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Inspection on 12/11/07 for Woodland House Nursing Home

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

This inspection was carried out on 12th November 2007.

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

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

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

What the care home does well

The staff at Woodland House are friendly and supportive when caring for the people who live there. The way individual people`s health, personal and social care needs are assessed ensures that their care can be planned in a way that meets their needs. Health professionals have reported that staff appear to understand how to care for people who are mentally infirm and relatives have praised the staffs` skill in caring for their relative.

What has improved since the last inspection?

The redecoration of individual peoples` rooms and communal areas has continued. New furniture has been provided in further individual peoples` rooms. This means that the overall look of the environment has continued to improve. Regularly twice weekly activities from an external organisation are provided for people at the home. Records are kept of who has participated in the activities provided.

What the care home could do better:

Prescribed creams were being used for people they were not prescribed for and two of these were past the date recorded as the expiry date. Stock control of products kept in the treatment room had not ensured that out of date prescribed treatments had been disposed of. By not ensuring good stock control people may be at risk of receiving out of date treatment or medication. People living at Woodland House do not appear to have many opportunities for stimulation through leisure and recreational activities that have regard for theircare needs and abilities. Staff on duty were responding to those people who had behaviour that challenged, and the one to one support and activities the manager had said take place in the afternoons did not appear to be involving those people sitting quietly in the lounge or the people who were in their own rooms. The numbers of staff provided for each shift or the way they are deployed still does not appear to be meeting all the care needs of the people living at Woodland House. Basic care needs are being met, however the number of staff provided does not appear to give staff time to spend with individual people to enhance their experience of care. The extra staff member deployed for the evening meal has left since the last inspection and the manager has still to replace their hours. This means that people living at Woodland House do not always have the support they need to eat their evening meals. The manager had not ensured that all untoward incidents/accidents that have adversely affected people living at Woodland House were reported to the Commission.

