Inspection on 04/07/06 for Woodland Hall

This inspection was carried out on 4th July 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Woodland Hall 22/08/07

Woodland Hall 07/02/06

Woodland Hall 13/10/05

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 Key Unannounced Inspection 4th July 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Woodland Hall DS0000063588.V302317.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 Hall DS0000063588.V302317.R01.S.doc Version 5.2 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 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.V302317.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th February 2006 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 homes second 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 and there are two respite beds: 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 were two vacancies at the time of the first inspection and at the second visit there were nine vacancies. Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This home was first registered by the Commission for Social Care Inspection in July 2005, as a care home with nursing. It was previously registered as an independent hospital. This inspection took place across two days in early July. The lead inspector was accompanied by a nursing inspector. The focus was on inspecting all of the key standards, and with checking on compliance with requirements from the last inspection report. The inspection process involved meeting with a number of service users across the units individually to discuss the services provided in the home. Whilst some service users could provide some degree of feedback, many service users were unable to due to their nursing needs. The inspectors also discussed aspects of the service with a number of visitors present during the visits, with staff who were working during the visits, and with the manager. Additionally, care practices were observed across the first day, most of the environment was checked on, and a number of records were sampled. A few months before the inspection, the CSCI sent out comment cards to involved people. Consequently comment card information from 29 friends and relatives, and five health & social care professionals, has been included in the inspection process and this report. Feedback was mostly positive. Comments such as “I am lucky to have my mother in such a caring home. The staff are great and she is well looked after” were very typical. The inspector thanks all involved in the home for the patience and helpfulness before, during, and after the inspection. What the service does well: There is a strong emphasis by staff and management on monitoring service users’ healthcare. One healthcare professional commented: “I have been consistently impressed with the standard of care offered to residents and by the most positive approach and interaction with relatives.” Positive feedback was generally received from relatives and friends of service users about the care in the home, particularly the healthcare. Service users continue to benefit from the good standard of activity provision. Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 6 The home is purpose-built and is hence spacious and functional. The home was being kept clean 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: There are some outstanding requirements from previous inspections that must now become fully addressed. These include the need for refurbishment of some furnishings and carpets, completing the NVQ training of a suitable proportion of care staff, and providing all staff with updated infection control training. It is encouraging that there are clear plans in place to address all of these issues. There are some significant areas for improvement arising from this inspection. It was found that the recruitment checks of some new staff lack suitable references and Criminal Record Bureau checks. This must be promptly rectified to help ensure that unsuitable people are not working with service users. There were some concerns about the amount of staff available to support dependent service users during mealtimes. Staffing levels and staff availability needs to be reviewed to better meet needs. Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 7 Whilst the hands-on care of service users was generally of a good standard, there were occasional shortfalls. For instance, staff-call alarms were not always placed within reach of service users who can use them. Meal plates were sometimes removed without first asking service users if they were finished. The manager must ensure that these specific issues are addressed. 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.V302317.R01.S.doc Version 5.2 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.V302317.R01.S.doc Version 5.2 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): 3 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Prospective service users’ needs are comprehensively assessed before admission to the home, to ensure that the needs of the prospective service users will be met in the home. The home collectively has the resources to meet the needs of the service users who are admitted. EVIDENCE: A sample of care records was inspected. They all contained pre-admission assessments that have been completed by senior staff from the home. Letters were also available on the files about some service users, from their previous place of stay, providing information about the needs of the service user. The manager stated that all new referrals are made together with the needs assessment of the funding authority. The home has introduced a computerised system called ‘Saturn 2’ for the management of care records. This is a comprehensive system whereby all records are kept on the computer. Access to the system is password protected. Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 10 The inspector was however provided with access to these records for inspection. Staff stated that they have had training to use the system and are able to access the care records on the computer. The records can also be accessed remotely for audit purposes by Head Office staff. All the assessments of the needs of service users have been transferred to the computerised format. However two service users whose care records were inspected did not have a fully completed assessment of needs on the computer. It is therefore necessary that the care plans of all service users be checked on the computer to ensure that these are comprehensive. The mental health needs of service users were assessed using the Clifton Assessment Procedures for the Elderly (CAPE). A mental status questionnaire, based on the mini-mental scoring system, was also in use as part of the assessment of needs. The computerised care plan however did not have the CAPE and staff were still using the manual format for CAPE. The manager stated that the Saturn 2 system was in the process of being updated to include all the necessary information. Staff in the home were familiar with and understood the needs of the service users in the home. There was also input from a range of healthcare professionals such as the psychiatrist, psychologist, dietician, and tissue viability nurse, to support and to advise staff in the home about the needs of service users. Regular review meetings were also held with healthcare professionals to ensure that the needs of the service users were continuously being met. The assessment of the needs of service users at times took into consideration the cultural and ethnic background of the service user. For example information about the likes and dislikes of these service users with regard to food and their religious practices are recorded. As a result of the above it is possible to conclude that staff in the home has the skills and experience to care for the service users who are admitted to the home. Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There has been an improvement in the content of care plans. However some service users’ care plans need to be more comprehensive with regard to containing all the actions that need to be taken to meet the identified needs of the service users. The health care needs of service users accommodated in the home are generally met. Some assessment areas need improvement. Medicines management was generally good, with a few issues identified which need to be addressed to ensure the safety of service users at all times. The management of the death and of end-of-life care of service users in the home was in the main good, but the records about the wishes and instructions of service users and/or their relatives with regard to these matters were not very detailed. EVIDENCE: Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 12 Eight care plans located on the computer were inspected. Hard copies of some of the care plans were also inspected. The inspectors noted that there has been progress in making care plans more comprehensive. However there was room for further improvement as some plans of care needed to be more specific and others more comprehensive. For instance, one service user care plan with regard to constipation only contained one action, about giving a laxative. It did not mention the need to refer to the continence assessment, to monitor and record the bowels movements, to monitor fluid intake and to provide encouragement with eating a diet high with fibre. Another service user with a care plan on mobility recorded that the service user will be assisted to mobilise safely but did not clarify how many staff were to assist the service user with mobilisation and how the service user was to ‘mobilise safely’. See also comments under standard 18 about responses to challenging behaviours. The manager must ensure that these required improvements are addressed. The manual handling risk assessment addressed the transfer of a service user from chair to hoist or chair to toilet/bath but did not always address the turning or the movement of service users up and down the beds and the equipment to use for these manual handling manoeuvres. This puts service users at risk of injury and so must be addressed. It was noted that two out of the eight records inspected did not contain updated risk assessments such as the Braden risk assessment, falls risk assessment and nutritional risk assessment. This puts those service users at risk of outdated or inappropriate care, which must be addressed. Relatives spoken to, said that they were involved in the care of the service users and that they were consulted and involved in decisions about service users. Although there was no formal process to record the signature of service users’ representatives on the computer, there was evidence that care staff make further records when the care records are discussed with service users or their representatives. The home arranges for six-monthly reviews of the care of each service user. Minutes of the review meetings were available for inspection. Normally present in these reviews are members of the multi-disciplinary team including the consultant psychiatrist, psychologist, dietician if involved, members of staff from the home, and the relatives/representatives of the service user. This is again another avenue to engage relatives/representatives of service users in the care of the service users. The Braden Score is used on the computerised system to assess service users who are at risk of pressure sores. Pressure relief equipment was noted to be in place for service users who were identified at risk of developing pressure sores depending on the risk. Care plans were also put in place where service users were found to be at high risk. The care plans however did not always describe the pressure relief equipment in use by the service user. They also did not Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 13 clarify the seating regime of service users. This is necessary for a consistency of care. There were two service users with pressure sores in the home. The pressure sores for both service users were showing signs of healing. Photographs of the sores were taken at regular interval, normally monthly, to monitor the sores. Care plans and wound progress notes were completed when the dressings of the sores were renewed. It was noted that one service user was helped to bed in the afternoon as a way of relieving pressure from the sacrum. This is good practice. Most service users did not have a computerised version of a continence assessment. One service user’s care plan about elimination stated that the ‘pad should be changed regularly’. Another service user’s care plan mentioned