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

This inspection was carried out on 17th September 2008.

CSCI 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 17/08/09

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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Fairfields Country Rest Home

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Poldhu

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Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 06/12/2008.

CARE HOMES FOR OLDER PEOPLE Woodland House Nursing Home Middle Warberry Road Torquay Devon TQ1 1RN Lead Inspector Clare Medlock Unannounced Inspection 17th September 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Woodland House Nursing Home DS0000028763.V372293.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.V372293.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 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.V372293.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. 12th November 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. The majority of these people are elderly with dementia type illnesses, sometimes these people have challenging behaviours associated with their illness. The home 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 can be found in the entrance hallway of the home. Fees are dependant on care needs. Chiropody, hairdressing, personal toiletries, and clothing are extra to this cost. Woodland House Nursing Home DS0000028763.V372293.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was unannounced. The site visit took place on Wednesday 17th September 2008. Prior to this inspection we sent anonymous questionnaires to 10 relatives of people who use the service. This was because the majority of people at the home lack the ability to complete surveys. We also sent 10 questionnaires to staff who work at the home. We received 2 surveys from relatives and 5 surveys from staff. We also received a completed Annual Quality Assurance Assessment from the Registered Manager. The AQAA is a self-assessment record that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. During our site visit we spoke to the Registered Manager, clinical nurse manager 3 people who live in the home, 1 visitor, and 4 staff members. We case tracked three people who use the service. Case tracking means we looked in detail at the care three people receive. We spoke to staff about their care, looked at records that related to them and made observations if they were unable to speak to us. We looked at five staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the systems used at the home work and what this means for people who use the service. During the inspection we performed a brief informal period of observation in the lounge area. This enabled us to watch interactions between staff and people living at the home. 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. Fees at the time of this inspection ranged from £504.78 - £549.78 dependant on care needs. Chiropody, hairdressing, personal toiletries, and clothing are extra to this cost. What the service does well: Woodland House Nursing Home DS0000028763.V372293.R01.S.doc Version 5.2 Page 6 People who use the service and their relatives have the information they need to decide whether Woodland House is the right home for them to move into. People who use the service receive a contract to which they or their representative have agreed. It gives clear information about fees and extra charges, which is reviewed and kept up to date. The health and personal care people receive is satisfactory and provided in a safe way. The care planning systems and documentation at the home are generally good. Relatives tell us they are generally pleased with the care that their relative received. We are told that ‘Staff are in tune with my relatives ‘mood’ and treat him with care, kindness and respect.’ And ‘In general, I feel my relative is very well cared for and treated with kindness and respect. All the staff are friendly, hard working and sensitive to residents needs’. Health care professionals are accessed wherever appropriate and referrals to health care are made when necessary. Medication is managed well at the home. Visitors tell us that they are always welcomed and staff are always willing to discuss relatives needs/condition. Food provided at the home is good. All the food is freshly prepared each day by the kitchen using good quality produce. Extras and diet supplements are also provided to improve individual’s nutrition. Staff know what to do if they suspect any abuse is occurring at the home and know who to contact. Generally the home is well maintained. Communal areas of the home are clean and tidy. Visitors tell us ‘The cleanliness of patients rooms is second to none.’ New furniture is introduced on a regular basis and appears to be of a good standard. People are able to personalise their rooms with items of their choice. The staff group are stable and work very hard. They are knowledgeable about the needs of each person and what care is given. Relatives told us that they are impressed with ‘The kindness and patience of staff whom I’ve seen being pinched bitten and screamed at by these poorly people, sometimes when one of the staff sits next to them to have a chat’. Staff files were organised and well maintained and show that staff have received all the pre employment checks before employment and had received an induction prior to work. Staff tell us they find the training they receive is both informative and straightforward. The home is run in an organised and efficient way. Feedback from staff and relatives regarding the manager is positive. Staff told us they know what is Woodland House Nursing Home DS0000028763.V372293.R01.S.doc Version 5.2 Page 7 right and where they can improve and say when they get good feedback it is a morale booster. What has improved since the last inspection? What they could do better: Safety of people at the home must be a priority at the home and keeping people safe must be clearly managed. When staff at the home use any forms of restraint, which include the use of bed rails and reclined chairs staff must follow examples of good practice. This will show that the decision is based on ensuring the persons safety and not for the convenience of the home, where people are unable to say what they want the assessment to use restraint has been assessed by a health care professional who is independent of the home and relevant risk assessments and records are kept under review. Staffing numbers should continually be under review and should focus on dependency of people at the home rather than numbers of people. 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. Although care plans are generally well written improvements should be made to make sure care plans are clear to follow and do not contain contradictory information. Care plans should also show how small marks, knocks and bruises are treated, monitored, prevented and reviewed to mirror the way larger bruises and wounds are managed at the home. Woodland House Nursing Home DS0000028763.V372293.R01.S.doc Version 5.2 Page 8 The Manager must ensure arrangements are in place to prevent the spread of food poisoning and infection, by ensuring cleaning and food management systems introduced by the environmental health department are followed. The manager should also ensure all staff working in the laundry are aware of how to correctly handle foul laundry and should consider requesting the health protection agency to come and perform audit for guidance and advice. The Manager must ensure those people that need nursing care are provided with suitable beds to enable use of a hoist and specialist equipment. This will ensure those that require adjustable beds for nursing purposes are provided with one. 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. The manager should ensure the supervision programme continues and ensure the system is robustly managed to ensure all staff are up to date with mandatory training. 