CARE HOMES FOR OLDER PEOPLE Woodland House Nursing Home Middle Warberry Road Torquay Devon TQ1 1RN Lead Inspector Rachel Proctor, Stella Lindsay Unannounced Inspection 12th November 2007 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 House Nursing Home DS0000028763.V355173.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 House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodland House Nursing Home Address Middle Warberry Road Torquay Devon TQ1 1RN 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) 01803 296809 01803 380144 Woodland Healthcare Ltd Mrs Karen Gwilliam Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (30), Old age, not falling within any other category (3), Physical disability over 65 years of age (3) Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia aged 65 years and over on admission - Code DE(E) Mental disorder aged 65 years and over on admission - Code MD(E) Old age, not falling within any other category - Code OP maximum number of places 3 Physical disability aged 65 years and over on admission - Code PD(E) maximum number of places 3 The maximum number of service users who can be accommodated is 30. 7th June 2007 2. Date of last inspection Brief Description of the Service: Woodland House is a nursing home that provides care to people who suffer from mental health problems, mainly elderly people with dementia. It is located in the suburb of Wellswood, which is approximately one mile from the town centre of Torquay. The home has eighteen (18) single rooms and six (6) shared rooms spread between three floors that are accessible by two shaft lifts. The lower ground floor is a modern extension to the main home. There is a large lounge and a medium sized dining room on the ground floor. The Statement of Purpose is available in the entrance hallway of the home. Fees range from £467 -£575 dependant on care needs. Chiropody, hairdressing and daily papers extra. Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection, which took place on 12 November 2007 between 9.30 am and 4.30 pm. Two inspectors completed the inspection. We (the Commission) used a short observational tool as part of this inspection, this enabled the quality and amount of interaction between staff and people living at Woodland House to be assessed. A tour of the home was completed. Three people living at the home had their care followed. Records relating to the management of the home were reviewed with the manager. Records of incidents and accidents in the home for a period between May 2007 and October 2007 were discussed with the manager. Two relatives, a visiting professional, the manager and the staff on duty were spoken to during the inspection. What the service does well: What has improved since the last inspection? What they could do better: Prescribed creams were being used for people they were not prescribed for and two of these were past the date recorded as the expiry date. Stock control of products kept in the treatment room had not ensured that out of date prescribed treatments had been disposed of. By not ensuring good stock control people may be at risk of receiving out of date treatment or medication. People living at Woodland House do not appear to have many opportunities for stimulation through leisure and recreational activities that have regard for their Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 6 care needs and abilities. Staff on duty were responding to those people who had behaviour that challenged, and the one to one support and activities the manager had said take place in the afternoons did not appear to be involving those people sitting quietly in the lounge or the people who were in their own rooms. The numbers of staff provided for each shift or the way they are deployed still does not appear to be meeting all the care needs of the people living at Woodland House. Basic care needs are being met, however the number of staff provided does not appear to give staff time to spend with individual people to enhance their experience of care. The extra staff member deployed for the evening meal has left since the last inspection and the manager has still to replace their hours. This means that people living at Woodland House do not always have the support they need to eat their evening meals. The manager had not ensured that all untoward incidents/accidents that have adversely affected people living at Woodland House were reported to the Commission. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6, Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The people living at Woodland House have their care needs assessed by a staff team who understand them and have their best interests at heart. The information, care plan and assessments provided by the health teams are used to influence the home’s assessments and care plans. This should ensure that people’s needs continue to be met in a way that they expect and require. The home does not provide intermediate care. EVIDENCE: Three people who live at Woodland House had their care followed as part of this inspection. The home staff had completed an assessment of care for these people and where a social service assessment of care needs had been completed copies of these were available with that persons care plan. The Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 9 care manager and relative for one of the people whose care was followed was spoken to during the inspection. One person admitted in the last seven days had a completed assessment and care plan from the health team with their care plan information. The registered nurse had completed a pre admission assessment of need. The admission had followed in-patient assessment. The visiting relative said that they appreciated the help of the social worker who had helped them with the move. They were both getting used to their new situation, and the relative was visiting every day. Woodland House does not provide intermediate care. Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The clear care planning for individual’s care needs should ensure that staff have the information they need to care for people. However the number or deployment of staff does not always provide sufficient staff time to follow one to one support identified for some people. This may mean that although the care needs are well documented there may be times when people do not receive the care they need. Stock control of medication should ensure that out of date medication and treatments are disposed of. Prescribed treatment creams should only be used for the person they are prescribed for. By not ensuring good stock control and use of medication for the person it is prescribed for; people may be at risk of not receiving treatment that is right for them. EVIDENCE: Woodland House is a care home with nursing. They admit people who are elderly mentally infirm. People living at Woodland House have access to a Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 11 registered nurse to plan and monitor their care over 24 hour 7 days a week. The clinical registered nurse lead is a first level registered general nurse with an interest in mental health. The registered nurses have the support from an operations director who is a first level registered nurse with dual qualifications in general and mental health nursing. An Occupational Therapist visited during this inspection, in response to the requirement made at the previous inspection. Use of a special chair was advised. One was available in the home, for immediate use. The manager said that she would commission one to be made to measure for this person. A qualified staff member said that the Mental Health Team had given them guidance for Older People on the best way of dealing with problematic behaviour. This was recorded in the care plans. However it was acknowledged that agency staff do not always have time to read this before helping the person. A visiting relative commented that the staff are very kind and helpful and seem skilled in caring for their relative. However they raised concerns that there did not appear to be sufficient staff to provide one to one support to manage the challenging behaviour of some of the people in the home. They also said that some attention to detail was missing, such as providing stimulation for people that would encourage them to maintain their interests. Two health professionals commented that they felt staff at Woodland House had a good understanding of how to care for people who were elderly mentally infirm. They also commented that on occasions the number of staff available for the people living at the home had meant that people were not always given the support they needed to reduce the risk of their behaviour becoming challenging. One commented that the registered nurses at the home regularly contact them for advice, staff listen to their advice and act on what they have said. Clear care plans were in place for two people whose care was followed who had challenging behaviour. The care plan guided staff how to manage and promote the person’s wellbeing if this occurred. One relative commented that staff really understood their relative and were able to engage them in conversation and distract them if they became agitated. They also commented that on occasions when they visit, staff did not appear to have the time to spend talking to individual people or provide stimulation for them through activities. They said that they were concerned that if their relative did not receive support to encourage them to maintain their ability to take part in activities they may lose the ability to do this. One person’s health had deteriorated since the last visit to the home. They were being cared for in their own room. This person’s care plan had been updated to reflect the increased care needs. A high risk of pressure sore development had been identified. The plan of care clearly showed how this was being managed and the type of equipment needed to reduce risk. The Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 12 person had a high dependency air flow pressure relief mattress being used on their bed. However the bed they were using was of a divan style, which did not have hoist access under the bed. The care plan showed that the care had been discussed with the person’s relative and the GP had been informed of their condition. At the random inspection in September 2007 the Commission had not been informed of the drug error through regulation 37 reporting mechanism. At this visit no further concerns were identified with the recording in the drug record book. The registered nurse on duty explained the drug returns and receipt recording systems in use. The three peoples’ medication records seen had been recorded and signed as required. The reasons for people not receiving medication had been recorded. This revised system should reduce the risk of further errors occurring. The manager provided information regarding discussion she had with the pharmacy that supplied medication for people at the home. During a tour of the home two emollient creams used for hydrating skin were found to be out of date. One of these was not being used for the person it was prescribed for. These were removed from use during the inspection. A review of the medication and dressing being stored in the treatment room was carried out with the nurse in charge. Dressings being used for individual people were available for them. However some microlacx enemas being stored did not have the name of the person they were prescribed for on the box. The expiry date recorded on individual enemas and on the box was September 2007 these should have been disposed. Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff time still appeared to be taken up with the people who had behaviours that challenge. This means that other people may be denied the opportunity to have one-one support from staff. The deployment of a member of staff for lounge duty though out the day should ensure people have access to a member of staff who will be able to talk to them and encourage them. The time between meals has increased by starting breakfasts earlier and moving the lunchtime. This should enable people to have sufficient gaps between meals. People do not always have the assistance with their evening meal that they need. The manager needs to rearrange staffing to ensure more staff are available for the evening meal. EVIDENCE: The Manager said that she was in the process of appointing an activities worker. This would be beneficial to the people living at Woodland House. Staff Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 14 already working with them need training to improve their ability to engage with people. The Manager ensures that a staff member is in attendance in the lounge to respond to peoples needs and ensure their safety. They were seen to help the people they were caring for tenderly and respectfully. With guidance, they could use their time to enhance people’s lives in the lounge with a variety of low-key social activities. The manager advised that staff do carry out some activities with people in the lounge such as one to one, however this is dependant on the how the people there are responding to staff. An external activity provider visits the home two afternoons a week to provide activities for the people at the home. They provide a report at the end of each session to show what people have been taking part in and who has participated. On the day of this inspection they were providing a quiz to complete well known proverbs. Several people were taking part in this. There was a whiteboard on the wall in the lounge, but nothing was written on it. This has been used in the past to record the day, month and what is for lunch that day. There is a big clock in the