the promotion of continence but did not mention the management of incontinence even though the service user assessment mentioned that the service user had occasional incontinence. This can provide inconsistency of care, and so must be addressed. The inspectors were informed that relatives could stay with service users who are dying. Staff engage with relatives at a stage when service users are not well, to clarify the wishes of the service users and relatives with regard to end of life care. Care plans contained sections about the future of the service users and about end of life care. The content of these again varied from service user to service user. One clarified clearly that the service user was non-practising. One care plan mentioned that ‘the wishes of the service user are to be honoured’ but did not describe what these were. Another service user had information about the funeral arrangement but did not have information about the management of end of life care with emphasis on the cultural and religious background of the service user. Individual end-of-life care must be clear within all care plans, to help uphold the decisions of service users and their representatives. Medicines were inspected in a sample of the units. All the clinical rooms have air conditioning. The room temperature and the medicines’ fridges temperatures were appropriate for the storage of medicines. Inspection of the medicines charts showed that management of medicines in the home was good, with few issues identified. Medicines sheets were signed when medicines were administered and records were kept when medicines were received into the home or when sent for disposal. The home has a number of diabetic service users. Nurses were using lancing devices that were for self-use on the service users for blood sugar testing. They must use a professional lancing device, to help prevent needle stick injuries and cross-infection. Control solutions were also not available for calibrating the glucometers, which must also be addressed. Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 14 It was noted that the times for the medicines to be administered, as written on medicines charts, were 09:00, 12:00 and 18:00. This is only three hours between the morning and lunch medicine rounds. While this may be appropriate for some medicines, others have to be administered at longer intervals of times. This is to ensure that it is safe for people taking these medicines, such as paracetamol that should be given at least every 4-6 hours if one gram is prescribed four times a day, or to ensure a constant serum level of these medicines such as in cases of anti-convulsion medicines. As a result the registered person must review the administration times of medicines with the relevant healthcare professionals. Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users benefit from the input of a committed activity co-ordinator and good staff support. Contact with family and friends is maintained and encouraged. Service users receive a generally balanced and appeasing diet. EVIDENCE: The home has a full-time activities coordinator. The inspectors were informed that the home would be recruiting a second activities coordinator in October 2006. A programme of activities was available for inspection and this was placed on the notice boards around the home. There was a dedicated room for activities, where all the resources used during activities are stored. The activities coordinator was in the process of completing an NVQ in the Provision of Activities. She has introduced a number of ideas in the home to involve service users in leisure and recreational activities such as the ‘rummage box’ and ‘doll therapy’. Some service users were at various times observed sitting around a table and actively going through the ‘rummage box’. Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 16 It was positive to note that this was something that could capture the attention of the service users. There were a number of framed ‘arts effects’ around the home which have been made by service users and which could be admired by the service users, their relatives and visitors to the home. This was commendable and showed what can be achieved with some very good ideas. The home uses the National Library of the Blind to obtain books in Braille for one service user. The Home-Bound Library service visits regularly. The assessment of the social and recreational needs of service users was recorded on the computer system. Once these have been identified, care plans were put in place. The activities coordinator recorded the daily activities that service users took part in, on the computerised care file of the service user. Visitors were very pleased with the input of the activities coordinator. The psychologist was also observed engaging in reminiscence activities with service users, which they clearly enjoyed. It was noted that the psychologist could involve service users in group therapy or in individual therapy. It was positive to note that the service users in the home could benefit from this input. A number of religious leaders visit the home regularly including people from the Church of England, the Roman Catholic Church and the Greek Orthodox Church. There is a Jewish service every month and the inspectors were informed that in the past there has also been input from an Indian Priest. It was noted that the home arranges outings for service users. The last one was during the end of May when some service users visited a school. Service users were seen to be able to walk in the grounds at the back of the home. There are a number of tables and chairs for use by service users in this area. There is also an enclosed garden area within the centre of the building that a few service users were seen to use. The home makes arrangements for garden parties. Parties are also organised when a service user has a birthday, when a cake is provided by the home and entertainers are invited. The home has a four-weekly menu. On the day of the inspection there was a meal of pork, mashed potatoes, and mixed vegetables for lunch. The second choice consisted of mincemeat. Desert was sago pudding and a choice of banana and yogurt. For supper there was baked beans and potatoes and a choice of sandwiches. Service users were observed making choices when a choice of two meals were brought in front of the service user to choose from. Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 17 Staff were seen to make good efforts to meet the individual needs of service users in respect of food and drink. The inspectors were informed that the home was in the process of introducing photo menus for the service users to choose from, which will be good practice. A number of questionnaires have mentioned that the home served a lot of mashed potatoes. It was indeed noted that there was mashed potatoes for each meal of the day. There were boiled potatoes for the roast lunch on Sundays instead of roast potatoes. It is recommended that the home reviews the menu particularly with regard to exploring other ways of presenting potatoes, and of introducing other sources of carbohydrates such as rice and pasta, while taking into consideration the wishes and tastes of the service users. Fruits were also sent from the kitchen upon service users’ request as part of a meal and were not normally provided for service users to choose or pick from during the course of the day. It is recommended that the home review and improve how it includes fruit within service users’ diets. The inspectors noted that nurses’ aprons were in use for the protection of service users’ clothes. This compromises dignity. It is recommended that the home explore the use of other means, such as serviettes or disposable bibs, to protect service users clothes, on the basis of an individual assessment. Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 18 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): All of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There is suitable training for staff to enable them to address complaints and abuse allegations suitably. The home aims to address all complaints and allegations. Accident and incident processes are suitable. Minor improvements are needed to ensure that suitable guidance in response to challenging behaviours of individual service users is suitably in place. The expectations on staff on upholding service users’ rights to consent also needs to be recorded about and clarified to all. EVIDENCE: The induction process currently used includes reference to abuse prevention. The home has a local abuse policy, to back the Care UK policy. The manager stated that abuse training includes test papers, and that abuse awareness has been discussed within recent staff and relatives’ meetings. Abuse is minimised through there always being two staff working with a service user when in their room. Training records show that the vast majority of staff had training on abuse prevention in 2006. Accident and incidents are all documented about on the computerised recording system. Requested samples of such recordings were seen to be in place as expected. Accident records showed that there are records typically for falls and for bruises. The manager noted that there have been no significant incidents, including no fractures, since the last inspection. Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 19 The home’s Care UK policy on consent was considered. Whilst comprehensive, it lacked details on the approach should a service user refuse consent for such things as medical treatments. There was insufficient evidence of the policy being discussed amongst staff, including through there being no signatures to confirm that anyone had read it, a good practice area that is addressed for some other policies. It is noted that the policy was however raised in a recent staff meeting. The issue of consent was significant in one of the three abuse allegations that the home has faced and cooperated with since December 2005. There is some degree of risk, based on evidence at this inspection, that service users are at risk of not having their rights to express consent upheld. The manager agreed, as required, to implement a policy in this respect for the home, and to ensure that it is clarified with all staff. The majority of relatives’ and friends’ feedback cards reported that they have not had to make a complaint about the home. The majority of those who had reported that the issues had been fully addressed by the home. This is encouraging. The manager stated that there has been only one complainant since the last inspection, and produced records from the computer system to show what the complaints are and how these have been addressed. The complaints related to care and practice issues. As mentioned above, there have been outcomes to three investigations into abuse allegations in the home. The home and organisation have co-operated with the investigations. All allegations have been partly upheld. The home have taken clear steps to reduce the risk of abuse to service users in response to the allegations. There have been no other complaints to the CSCI since the last inspection. The inspectors observed staff and the manager work calmly with a service user who was being verbally aggressive in a communal area. Staff confirmed this general approach in discussions. The manager noted that the use of ‘rummage boxes’ has notably reduced the amount of challenging behaviours overall. As identified under standard 7, the care plans in respect of challenging behaviours were found to lack suitable detail. For instance, one service user’s care plan with regard to managing their aggressive behaviour only mentioned that the relative should be contacted. It did not contain any other actions such as close observation, input of one or more members of staff, diversion therapy or the use of medicines if that was necessary. Another care plan on aggressive behaviour mentioned that ‘the service user should be offered encouragement and understanding’ but did not described how this was to be achieved. Greater detail on planning to manage the behaviour is required. Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 20 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home’s environment is reasonably maintained, and improvements are being made. There remains however a significant amount of refurbishment work needed to fully uphold standards. The home is generally kept clean, but a couple of hygiene issues must be improved upon. The shared areas provide service users with a choice of communal space with opportunities to meet relatives and friends in privacy or in their own rooms. EVIDENCE: Most areas of the home were viewed, including a sample of bedrooms in each unit. 