Inspection on 17/08/09 for Woodland House Nursing Home

This inspection was carried out on 17th August 2009.

CQC found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Woodland House Nursing Home 17/09/08

Woodland House Nursing Home 12/11/07

Woodland House Nursing Home 07/06/07

Woodland House Nursing Home 20/07/06

Woodland House Nursing Home 11/10/05

Woodland House Nursing Home 19/04/05

Woodland House Nursing Home 17/11/04

Woodland House Nursing Home 21/09/04

Woodland House Nursing Home 11/08/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Woodland House Nursing Home Middle Warberry Road Torquay Devon TQ1 1RN Lead Inspector Clare Medlock Key Unannounced Inspection 17th August 2009 09:00 DS0000028763.V377160.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Woodland House Nursing Home DS0000028763.V377160.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 woodlandhousemanager@adlcare.com Woodland Healthcare Ltd Vacant Care Home with nursing 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.V377160.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. 17th September 2008 2. Date of last inspection Brief Description of the Service: Woodland House is a nursing home that provides personal and nursing care to up to 30 people who suffer from dementia type illnesses and/or physical disabilities. The majority people at the home are elderly with dementia type illnesses, sometimes these people have challenging behaviours associated with their illness. The home is located in the quiet suburb of Wellswood, which is approximately one mile from the town centre of Torquay. The home is a large period property with many large rooms. Eighteen (18) bedrooms are single rooms and six (6) shared rooms. Private accommodation is arranged 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 can be found in the entrance hallway of the home Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 5 along with the latest inspection report. Fees are dependant on care needs and range from approximately £500-£580 and do not include chiropody, hairdressing, personal toiletries, and clothing. Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. Prior to this inspection we sent surveys to people who use the service (or their relatives if they were unable to complete the survey)-the findings of these surveys are incorporated into the report. We also sent surveys to staff who work at the home, these findings are also incorporated into the report. We inspected this service with an ’expert by experience’. The Care Quality Commission (CQC) consider an expert by experience as a person who either has a shared experience of using services or understands how people in this service communicate. The expert visited the service and spoke with four people and one visitor. This helps us gain a picture of what it is like to live in or use the service. Prior to this inspection we requested and received (within timescales) a completed annual quality assurance assessment (AQAA). The AQAA is a selfassessment record that focuses on how well outcomes are being met for people who use the service. It also gives us some numerical information about the service. The key inspection to the home was performed on 17 August 2009. During the inspection we spoke to the three ‘managers’ at the home. We also spoke with one person, two visitors and four members of staff. We case tracked three people who use the service. This means we looked in detail at the care these people receive. We spoke to staff about their care, we looked at records that related to them, and made observations if they were unable to speak to us or provide feedback. We looked at care plans, maintenance records, staff recruitment records, training records and policies and procedures. We also looked at the quality assurance programme performed at the home. We did this because we wanted to understand how well the recruitment, safeguarding and quality systems work and what this means to the people who use the service. All this information helps us to develop a picture of how the home is managed and what it is like to live at Woodland House nursing home. Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 7 What the service does well: The admission process followed at the home is very good, which means that people and their relatives have the information they need to decide whether Woodland House is the right home for them to move into. Staff perform indepth pre-admission assessments to ensure they are able to meet the person’s needs before they are admitted to the home. The health and personal care people receive is good and provided in a safe way. The improved care planning systems and documentation at the home are good and mean that staff know how to care for somebody in a safe and consistent way that meets their individual needs and preferences. Medication systems are well managed at the home. Staff at the home ensure people see healthcare professionals when they need to. Relatives tell us they are happy with the care of their relatives received at Woodland House. People have access to an improved activities programme and are able to maintain contact with their family and friends. People appreciate and enjoy the activities provided at the home particularly the 1 to 1 sessions and the small pets that visit the home. The food is very good at the home and any issues regarding dietary requirements, preferences or weight issues are effectively and sensitively managed. People who use the service and their relatives can be confident that if they complain their concerns will be listened to and acted on appropriately. Complaints are seen by staff at the home as a way of improving the care and services provided. Staff are aware of how to prevent and report any abuse, and who to report allegations. The use of equipment that can be perceived as restraint is done so only after careful consideration to show that the decision to use such equipment is in the best interest of the person. Recruitment, induction and training is good at the home and means that vulnerable adults are cared for by a stable group of staff who have had the necessary pre-employment checks, and training in order to provide care in a safe and effective way. The staff group are popular with people who live at the home, and their relatives. People say the staff work very hard. Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 8 The home is a safe and clean place to live and work. Maintenance systems are very well managed and an improved level of decor and furnishings is provided at the home. What has improved since the last inspection? What they could do better: The provider must make arrangements to appoint an individual to manage the care home. The provider should ensure this manager is responsible for no Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 9 more than one registered establishment and must ensure that the health and welfare of people in the home are protected by introducing clear lines of accountability and leadership at the home. Activities at the home should also continue to be improved, ensuring that activities are not delayed because of staffing issues or lack of defined roles. Staff at the home should ensure the privacy and dignity of people is protected at all times, especially when being transferred in a hoist. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 10 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.V377160.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission procedure is good and means that people and their relatives have enough information to decide whether the home is the right place for them to be. The pre-admission process is good which means staff have sufficient information to decide if they are able to meet the needs of the person. EVIDENCE: The relatives we spoke to said they had involvement in the admission process and were given enough information. One person told us they were unaware of why she was at the home but care plans clearly showed the reasons for their admission and showed family had been involved in the admission. Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 12 Surveys sent to people who use the service asked: Did you receive enough information to help you decide if this home was the right place for you, before you moved in? Three people ticked yes one ticked dont know. The statement of purpose and service user guide had been updated since the last inspection and reflected the changes at the home and the changes within the CQC. The AQAA stated ‘We have incorporated more visual features into our information file and given more detail regarding our services. The new format of our statement of purpose is more definitive and easy to read with less duplication. We have a relative’s chairman who had involvement of the information in the statement of purpose. At present he is taking photographs of the home which he believes will provide a better view.’ At the inspection these photographs were presented by the relative and provided visual information of what rooms looked like. One of the managers stated that it was the intention to provide people with these images prior to then visiting the home. Each person is assessed by nursing staff at the home before they are admitted. Pre-admission assessments were well completed, detailed and used to form the initial care plan. Information from healthcare professionals and social services is also used in writing the initial care plan. The home do not provide intermediate care, but do provide respite care. Each person is provided with the written contract from the home which contains the room to be occupied, fees charged and other responsibilities of both the home and person. Surveys sent to people who use the service asked: have you being given written information about the homes terms and conditions (sometimes called a contract)? All respondents ticked yes Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care people receive is good. The improved care planning systems mean that people have their health needs identified and met in a safe and consistent way. The management of medicines is performed well at the home. EVIDENCE: People we saw appeared well cared for with finer details of care provided- for example appropriate foot wear, glasses, hearing aids etc in place. Ladies hair had been styled appropriately and some ladies had finger nails painted. The gentlemen were cleanly shaven. Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 14 Surveys sent to people who use the service were completed by relatives in some cases. These surveys asked: Do you receive the care and support you need? Two people ticked always two people ticked usually. Surveys also asked: Does the home make sure you get the medical care you need? One person ticked always three people ticked usually. People living at Woodland House have access to a range of health care services both at the home and in the community. People have access to local and national NHS services and routine screening programmes. Each person is allocated a General Practitioner who attends when staff request. We saw records of healthcare professionals’ visits including community psychiatric nurses, speech and language therapists, occupational therapists, chiropodist and social workers. Accidents at the home are well-managed and recorded to show what action has been taken. Although