lounge, which people can easily see to tell what time of day it is. A visiting relative said that the Manager keeps them well informed and sends emails if there are any concerns. Another relative spoken to during the inspection said although they let the manager or person in charge know when they are going to visit to take their relative out they are not always ready when they arrive. They said this means that the time they have to spend outside the home with their relative is reduced. Lunch had been put back to 1pm since the last inspection, to give people a gap between meals. At 11am on the day of this inspection, three people had not had breakfast – one of these was ill in bed, and not managing meals, and one other prefers to rise late. The third person was being visited by their social worker and relative for a review. They raised concerns that sometimes their relative has to wait too long for help to get up and dressed. The cook was seen preparing fresh vegetables and said that fresh fruit is used for puddings. The company provide four-weekly menus, which show a choice of main meal. At Woodland House these are provided alternately, so that people are not offered a choice but have a wide variety of meals. The cook is prepared to offer alternatives, and keeps a ‘change book’ to record when an alternative has been provided – but no entry had been made since 21/10/06. Residents ate porridge and toast and marmalade for breakfast, with tea. Staff agreed that people enjoy their food, and that liver, sweet and sour chicken, and lasagne have been found to be popular recently. Puddings go down very well. The three people whose care was followed had nutritional risk assessments completed, their plan of care guided staff how to promote good diet. They had Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 15 a record of their weight recorded each month; this should enable staff to identify problems sooner. Nutritional supplements were provided for people who needed them. There was evidence that the advice of the community dietician had been sought for people who had been identified as being at risk. Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The people who live at Woodland House and their representatives can have confidence that any concerns they have will be dealt with sensitively by the staff team. However it is unclear if staff have confidence or are encouraged to raise concerns about care practices in the home with the manager, as there were no records being kept of the actions taken when staff had raised concerns. EVIDENCE: The Manager had received a concern from a relative that not enough activities were provided. She increased the provision of entertainment within the home. It would be good practice to keep a record of concerns expressed, and any action taken in response. A clear complaints policy and procedure was provided for people at the home and their representatives. This was displayed in the reception area of the home. People asked said they knew who to speak to if they had a concern. They also said they felt they were listened to, however not all felt that their concerns had been addressed adequately by the manager. The lack of provision for activities that would stimulate their relative and keep them interested was one of the comments made. Two commented that the staff were very helpful and friendly and understood their relative. However they Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 17 also commented that they would like to see more staff provided who would be able to sit and talk or take part in activities with their relative. The manager advised that she had interviewed a new member of staff who would be employed as an activities co-ordinator for people in the home. At the last inspection the manager was asked to ensure staff understood the whistle blowing policy and how they should raise concerns. The whistle blowing policy had been revised and a copy was available for staff. However a record of the actions taken when a staff member raised concerns had not been kept. The manager has introduced a robust recruitment policy and procedure, which should protect people from unsuitable staff. The staff files seen during the inspection evidence that good recruitment practices have been followed. Staff had two references and a record of a police check completed before they started work at the home. A record of staff training showed that staff had update training for the protection of vulnerable adults. Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The improvement to the environment has continued to ensure that people live in a clean pleasant environment. The bathrooms people have access to were not all fully functioning or well maintained. In order to ensure there are sufficient baths available for people these should be rectified as soon as possible. Some people who require physical nursing care in bed have not been provided with the most suitable equipment, this may mean that staff are not able to provide care easily in the way the person needs. EVIDENCE: The home has a large communal lounge and separate dining room, both of which were being used by people living at home and their relatives during the inspection. Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 19 The areas people who live at home have access to have continued to be refreshed and redecorated since the last inspection. New furniture and vanity units have been provided in some peoples rooms. One relative commented that a new wardrobe had been provided for their relative’s room. The manager advised that the replacement carpet for the lounge and corridor in the home, which had faded would be replaced this month. (The operations manager confirmed this had been completed prior to the publication of the report) The security of access to stairs had improved with the addition of a stair gate to the lower ground floor. Each stair gate had a lock. This should reduce the risk of people using the stairs unattended. The shared rooms in use had screening provided. People had separate wardrobes and dressers for their personal clothing. Toiletries for individuals had been stored in separate areas in one shared room viewed. People who live at Woodland house have access to toilets, which are within easy reach of the lounge, dining room and their individual accommodation. However the bathroom on the first floor was in need of up grading, as there were some damaged tiles and paintwork, and stains on the ceiling. There was chipped enamel in the bath, posing a hazard with regard to infection control. This should be dealt with promptly. The disabled access bath on the lower ground floor was still out of action because of problems with plumbing. The manager advised that she was hopeful the fault had been rectified and they would be able to use this bath again soon. Bad odour was found in one toilet, which was known to the