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 providing more opportunities for social contact amongst Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 21 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 and wishes. Written feedback from relatives and friends found that the majority of people consider the home to be clean and free of odour when visiting. Four replies raised concerns about odour control. There were however no offensive odours noticed during the inspection, from which it is concluded that the home has addressed concerns raised in feedback dating from Spring 2006. There was improved decoration in the hallway and reception areas of the home compared to previous visits. The manager also noted that 24 adjustable beds have been purchased and placed in the bedrooms of those service users most in need of them. Some areas of the home require further redecoration or refurbishment. These included in particular: • That carpets in the Hillside lounge and around the visitors’ room in Sunshine have ingrained stains and/or burn marks, and so must be cleaned or replaced as applicable. • One table in the Hillside lounge is coming loose at the joints and has a surface hole in it, so needing replacement. • Some toilet seats especially in Greenview were found to have large cracks on their underside, which compromises hygiene and hence must be replaced. • The bin in Cedar kitchen has a hole in the lid, which compromises hygiene and hence must be addressed. • Fencing around the whole garden area, especially in the balcony upstairs for the combined units, needs varnishing and in some areas fixing. • The garden area generally needed weeding as it was generally overgrown, however the main seating area was well-attended to. Furnishings remained worn but generally useable. Some chairs had cuts, holes or marks on them, so making them unattractive for use. The manager stated that a change of soft furnishings is part of the October budget. It will also include changes of carpet where needed. Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 22 Written feedback from friends and relatives about bedrooms was generally very positive. Checks were made of a number of bedrooms throughout the home on the first day. All the rooms, including the en-suite facilities, were suitably clean and with no odour concerns. There was generally reasonable bedding, carpeting, and curtains in each room. A sample item of clothing in each room was labelled correctly. Each room had a chair unless there was a clear reason for not needing it. The bed frames in rooms 26 and 27 were covered with dust. Other areas such as pictures frames were dust free. The manager must ensure that bed frames are included in the cleaning of bedrooms, for health and hygiene purposes. A couple of staff-call alarms were not set-up to work correctly within the bedrooms seen. In many cases service users lack the skills to use them. However one service user pointed out that their alarm was not within reach when asked how they get staff attention. The manager must ensure that capable service users are provided with access to their alarms at all times. Weekly maintenance checks are made of service users’ alarms, but the recording of this lacks detail. It is suggested that a list of service users who are considered capable of using their alarms be kept, and that regular checks for the availability of the alarm for these people be documented. Bedrooms tended to have small fans in them to help combat the effects of the high weather temperatures. The manager stated that family or the relatives’ group provide the fans. As service users’ health is the responsibility of the home, the provision of fans or effective temperature control in service users’ bedrooms should be provided through Care UK. The inspector noted that temperatures in bedrooms during the visit tended to be at 30ºC. It was positively noted that a difficulty with the reception for one service user’s bedroom television was quickly fixed through the internal radio-communication system helping to summon the maintenance worker within one minute. The laundry area was seen to have two working industrial washers and two similar drying machines. Other suitable equipment was seen to be in place. The area was clean, and is structurally designed to minimise chances of infection. There was no backlog of washing. It was however noted that vest and nightwear clothing was stained for some service users, which management must ensure is appropriately addressed. The kitchen was seen to be clean and with suitable equipment. Attention was paid to ensure that hot food stayed hot from kitchen to delivery in the units. Many suitable health and safety systems were in place. Staff were sometimes observed to not wash their hands in-between supporting different service users with meals, particularly in Cedar unit. This was Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 23 consistent with there being insufficient staffing to attend to many dependent service users, as discussed in the next set of standards. The manager must ensure that staff wash hands in-between supporting service users with food. Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 24 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There are generally good standards of training in place in the home, with NVQ targets being moved towards and many courses being provided to all staff during the last six months. Feedback about staff was very positive. Staff generally showed practices that aim to meet service users’ needs. There were however some occasions when there were not enough staff working on individual units to meet service users’ needs, which must be improved on. Recruitment practices had significant shortfalls in acquiring appropriate references and Criminal Record Bureau checks of some new staff, which must be promptly addressed. EVIDENCE: There was overwhelming praise of staff from relatives’ and friends’ questionnaires. Those service users spoken with generally confirmed this, one saying that staff dig deep and are marvellous. The inspectors observed generally good standards of staffing. Staff showed reasonable care knowledge during