people were unable to tell us what care is like at the home, relatives told us in the surveys but they were ‘happy with the care their relative received’. Observation confirmed the majority of interactions were positive between staff and people at the home. People were encouraged to wander and staff used diversionary techniques to prevent the escalation of some behaviour. Staff were observant and able to recognise when a person was becoming distressed. Staff were seen to work at an appropriate pace for people in the home and appropriate displays of affection were used. Surveys asked people to comment about care at Woodland House. One comment read: Woodland House is obviously an EMI (elderly mentally infirm) house. As such, probably none of the residents (patients) are unable to read and fill in questionnaires. My observations, based on a very regular visits to Woodland House (each day for at least one hour) is that considering the nature of the residents conditions -- i.e. not able to explain how they feel or what they feel they need, the staff do an excellent job in what was a very trying and difficult environment. 90 of the time they guessed right as to the residents needs. Health care needs are communicated both verbally between staff and within care plans. Care staff said they were fully involved in each hand over and fell communication regarding people in the home was very good. Care is also monitored in well written care plans. Care plans have greatly improved since the last inspection. Each person has a plan, which sets out his or her specific needs. These need include long-term needs and short term needs. One example was of a person that sustained an injury. The injury and treatment of this was then clearly recorded in the care plan. Each care plan contains assessments for issues such as falls, nutrition, moving and handling, skin care and more general risks. Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 15 Risk assessments are also completed when bed guards (bed rails) has been considered. These assessments are well written and show that good practice guidelines have been followed. The maintenance man also showed records of weekly observation checks of bed rails and the tool used to ensure the risk of entrapment is reduced or removed. People who were being cared for in recliner chairs appeared comfortable. Care plans show that that the decision to use reclining chairs, which the person is not able to get out of independently, was well recorded and made in the best interest of the person and involvement of occupational therapy colleagues. Specialist health care professionals are sought for advice and guidance when needed. Visits by health care professionals are recorded within the care plans and social care plan also records the life history and life story of each person and the activities that each person has been involved in and their response to the activity. The management of medications is performed well at the home. Medications are stored in locked trolleys or locked cupboards. The clinical nurse manager is responsible for the management of the medication from receipt into the home to disposal. Medication storage areas were clean tidy and securely stored. Fridge temperatures are recorded daily and recorded adequately. The records of administration were clear. Patient information leaflets, homely remedies policy, specimen signatures, and controlled drug records were well maintained. A spot check of controlled drugs showed that the system was robust and well-managed. People were encouraged to move freely around the home if they were able to. Walking aids, such as zimmer frames were available. Surveys sent to people in the home asked what the home does well? One comment read: the home helps residents to keep as mobile, happy and contented considering their individual needs and desires. Staff surveys also asked what the home does well. Comments included: ‘the carers work hard to see that the clients are looked after and cared for, with the facilities that we have’ and ‘I feel as a home our clients are very well groomed daily: teeth, hair, nails, hygiene needs and we always respect their needs.’ We saw staff transfer people from wheelchair to chair using a hoist. Although this was done safely, attention to privacy and dignity was not always noted by staff. One issue regarding poor practice was addressed with the member of staff at the inspection. Our expert noted ‘At one point staff seemed to have difficulty with operating the slings on the hoist.’ During the inspection it was also noted that it Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 16 appeared that footplates on wheelchairs were brought into use as an afterthought rather than when people were first transferred.’ these issues were fed back to the managers who gave assurances that staff had been informed about the use of foot plates and training had been given regarding moving and handling but reminders about these issues would be given. Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The improvements in the activities programme are beginning to provide people with meaningful stimulation and entertainment. Further improvements would ensure staff have opportunities and time to facilitate the activities programme. EVIDENCE: Staff surveys asked what could the home do better? Many comments included ideas regarding improving the activities for people at the home. One comment read ‘More activities for the clients. It is always written down but never done’. Since these surveys were sent out staff told us that a member of care staff has been allocated to be responsible for the activity programme, and this has improved over the last two weeks. Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 18 Other activities seen during the inspection included an informal sing along session. Certain music prompted some less responsive people to foot tap and hand tap in time with the song. Some songs triggered one person to sing along. According to a programme on the office window many parts of most days are occupied but closer inspection revealed that these “activities” include watching television programmes and looking at books and magazines etc. A member of staff has recently been allocated 1 hour in the morning and 2 hours in the afternoon Monday to Friday for “activities”. However, it was noted this member of staff also works as a member of the care team, and only facilitates activities when care duties have been completed. A discussion was held regarding the benefit of having defined roles, so designated time can be given to activities. During the morning the activity person was seen to be encouraging people to pass, bounce and throw a large balloon around the lounge. This was being enjoyed by some people. She mentioned that she had also been trying to find suitable song CDs in charity shops without success. In the afternoon the activity member of staff was seen to perform excellent one to one discussions with some people at the home. This was sensitively done and achieved high quality stimulation for the person. Discussion with the activity member of staff confirmed that fund-raising was in progress for activity equipment, and new ideas were being discussed to improve the quality of the activity programme. We were told a professional activity company visit 2 or 3 times a month. Recently, there had been a visit from a singer and also by a man with small animals that could be stroked. Staff said the animals provoked very positive responses from people and has now been booked to return regularly to the home. The AQAA stated in regard to activities ‘we intend to expand upon our existing work and provide even more specific activities to suit individuals and their conditions. This will involve liaising with other agencies, contact with the Bradford dementia group and Alzheimers Society. The therapies we intend to focus on are: spiritual, sensory and relaxation, music, pet therapy, doll therapy and teddy therapy, family support, and creative groups.’ The AQAA also highlighted more areas where the home could improve including the use of memory boxes and including more information in the lifestyle care plans. Currently there are no visits from religious organisations but one manager is hopeful that this will change following enquiries. Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 19 The majority of interactions we saw were respectful and promoted peoples dignity. People were called by their chosen term of address. Staff were seen and heard to knock on bedroom doors and wait before entering. Visitors and relatives told us they were always made to feel welcome at the home and were always offered a cup of tea and welcomed to help care for their relatives. Relatives said staff ask them to sign the visitor’s book for fire safety reasons. Surveys sent to people who use the service asked: Do like the meals at the home? Two people ticked usually to people ticked always. Hygiene within the kitchen area had improved since the last inspection. Cupboards were tidy and well organised work surfaces were clean and kitchen systems work well maintained. The cook has been issued with aprons to improve hygiene within the kitchen. The cook was knowledgeable about dietary needs of each person. Care plans contained information regarding nutritional needs for each person. Speech and language therapists are consulted by people have problems swallowing, and dietary supplements are provided for people who are underweight. On the day of the visit the lunch consisted of either ham and egg or beef stew with dumpling, cabbage, peas and sauté potatoes, followed by pineapple sponge and custard. The plated food was hot, tasty and well presented and the beef was very tender. The cook explained that all the meat, fish and most of the vegetables are procured locally from trusted suppliers to ensure good quality and freshness. Some people ate in the pleasant dining room and others in the lounge either in their armchairs or at a table in the window overlooking the garden and car park. Staff informed us that the dining table in the lounge was a new idea and proving popular with a small number of people at the home. Carers and the manager were seen to assist diners in a gentle and relaxed manner sitting beside them and engaging with them on a one to one basis. Pureed food was attractively presented in separate portions. The AQAA read ‘we have decreased the amount of clients losing weight by intensifying to our efforts in the areas of understanding nutrition and diets’. Surveys sent to people who use the service asked how the service could be improved: one comment read- ‘Small improvements that mealtimes would probably require extra help at those times to enable some of the residents to eat (with help)’. The AQAA received after these surveys stated ‘Our routines have improved during the client observation period and has resulted in the rostering of an additional staff member at mealtimes’. Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that complaints will be well managed at the home. Staff knowledge and training helps to protect people from abuse and had improved documentation clearly shows why forms of restraint have been made. EVIDENCE: Surveys sent to people who use the service asked: Is there someone you can speak to informally if youre not happy? All respondents ticked yes. One comment read ‘there is always somebody I can speak to although this changes regularly at the moment’ This comment refers to three people acting as manager at present. This issue is addressed within the management section of the report. Surveys also asked relatives: Do know how to make a formal complaint? All respondents ticked yes. These findings were also supported during discussions with relatives at the home. One relative said minor issues are dealt with straightaway said they do not become complaints. Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 21 Staff surveys asked: Do you know what to do if someone has concerns about the home? All staff ticked yes. The Care Quality Commission have not received any formal or informal complaints regarding Woodlands House in the last year. The complaints register at the home confirmed staff have received four complaints, all of which are minor issues which have been dealt with appropriately within timescales. Staff spoken to knew how to recognise and report allegations of abuse at the home. Staff also had posters and information available on how to report allegations outside of the organisation. Staff said they had received training on the protection of vulnerable adults, and had a CRB and POVA checks performed before they were employed. During the inspection we saw bed rails being used. Care plans clearly showed how the decision making process had been made, and showed good practice guidelines had been followed including the use of health care professionals outside of the organisation. We also saw one person being restrained in a recliner chair. Care plans also showed how and why this decision was made and clearly demonstrated an occupational therapist had measured the person and provided the specialist reclining chair for their use. Our expert asked: Do you feel safe at the home? Those spoken with indicated that they felt safe apart from one person. This person gave specific details. After reading care plans it was confirmed that these allegations were being managed appropriately by staff at the home and healthcare professionals. Further discussion with the clinical nurse manager and another manager confirmed meetings had been held and appropriate action was being taken. A discussion was held about the importance of treating each new allegation seriously, which assurances were given, are done. Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,25,26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is a pleasant, clean, and safe place to live and work. EVIDENCE: A tour of the home showed that the environment was a safe and well maintained place to live and work. The programme of routine maintenance and renewal of the fabric and decoration of the premises had continued and increased since the last inspection. Many internal communal areas had been refreshed by redecoration some bedrooms had been refurnished and the garden area had been attended to with new railings inserted to provide a safe outside space for people to sit safely. Fabric had been purchased in preparation for new curtains to be made. Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 23 A rolling programme of providing more adjustable beds has commenced. Staff informed us that many adjustable beds have been purchased and one bed every other month will be purchased unless a person is admitted who needs one before this time. All areas of the home were clean, tidy and free from obvious risks. Furnishings throughout the home were of a good standard. All bedrooms visited were clean, tidy and contained varying amounts of personal memorabilia and furniture. The AQAA stated it is the intention to increase the personalisation of each persons room. Since the last inspection a new maintenance man has been employed on a part time basis. He attends to ad hoc day to day repairs using a maintenance log completed by staff. In addition to the daily repairs the maintenance man has a responsibility to perform regular checks on fire equipment, emergency lighting, call bell systems, wheelchairs, bed rails, and water temperature. The maintenance man was able to confirm that since a recent fire department visit the fire systems had been increased to meet new legislation. People were asked whether the home was always fresh and clean. Three people ticked always, one person ticked sometimes. The standard of hygiene within the kitchen areas had improved since the last inspection. Cupboards were well organised and clean. Maintenance records and quality assurance records were well maintained and show regular checks are performed to ensure compliance with health and safety issues. All areas of the home were clean. Protective personal equipment such as gloves, aprons, soap, hand gels and hand towels were present throughout the home and were being used appropriately by staff. Laundry facilities were very well organised despite the small space and contained equipment suitable for washing items of foul laundry. Sheets, towels and other bedding are sent to an external company for laundering. The laundry manager informed us of the process followed to maintain hygiene whilst managing items of foul laundry. People who use the service are free to wander all areas of the ground floor. Stair gates had been provided to prevent people using the stairs unattended. Each stair gates has a lock, which could be removed without key in the event of a fire. There are shared rooms within the home where screening is provided. People have separate wardrobes and dressers for their personal clothing. Toiletries the individuals provide had been labelled and stored in separate areas. Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 24 People who live at Woodland House have access to toilets, which are within easy reach of the lounge, dining room and their individual accommodation. Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are cared for by staff who have had appropriate pre-employment checks, induction and training performed. Continuing to monitor staffing levels would ensure people have their needs met. EVIDENCE: On the day of inspection there were 23 people living at the home. Off duty records confirmed that generally there is at least one registered nurse and 3 to 4 carers on duty in the morning. In the afternoon there is always a registered nurse and to 3 carers and at night there is one registered nurse and one care on duty. In addition to these numbers additional maintenance staff, kitchen staff and domestic staff are also employed. Staff surveys asked: Are there enough staff to meet the individual needs of the people who use the service? Two members of staff ticked usually two members of staff ticked never. Since the receipt of these surveys the AQAA was received, which informed us that Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 26 additional staff have been deployed at mealtimes to assist people with their meals. During the time of our visit, the staff appeared to be fully occupied with care duties with seemingly no time to engage with people who use the service. A visitor commented, “Generally there are enough staff but when someone is away there can be problems and whilst everything gets done it is all at a later time than normal. The staff always seem to be pushed to get through their work”. During the inspection this was confirmed when the activities coordinator was late finishing her care duties and therefore this had a knock-on effect on the activities provided. Staff told us ‘due to the client group some days people are assisted to get up with plenty of time to spare, where as on other days this takes longer’. Staff surveys asked: Did your employer carry out checks, such as your CRB and references, before you started work? All respondents ticked yes. These findings were confirmed with the inspection of staff files. Each member of staff had completed an application form and provided a photograph. Staff undergo criminal records bureau checks (police checks) and protection of vulnerable adults checks before they are employed. Two written references are obtained and proof of identity checked by looking at birth certificate, passport, driving licence or utility bills. Staff who are employed from overseas provide evidence from the Home Office that they are suitable to work in the UK at Woodland House. Staff were also asked: Did your induction cover everything you need to know to do the job when you started? One ticked very well three ticked mostly. One of the managers provided an induction and information booklet which uses a nationally recognised induction programme. Staff were also asked: Are you being given training that: Is relevant your role -- all respondents ticked yes Helps you understand and meet the individual needs of people -- all respondents ticked yes Keeps you up-to-date with new ways of working? -- all respondents ticked yes Gives you enough knowledge about health care and medication? -- all respondents ticked yes. The majority of staff told us they thought the training at the home was very good. More than one member of staff talked about the ‘excellent’ dementia correspondence course that had been arranged by the home. Staff told us the information learnt from this course was invaluable and they were already implementing what they had learnt into the workplace. All staff said that they had received mandatory training within the last year and said this training was good. One member of staff said sometimes the quality of training is rushed and not as good as external training they had attended the past. Staff said they were encouraged to attend NVQ training and were supported in accessing this. Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 27 Staff told us there is a company training manager who visits the home regularly to refresh mandatory training. Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 28 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there are management systems in place, one appointed registered manager would provide staff with a clearer sense of direction and leadership. EVIDENCE: Staff told us that generally morale had improved since the last inspection, and the turnover of staff has reduced. However, information from speaking with staff, relatives and staff surveys informed us that the present management structure sometimes provided lack of clear direction for staff. Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 29 Since the last inspection the registered manager had left the home. The provider has been proactive in seeking a replacement but has been so far unsuccessful. In the interim, part time temporary cover has been provided by another manager from a sister home in Torbay. In addition to this an operations manager for the organisation has attended the home on a regular basis. The clinical nurse manager has also been present throughout this period of time. Comments received from speaking with relatives, staff and staff surveys included ‘We need improved communication between the managers and carers. We do not have a permanent manager of the home at the moment. I feel our home comes second to the managers other home and we do not get the attention we need from a manager- or the right support.’ Another comment was ‘There are too many chiefs and not enough Indians. New ideas are being given all the time but not always practical with our client group or staffing levels.’ Whilst a further comment read: ‘At the moment there are too many people we are to call managers. They all give us different orders at the same time which is confusing. I feel we are not given the support we need and are very often not listened to when we have any concerns. It is often passed from one manager to the next and then forgotten’. At the inspection we were also told ‘The managers are all nice, but there is too many of them, they all have their own ideas. It will be better when H is here’ Staff surveys asked: Does your manager give you enough support to meet you to discuss how youre working? One member of staff ticked regularly, two members of staff ticked sometimes and one member of staff ticked never. Staff spoken to at the inspection were also mixed about the amount of support and supervision they received. One member of staff said they had not received supervision recently ’because of all the changes’. The AQAA question what could be improved in the management and administration? read: Define who is in charge? Once this is agreed -- update the job description to reflect this’. At the inspection staff told us that within the last week a decision had been made to nominate one person as the manager for the home. All staff spoken to were complimentary about this manager. This manager stated that she intended to complete the application form in the next few weeks and gave assurances that this would be submitted to the Care Quality Commission as a matter of priority. Not all comments were negative about the management structure. One comment in a staff survey read ‘I feel very supported with the new changes in the home and look forward to progress’. Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 30 When asked about the management of the home, one visitor commented, “The new manager had come with energy and promises of many improvements but this has tailed off”. Other relatives did not express an opinion but one relative said they were aware of who to make a formal complaint to but this depended on who was acting as manager at the time. Despite the negative feedback regarding management of the home, many improvements have occurred since the last inspection. Effective quality assurance programmes are in place to ensure the home is run efficiently. Quality assurance of maintenance of the home is conducted by the maintenance man and audited by the organisation quality maintenance representative. Inspection of office documents showed that regular checks had been performed at the home with the exception of Legionella prevention checks, however records showed that this had been referred to a company director for action. The maintenance man was keen to explain that the home were now compliant with new fire legislation following new smoke detectors and fire equipment being installed at the home. An in-depth quality assurance programme and business plan are performed well at the home. This document looks at information produced in regulation 26 visits, business plans, accident records and regulation 37 notices. A detailed training matrix is provided each year to show that staff attend annual training in moving and handling, health and safety, infection control, fire safety and first aid. Staff told us the organisation has a training manager who visits the home on a rolling programme to renew training. Staff told us that training was very good at the home. Communication between the Care Quality Commission and the operations manager has been good. Notifications are sent promptly, and the AQAA has been completed by the operations manager and sent within timescales. We were told staff at the home do not handle personal money for people in the home. Where services such as hairdressing and chiropody are performed, the home pay the bill, then families or representatives are sent an invoice. Health and safety is taken seriously at the home. The inspector and expert by experience were given fire evacuation instructions upon arrival at the home. Accidents are recorded well with any incidents being reviewed by senior managers before filing in the person’s notes. Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 3 3 3 Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP31 Regulation 8 (1) Timescale for action The Provider must appoint an 17/11/09 individual to manage the care home – This will provide clear lines of accountability for staff. 2 OP31 12 (1) (a) (b) There must be clear lines of 17/11/09 accountability at the home – This will promote and make proper provision for the health and welfare of people and make proper provision for the care and treatment of people. Requirement 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 OP8 Good Practice Recommendations Systems should be in place to ensure staff are aware of how to use the hoist and how to protect the privacy and DS0000028763.V377160.R01.S.doc Version 5.2 Page 33 Woodland House Nursing Home 2. 3. 4. 5. OP12 OP27 OP31 OP31 dignity of people when transferring them using a hoist. The activity programme provided for people at the home should not be dependent on whether staff have finished care duties. Staffing numbers should continue to be kept under review to ensure people have their needs met The manager responsible for the home should not be responsible for more than one registered establishment An application for registered manager should be submitted soon as possible to the care quality commission Woodland House Nursing Home DS0000028763.V377160.R01.S.doc Version 5.2 Page 34 Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.southwest@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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