards of the home in the summer of 2005. Their report audits health and safety needs of the environment well, but lacks much consideration of service users’ needs (e.g. absconding, electrocution, and scalding). The manager agreed that the home must develop risk assessments around service users’ collective needs. He noted that a health and safety committee for the home has just been formed, and that the assessments would be developed in conjunction with further training. Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 28 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 2 X 2 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 2 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 X 2 Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 29 Are there any outstanding requirements from the last inspection? N/A 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. Standard Regulation Requirement The Statement of Purpose and the brochure (Service User Guide) need minor updates, to reflect that the home is now registered with the CSCI and any consequences of this. The manager must ensure that all service users have a fully comprehensive assessment of their needs. This will include detailed assessments of communication needs and of food likes and dislikes. The lack of sufficient staffing levels leaves service users potentially at risk of accident or incident, and does not provide for a stimulating enough environment. The manager must ensure that this is addressed. The manager must ensure that comprehensive care plans are in place to address all identified needs of service users (see under standard 7 for identified examples). The manager must ensure that there is comprehensive monitoring of the vital signs of DS0000063588.V258477.R01.S.doc Timescale for action 1 1 6 15/12/05 2 3 14 15/12/05 3 4 12, 18(1)(a) 15/12/05 4 7 15 01/12/05 5 8 17(1)(a) s.3 p.3(k) 20/11/05 Woodland Hall Version 5.0 Page 30 6 8 17(1)(a) s.3 p.3(k) 7 9 13(2) 8 12 18(1)(a) 9 12 16(2)(m, n) 10 14 12(3, 4), 18(1)(a) 11 15 12(3, 4), 16(2)(i) 12 15 12(1), 16(2)(i), (4) service users as necessary relative to their identified needs (see under standard 8 for identified examples). The manager must ensure that comprehensive records are kept about the treatment of service users with pressure sores, including regular assessment of the wound to monitor the progress of the sores with regard to healing. The manager must ensure that the requirements of the pharmacy inspector’s report are addressed within the timescales provided. The manager must ensure that a suitable activities co-ordinator is promptly recruited. The manager must ensure that there is a comprehensive programme of activities for service users according to their assessed needs. The manager must ensure that service users are only dressed when they are ready to get up, and that there are enough staff in the mornings to support in key areas such as with getting up and dressed. The manager must ensure that meals are served to service users in a manner that enhances their choice and enjoyment of the meals. The manager must review the provision of fluid in the home, to ensure that service users have adequate amounts of fluid. Water jugs must be provided in service users’ bedrooms unless risk-assessed as not appropriate for any individual. Many of the communal living areas require further DS0000063588.V258477.R01.S.doc 20/11/05 14/11/05 15/12/05 15/11/05 15/11/05 01/12/05 15/12/05 13 19 23(2)(b, d) 01/02/06 Page 31 Woodland Hall Version 5.0 refurbishment. Carpets, curtains, and some furnishings in particular were very worn, and some areas of carpet had ingrained staining. This must be addressed. The kitchenette floors must be replaced with flooring that supports good hygiene standards. The kitchenette floors must also be kept properly clean. It was noted that all the communal toilets lacked toilet covers. Unless there is a good reason for this (written risk assessment), they must all have covers installed. Care UK must provide adjustable beds to all service users unless the individual service user does not wish for, or would not gain from, such a bed (in which case, there needs to be records of this decision). The manager must ensure that the minimum care staffing levels previously agreed, of 10 care assistants working during the day (in addition to nursing staff), is upheld at all times (including late shifts during weekends). The confirmed staffing level increases must be recruited to promptly, or else temporary or agency staff must be used, due to reasons as given under standard 27. A plan to address the issue, of ensuring that a minimum of 50 of the care staff team become promptly qualified at NVQ level-2 in care, must be provided in writing to the CSCI. The manager must ensure that all care staff have attended a DS0000063588.V258477.R01.S.doc 14 19 23(2)(d) 01/02/06 15 19 23(2)(b) 01/02/06 16 22 23(2)(n) 01/02/06 17 27 18(1)(a) 10/11/05 18 27 18(1)(a) 01/12/05 19 28 18(1)(c) 01/12/05 20 30 18(1)(c) 01/02/06 Page 32 Woodland Hall Version 5.0 21 31 10(3) 22 38 13(4), 23(2)(c) 23 38 13(4) basic emergency first aid course, a course about dementia care, and a course on infection control. Care UK must ensure that the manager is supported to 01/10/06 undertake and complete the RMA (national management award). The manager must ensure that suitable electrical wiring and passenger lift inspection 15/01/06 certificates are copied to the CSCI. The manager must ensure that the home develops and actions risk assessments around service 15/01/06 users’ collective needs (see standard 38 for examples). RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard 1 3 Good Practice Recommendations It is recommended that the brochure be available within the reception area for visitors’ browsing purposes. There should be a summary of the needs of each service user after all their needs have been comprehensively assessed. It is recommended that where unsuccessful attempts have been made to involve service users or their advocates in the care planning process when these are being drawn up, that a record be made of this. It is recommended that all the entries about the visits of healthcare professionals and the outcomes of these visits are kept separately from the daily progress notes, for ease of extraction of the information. The manager should consider keeping photographs of pressure sores or wound mapping at least monthly, to help monitor the progress of pressure sores. It is recommended that staff receive formal training in the care of the dying and of bereavement, so as to improve DS0000063588.V258477.R01.S.doc Version 5.0 Page 33 3 7 4 8 5 6 8 11 Woodland Hall 7 8 14 15 9 19 10 11 12 13 19 22 25 32 their skills in supporting service users and families with this process. For service users that want more privacy, or who cannot easily leave their room, consideration should be given to alternative phone options such as a portable phone. A picture-based menu is recommended for those service users who cannot easily read. It is highly recommended that Care UK and the manager discuss and establish a plan of rolling maintenance and refurbishment work, to help to ensure that no areas of the home are left to become overly worn out before their upgrading is identified and addressed. It is recommended that, for reasons of health and safety and time management, peeling and cutting devices are invested in for the kitchen staff. Consideration should be given to upgrading the alarm system, so that it does not need switching on within each room to make it workable in that room. A system that allows service users or their representatives to adjust the heating in their rooms should be considered. The home used to have Investors in People status (a national recognition of strong staff support) but it is now elapsed. Consideration should be given to re-acquiring the award. Woodland Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 34 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: 0845 015 0120 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 Hall DS0000063588.V258477.R01.S.doc Version 5.0 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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