discussions, they were generally observed to be considerate, and they attempted to meet individual needs of service Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 25 users. Staff spoke to service users respectfully. Staff made good efforts to provide service users with choices, and they tried to enable independence. Staffing levels across mealtimes need to be reviewed, as observations and feedback raised some concerns about meeting service users’ needs in some units where there are a higher proportion of service users who need support. The inspectors observed for instance staff running between service users to support them to eat, rather than providing the necessary ongoing support for individuals. Staff were also occasionally seen to remove meals without asking, which must in itself be addressed out of courtesy to service users. Feedback from relatives found that meals were sometimes not hot and that they felt obliged to help with supporting their relative to eat due to the pressure on staff. The manager stated on the second day of the visit that she had taken initial action to address the difficulties, including through providing extra people at mealtimes. She explained that she undertakes monthly dependency level checks of service users, and that staff provide feedback if they feel that the work is too strenuous. She also noted that there has been a slight increase of staffing compared to previous inspections. This is all encouraging. Checks of rosters for the home showed no concerns with the amount of staff working, relative to the agreed minimum staffing levels. There was little use of agency staff. It is recommended that a clear, recorded system be in place to show how staffing levels vary according to service users’ collectively assessed needs, so that additional staff input can be identified quickly where needed. There are good general standards of staff training in the home currently. A comprehensive training grid showed that all staff have had manual-handling refresher-training in 2006. Nearly all have had fire safety, abuse prevention, health & safety, and food hygiene training in 2006. A majority of care and nursing staff have had first aid, and dementia, training in 2006, with the manager aiming to provide a further session to address the issue for those still needing them. This shows a considerable and impressive attention to training. The manager stated that there are 18 care staff working towards the NVQ level 2 qualification in addition to the 6 who have it. This shows good progress towards aiming to meet the expectation of 50 of care staff having NVQ qualifications. The induction records for one recently-started worker were found to be of a suitable standard. The manager explained that new workers work for a week in a shadowing role that includes some specific training, and that their knowledge is tested through answers to the induction booklet questions. Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 26 The recruitment files of three newer and one established staff member were checked through. Application forms, identification documents, and work permits were in place. Two suitable references were in place expect for one staff member who had worked with an agency at the home before taking permanent employment there. The manager explained that there were three other people in a similar situation, and that they had all passed their probationary period to be considered as suitable for permanent employment. However, reference requests were found to have been sent off on the day that they started permanent employment. In a similar vein, there was no Criminal Record Bureau (CRB) outcome in place for any of the three newer staff, although one was supplied on the second day of visiting. PoVA-First checks, of ensuring that the staff were not on the official list of people considered unsuitable for working with vulnerable adults, were in place. There was little to show however that CRB checks were being chased up. These shortfalls with both the CRB and references could put service users at risk, as these checks could show significant concerns about the suitability of the staff members. The manager must ensure that these issues are quickly dealt with, that staff are now never employed until two suitable written references are in place, and that there are clear records of following-up on outstanding CRB checks if the check is not promptly returned. PIN checks, of nurses retaining suitable nursing qualifications, were seen to be in place. Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 27 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, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home’s new manager demonstrated good ability in her role. She is undertaking appropriate management qualifications. Staff receive good support from management through a variety of sources. Service users’ and relatives’ meetings have been usefully re-established. A formal audit of stakeholders’ opinions of care is needed. There are suitable and established systems with which the home looks after service users’ money. Health and safety issues are generally suitably reviewed and addressed. Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 28 EVIDENCE: The manager has been in charge of the home since April 2006. She has previously worked as the deputy, and has been working in the home for many years. From discussions, feedback, and observations, it was evident that she is clearly service user led, and is adjusting the culture of the home to make the service more service user focussed. The manager stated that she is in the process of applying to be registered with the CSCI, and with undertaking the registered managers’ qualification, as is necessary. She has many years’ experience as a qualified nurse. The deputy manager had began employment in that role just before the inspection, following an internal promotion. The manager enabled the deputy to be much involved in the inspection process, which is good practice. Some staff meeting records from May were seen. These included general meeting, nurse meetings, and health & safety meetings. Management advised that meetings are also held for domestic staff and kitchen staff. Meetings showed suitable consideration of relevant issues, including many health and safety hazards in respect of