Manager, who said that it was due to be up-graded. (The operations manager confirmed this had been completed prior to the publication of the report) The other odour developed through the later morning in the lounge, and was thought to be an issue of personal care rather than the environment. Several of the individual rooms provided at Woodland house have en suite facilities. Peoples rooms entered during the inspection had been personalised with items of their choice. These included photographs, ornaments and small items of furniture. The staff had access to gloves and aprons for use when attending to personal care for individual people. Staff were observed using these when attending to personal care for individual people during the inspection. A Waste Disposal Company disposes of clinical waste for the home. The manager advised that training provided for staff included infection control. Infection control policies and procedures were available staff. The laundry area was situated away from the areas where food is prepared. A disinfecting sluice was provided for cleaning of commode pots Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staff are friendly and supportive as they care of individual people living at Woodland house. However the number of staff provided, or the way they are deployed to care for the people living at Woodland house means that individuals may not always receive the care they need. Further training in social engagement with people with dementia needs to be provided to enhance the lives of residents at Woodland House. This would ensure that people are cared for by staff who have a greater understanding their condition and know how to engage with them. A clear staff recruitment policy is followed; this should ensure people are protected from unsuitable staff. EVIDENCE: A staff rota was supplied. It showed that as well as a Registered Nurse on duty at all times three care staff are employed from 8 – 2pm, and two from 2 – 8pm. One carer assists the Registered Nurse by night. The Manager is normally additional to this, 8 – 5 Monday to Friday. Some staff have worked at Woodland House for a long time, and their consistency was appreciated by a relative who has been visiting for several years. A cook and a cleaner are also employed, but their hours were not shown on this rota. The rota for these staff is recorded and kept separately in the Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 21 laundry room. No groups of people living at Woodland House were left unattended during this inspection. Relatives said that their family members did not always get attention when they needed; they said they believed this was due to there not being enough staff available. Staff considered that the workload could be managed when the staff on duty are competent and well motivated, but not all colleagues work as well as this so some days do not run so smoothly. This results in a poorer atmosphere and some people having to wait for attention. More staff are needed at teatime. Residents can be restless at this time, there is no cook on duty until 8 am, and some staff have been on duty since 8am and may be tired. The person who worked the ‘sleeping-in’ shift, and worked with the night staff from 5 pm –11 pm and 5 am – 8am has left Woodland House, and not yet been replaced. This leads to delays and lack of attention for people who are waking at this time. They are also not available to assist with the evening meal. A way of providing care and safety must be found immediately, while the new appointment is arranged. A training matrix was supplied. This showed that since the inspection in September 2007 training had been provided in Moving and Handling, Protection of Vulnerable adults, health & safety, dementia awareness, and infection control. It showed that of the nine care staff listed, six had achieved or were engaged in training for the nationally recognised qualification, NVQ2 in Care. However, one of the four Senior Carers did not have this. Observation of staff showed that they would benefit from further training in dementia care. No unsafe moving and handling practices were seen, but it was considered that staff could have talked to the client more when using the hoist, for reassurance and dignity of the person. The training session they attended may have enhanced their understanding of people’s conditions, but they could improve their ways of observing and engaging with people. The files of two recently appointed staff were examined. They contained proof of identity, and two written references, which had been checked by phone. Criminal Record Bureau checks had been obtained. The right of overseas staff to work in Britain was recorded, and ability with use of language was included in the interview record. A new recruit who had not worked in care previously was given weekly supervision sessions throughout their initial induction training. They had engaged in training for NVQ2. The matrix enables the Manager to see which staff need to be up-dated, and shows that mandatory training has been provided on a continuing basis. In the porch there is a notice on display, saying that aggressive behaviour will not be tolerated. As this is a nursing home registered to care for people with dementia, we can properly expect staff to be trained and able to deal with behavioural problems. The training matrix shows that the Manager has attended a course (December 2006) in dealing with violence and aggression. Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 22 All care staff, starting with qualified staff and seniors, should be prepared in this way. Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. By not ensuring the deployment and/or numbers of staff provided are able to meet the needs of the individual people living at Woodland House, the manager may be putting the welfare of the people and staff at the home at risk. The introduction of a member of staff to remain with people in the lounge and/or communal areas during the day appears to have reduced the number of un-witnessed incidents and accidents. This provision of a staff member in the communal areas should ensure people are protected. Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 24 EVIDENCE: The manager has been registered by the Commission as manager for Woodland house nursing home. A clinical lead supports the registered manager. The clinical lead is a first level registered nurse; they take responsibility for peoples health care needs. Not all the requirements made at the last inspection have been met. The manager advised that she was working towards addressing these and the recommendations made at the last inspection. The way one person’s money was being managed by the home was discussed with the manager. The manager advised that the person’s relative regularly left money with them for anything their relative may need. The manager was keeping receipts for expenditure on behalf of this person and a record of the money provided by the relative. However when records were checked this had not been kept up to date. The manager up dated this during the inspection and the money held was checked against the records the manager had made. The manager was reminded that it is essential to keep the record of expenditure up to date at all times. The manager advised that none of the current people living at Woodland house could manage their own money. She further commented that it is company policy that families are encouraged to do this on behalf of the person where possible. A selection of records kept in a home were viewed during the inspection. Each person whose care was followed had a plan of care that had been reviewed and updated regularly. The plan of care had been developed from a full assessment of need, which included health professionals assessments provided prior to their admission to the home. The records of maintenance for equipment were seen at the previous inspection. These showed that equipment is serviced in line with manufacturers recommendations. The manager confirmed that all staff had an annual appraisal, and all care staff had already received three or four supervision sessions. Records were seen, but some were typed with no change from the previous session. Some recent records were hand written and showed that good performance had been appreciated and training needs discussed. Relatives spoken to during the inspection said the manager was approachable and they felt able to speak to the staff about any concerns they had about their relative. Some raised concerns about the number of staff on duty each day. One said that staff time appeared to be taken up with people who required one-to-one support. They also said this appeared to leave very little time for other people who would benefit from staff interaction to stimulate them. Two relatives spoken to said that they would like to have more meetings at the home. Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 25 Policies and procedures are available for staff in the office. The Commission has not been kept informed of all the incidents and accidents in the home that have adversely affected the people living there. Copies of four incidents, which fell into this category, were not provided through the Regulation 37 notice procedure. Accident records were seen with the care planning information for those people whose care was followed. These included body maps for the injury caused by the incidents. These are completed in line with good practice. The manager confirmed that she regularly reviews of records of accidents to see if any action needs to be taken to address the identified risks. The accident/incident record from May 2007 – October 2007 were taken to review. During this time several un-witnessed injuries and incidents occurred. Following a meeting with the manager after the last random inspection a member of staff has been deployed in the lounge at all times during the day. The accident/ incident records for the period after this had been introduced have reduced. Since September 2007 the manager regularly provides information about un-witnessed incident/accidents that have happened in the home. Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 26 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X 2 X 2 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 3 1 2 Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 27 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 OP9 Regulation 13(2) Requirement Medication and treatments, which has passed their expiry date should be disposed of in a timely manager. Treatment creams must only be used for the people they are prescribed for. 2. OP15 16(i) People living at Woodland House 05/01/08 must have the support they need to eat their meals and maintain their nutritional intake. There must be sufficient staff on duty for the evening meal times for people who require assistance to eat and meet individual people’s care needs. (Previous time scale 01/08/07 & 5/11/07 not met) Because work has been done and deployment of staff has been changed to partially address this; the time scale has been further extended. 3. OP27 18(1)(a) The numbers of staff provided for each shift must be sufficient to meet the care needs and DS0000028763.V355173.R01.S.doc Timescale for action 05/01/08 05/01/08 Woodland House Nursing Home Version 5.2 Page 28 dependency of the people living at Woodland House. Additional care staff are needed, so that a carer is on hand at all times to assure peoples safety. Staff shortages make people vulnerable to aggression from other people living at the home, and some people need supervision to avoid risk to them selves. (Previous time scale 01/08/07 & 05/11/07 not met) Because work has been done and deployment of staff has been changed to partially address this; the time scale has been further extended. 4 OP37 37(1)(e) The Commission must be notified 05/01/08 of all untoward incidents and accident which adversely affect the people living at Woodland House 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. 3 Refer to Standard OP3 OP7 OP12 Good Practice Recommendations Social care assessments should be followed with a plan of care to address the person’s social care needs People’s plans of care should include a social care plan. People living at Woodland House must be provided with opportunities for stimulation through leisure and recreational activities that have regard for their care needs and abilities. People should be given the opportunity to maximise their personal choices. DS0000028763.V355173.R01.S.doc Version 5.2 Page 29 4. OP14 Woodland House Nursing Home 5 6. OP24 OP33 Height adjustable beds should be provided for those people who need them. Results of quality audits should be made available to the Commission, the people who live at Woodland House and their representatives. The manager should ensure that the way staff are deployed and/or the number of staff provided each shift protects the welfare of the people living at Woodland House. Awareness training should be provided for staff on the homes policy and procedure with regard to Whistle blowing. There should also be sufficient staff to allow more time for individual attention, in order to develop their understanding of peoples needs, and provide individual social activities and attention. Staff should receive training regarding how to improve their ways of observing and engaging with people who have cognitive impairment (i.e. Dementia) and behaviour that challenges the service. 7. OP38 8. OP18 9. OP27 10 OP30 Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Woodland House Nursing Home DS0000028763.V355173.R01.S.doc Version 5.2 Page 31 - 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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