the health & safety group. Only ten staff attended the general meeting, which is a relatively small percentage of all staff employed at the home. Consideration for increasing numbers, to help with communication of issues, is suggested. Those staff spoken with said that they receive support from the home’s management. They spoke of receiving supervision sessions at least every other month. The manager confirmed this aim, including that shortfalls from earlier in the year would be addressed. Records supported this. The manager confirmed that staff receive training on what they should expect form a supervision, which is good practice. The home has been using a computerised recording system since late 2005 for documenting many aspects of the home including service users’ care. The manager reported that all staff have had training on it, and that it is for all care staff to add to. Its usefulness includes an ease of accessing specific information, legibility, and enabling Care UK management to monitor key areas. Some written records continue to be used where needed. Relatives’ and service users’ joint meetings with the home’s management have now begun. Records showed that relatives have clearly influenced the agenda. The meetings also include short presentations from relevant external groups. There has been no formal audit by the home of service users and their relatives’/friends’ views about the care in the home since 2004. The manager confirmed that this would be addressed later in the year, as required. Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 29 The manager noted that there are occasional night-time spot checks undertaken by her or other local managers, to help ensure that care at night is appropriate. The home’s business manager has primary responsibility for looking after service users’ money and financial records. He was able to explain clearly about how the systems operate. Minimal amounts are kept on behalf of the service users within the home, based on acquisitions from relatives or the bank accounts that the organisation keeps for some service users. Checks of a sample of service users’ finances found no discrepancies and clear recordkeeping, including with respect to cross-checking against bank account records. There was also a receipt in respect of each purchase. There was evidence of auditing of some service users’ records by senior figures within Care UK during 2005. Suitable systems of helping service users to make purchases, generally through staff going out on behalf of service users or of local deliveries, were in place. The inspection took place during two particularly hot days. There was evidence of heatwave documentation within units, many fans were in use, and cold drinks were made available to service users during the visit. There was however no specific plan in place to address service users’ general and specific needs during a heatwave, which is part of the governmental heatwave guidance, and which could provide service users with further relief during such spells. The manager agreed to address this. The manager said that the local environmental health department had visited recently. One hygiene issue was established for addressing, which the home was already addressing. Records of health & safety checks by the maintenance worker were in place and up-to-date. These included weekly checks of the fire alarm, hot water taps, and the staff-call system, and monthly checks of the emergency lighting and of wheelchairs. A fire risk assessment was in place using Care UK’s standard forms. It would be useful to also record what will be, or has been, done to reduce the risks. The manager noted that a fire professional also undertook a fire safety assessment in 2005. Professional health and safety checks were in place and up-to-date in most cases, such as with the gas, fire equipment, mobile hoists, and for electrical appliances. The electrical wiring had been checked but lacked an outcome certificate. The passenger lift and four hoists needed some remedial action that the home was starting to address. The manager must ensure that these latter points are fully addressed, particularly where these are outstanding requirements. Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 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 2 18 2 2 3 3 2 3 3 3 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 3 3 2 Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement The manager must ensure that all the needs assessments of service users are updated on the computer system since this is now the main form of record keeping. All service users’ care plans must set out in detail the actions that need to be taken to meet the health, personal, and social care needs of service users. The manager must ensure that the care plan and risk assessment for manual handling addresses all types of manual handling manoeuvres including turning and moving service users up and down the bed. The manager must ensure that risk assessments such as the Braden risk assessment, nutritional risk assessment and falls risk assessment are reviewed at least monthly or more often as and when the needs of service users change. The manager must ensure that care plans of service users with pressure sores or at high risk of DS0000063588.V302317.R01.S.doc Timescale for action 01/10/06 2 OP7 15 01/11/06 3 OP7 13(5) 01/10/06 4 OP7 12(1) 01/10/06 5 OP7 15 01/10/06 Woodland Hall Version 5.2 Page 32 6 OP8 12(1) 7 OP9 13(2, 4) 8 OP9 13(2) 9 OP11 15 10 OP17 12(5), 13(6) 11 OP18 15 12 OP19 23(2)(b, d) pressure sores clearly contain details of the pressure relief equipment in use in the home and the seating arrangements for these service users. Service users must have an upto-date continence assessment, and a comprehensive care plan in place to address the findings of the assessment. The manager must ensure that lancing devices for professional use, are in use in the home for blood sugar testing, and that control solutions are available in the home for the calibration of glucometers. The manager must review the times for the medicines round with the relevant healthcare professionals to ensure that there is appropriate interval of times between medicines rounds. The care records of service users must contain information about the wishes and instructions of service users or of their relatives with regard to end of life care and about arrangements in place after death taking into consideration the cultural and religious background of the service user. The manager must implement a suitable policy on service user consent, including rights to refuse, and ensure that it is clarified with all staff. Greater care-planning detail on how to manage individual service users’ challenging behaviour is required where applicable. Many of the soft furnishings of the communal living areas require further refurbishment. Carpets, curtains and some furnishings in particular, were DS0000063588.V302317.R01.S.doc 01/10/06 01/10/06 01/09/06 01/11/06 01/11/06 01/11/06 01/12/06 Woodland Hall Version 5.2 Page 33 very worn and some areas of carpet had ingrained staining and cigarette burns. This must be addressed. Previous timescales of 1/2/06 and 1/6/06 not met. Some areas of the home require further redecoration or refurbishment. These included in particular: • One table in the Hillside lounge that is coming loose at the joints and has a surface hole in it, so needing replacement. • Some toilet seats especially in Greenview were found to have large cracks on their underside, which compromises hygiene and hence must be replaced. • The bin in Cedar kitchen has a hole in the lid, which compromises hygiene and hence must be addressed. • Fencing around the whole garden area, especially in the balcony upstairs for the combined units, needs varnishing and in some areas fixing. • The garden area generally needed weeding as it was generally overgrown. The manager must ensure that capable service users are provided with access to their call-alarms at all times. The manager must ensure that staff wash their hands inbetween supporting service users with food. The manager must ensure that all bed frames are included in the cleaning of bedrooms, for health and hygiene purposes. DS0000063588.V302317.R01.S.doc 13 OP19 23(2)(b, d) 01/11/06 14 OP22 12(5), 13(4) 13(3) 01/09/06 15 OP26 01/09/06 16 OP26 16(2)(j) 01/10/06 Woodland Hall Version 5.2 Page 34 17 OP26 12 18 OP27 18(1)(a) 19 20 OP27 OP28 12 18(1) The manager must ensure that laundry systems enable clothing to remain stain-free, as it was noted that vest and nightwear clothing was stained for some service users. Staffing levels across mealtimes must be reviewed to ensure that there are enough staff working on each unit at those times to meet service users’ collective needs. The manager must ensure that all staff ask service users before removing meals from them. A minimum of 50 of the care staff team becoming qualified at NVQ level 2 in care must be achieved. Previous timescale of 1/7/06 partially met. The manager must ensure that: • The shortfalls in having suitable references and CRBs in place for key staff are promptly dealt with, • Staff are now never employed until two suitable written references are in place, and • There are clear records of following-up on outstanding CRB checks if the check is not promptly returned. The Manager must ensure that all care staff have attended a basic emergency first aid course, a course about dementia care and a course on infection control. Previous timescales of 1/2/06 and 1/6/06 partially met. The new Manager must be registered with CSCI at the earliest opportunity and supported in undertaking and DS0000063588.V302317.R01.S.doc 01/10/06 01/10/06 01/09/06 01/12/06 21 OP29 19 01/09/06 22 OP30 18(1(c) 01/10/06 23 OP31 10 01/12/06 Woodland Hall Version 5.2 Page 35 completing the Registered Manager Award. Previous timescale of 1/7/06 partially met. The manager must ensure that a formal audit by the home of service users and their relatives’/friends’ views about the care in the home takes place, and that a report on the outcomes is made available. There must be a specific plan in place to address service users’ general and specific needs during a heatwave. The Manager must ensure that a suitable electrical wiring certificate is available for inspection and copied to CSCI. Previous timescale of 1/4/06 not met. The manager must ensure that the remedial action needed for the passenger lift and four hoists, as identified in recent professional checks, is addressed. 24 OP33 24 15/12/06 25 OP38 13(4) 01/10/06 26 OP38 23(2)(c) 01/09/06 27 OP38 13(4), 23(2)(c) 01/10/06 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 OP7 Good Practice Recommendations It is recommended that a formal process is developed where the signature of service users or that of their relatives are recorded as evidence that they have been involved in the formulation of care plans. It is recommended that the home review and improve how it includes fruit within service users’ diets. It is recommended that the home reviews the menu DS0000063588.V302317.R01.S.doc Version 5.2 Page 36 2 3 OP15 OP15 Woodland Hall 4 OP15 5 OP22 6 OP25 7 OP27 8 9 OP32 OP38 particularly with regard to exploring other ways of presenting potatoes, and of introducing other sources of carbohydrates such as rice and pasta, while taking into consideration the wishes and tastes of the service users. It is recommended that the home explore the use of other means, such as serviettes or disposable bibs, to protect service users clothes, on the basis of an individual assessment. It is suggested that a list of service users who are considered capable of using their alarms be kept, and that regular checks for the availability of the alarm for these people be individually documented. As service users’ health is the responsibility of the home, the provision of fans or effective temperature control in service users’ bedrooms should be provided and funded through Care UK. It is recommended that a clear, recorded system be in place to show how staffing levels vary according to service users’ collectively assessed needs, so that additional staff input can be identified quickly where needed. It is recommended to encourage the majority of staff to attend the general staff meeting, to help with communications. A fire risk assessment should record what will be, or has been, done to reduce the identified risks. Woodland Hall DS0000063588.V302317.R01.S.doc Version 5.2 Page 37 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.V302317.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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