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.V372293.R01.S.doc Version 5.2 Page 9 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.V372293.R01.S.doc Version 5.2 Page 10 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): 1,2,3,4,5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service and their relatives have the information they need to decide whether Woodland House is the right home for them to move into. The good admission procedure shows that staff make sure they can meet the persons needs. EVIDENCE: One relative we spoke with said although their partner’s admission to the home was quite quick, this was because of their condition rather than the admission process. The relative said staff from the Woodland House came to their home and asked many detailed questions. They said staff were very polite and thorough in their information gathering. The relative confirmed they were given information both verbally and in a written form. Woodland House Nursing Home DS0000028763.V372293.R01.S.doc Version 5.2 Page 11 Each person has a set of records, which contains details of this initial assessment and information from social services and other health care professionals. Staff use the assessment to write a plan of how the persons needs will be met. Staff said on admission a full ‘handover’ is given about that person, their needs and family support. The home has developed a comprehensive statement of purpose and service user’s guide. Both documents are found in the entrance hall of the home. The staff perform their own detailed assessment as well as obtaining detailed information from other health care professionals. Records showed that information from the person and their family is also taken into account. The pre-admission assessments were comprehensive and gave a picture of how each person presented and a full base line dependency score. The information that had been gathered included personal information such as likes and dislikes, e.g. food and drink or hobbies, daily living skills, and information about their medical history, medication and risk assessments that had taken place such as mobility, risk of falls, moving and handling and nutrition. People who use the service receive a contract to which they or their representative have agreed. It gives clear information about fees and extra charges, which is reviewed and kept up to date. The AQAA informed us that the Statement of Purpose and Service User Guide have both been updated. Woodland House Nursing Home DS0000028763.V372293.R01.S.doc Version 5.2 Page 12 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 good. This judgement has been made using available evidence including a visit to this service. The health and personal care people receive is satisfactory and provided in a safe way. The care planning systems and documentation at the home are generally good, however changes are required to clearly show that some aspects of care are continually reviewed. The improvements in medicine management at the home mean that people are protected. Further minor improvements would continue to protect people. EVIDENCE: Surveys from relatives told us that generally people were pleased with the care that their relative received. Comments included ‘Staff are in tune with my relatives ‘mood’ and treat him with care, kindness and respect.’ And ‘In general, I feel my relative is very well cared for and treated with kindness and Woodland House Nursing Home DS0000028763.V372293.R01.S.doc Version 5.2 Page 13 respect. All the staff are friendly, hard working and sensitive to residents needs’. One visitor at the home said that it was a relief when she moved to the home and that he is able to go home and not worry about his wife. This visitor told us that staff had discussed the care of his partner with him and spoke to him each time he visited with updates or any changes in care. Every person living at the home has an A4 care records file. All files were organised and contained good levels of information about the person. The preadmission assessment was used to produce dependency rating and a care plan. The care plan is in company formats that begins with the assessed needs, expected outcome and then the support and care to be provided. There was a detailed description of the care in clear steps saying how an issue was to be dealt with. Risk assessments were available for such things as mobility, nutrition (using MUST, Malnutrition Universal Screening Tool), falls and pressure area risk. All assessments had been reviewed on a monthly basis or more frequently where the need arose. Some records gave clear guidance about how care was to be provided, whilst other records were less clear. One persons record explained that she was immobile in bed, however bed rails were in place to prevent her falling out of bed. The subject of restraint is reported on in the Protection area of this report. Smaller bruises, marks and cuts were recorded on the daily activity summary but there was no plan to show that staff had treated, monitored and reviewed these. There was also no evidence to show that staff had questioned why they had occurred and plans to reduce reoccurrence. People who use the service were seen to be transferred appropriately on the day of inspection. Staff were seen to use hoists correctly. Some people were transferred round the home in wheelchairs whilst others who were more able were encouraged to wander freely. There was evidence of specialist equipment at the home, although some equipment seen did not appear to be suited for the person it was being used for. An example of this was a reclining chair that appeared too big for the person. Specialist mattresses were present, although the use of these on a domestic divan style bed with bed rails was questioned because of lack of hoist access. This places people at risk. This had been raised at the previous inspection. Although the need for adjustable bed is health related the shortfall of this is reported later in this report. Health care professionals are accessed wherever appropriate. Care plans show that GP’s chiropodists, dieticians, speech and language therapists and community psychiatric staff visit the home. Appropriate referrals are made to dieticians where people are losing weight. Nutritional supplements are prescribed and given where needed. Monthly weights are recorded at the home. Seven of the twenty residents had lost weight. Of the three significant weight losses, all had been referred to the dietician. Woodland House Nursing Home DS0000028763.V372293.R01.S.doc Version 5.2 Page 14 The home cares for people with dementia who also have challenging behaviours. Some staff have been trained in the specialist ways of caring for people with these specialist needs and care plans show how care is delivered in a person centred way. Some use of diversionary tactics and orientation methods was used throughout the inspection. Medication management has improved at the home. Pots of cream in each persons room were prescribed for them only. Storage within the treatment room was organised and appropriate for medications at the home. No expired products were seen. Patient information leaflets were available for staff reference and Medication administration records were completed correctly. It was suggested that staff obtain two signatures when prescriptions are copied on to the MAR sheet to reduce errors being performed. A spot check of the controlled drugs was performed and found to be correct. Policies were available regarding homely remedies, receipt and disposal of medication. People who use the service were treated with respect and kindness by staff during the inspection. However, one member of staff spoke to people in a loud voice as if they were deaf. This member of staff was spoken to at the inspection about their tone. Staff were aware of what people who use the service like to be called. People who use the service were wearing their own clothes and were provided personal care in privacy. Woodland House Nursing Home DS0000028763.V372293.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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. Improvements are still needed to provide people with more mental and physical stimulation. People benefit from a wholesome, balanced diet. EVIDENCE: The feedback from relatives and staff was overwhelmingly that although the care at the home was good, more staff would mean more 1:1 care could be provided which could include stimulation. Comments included ‘If we had one more member of staff per shift we could do more 1:1 care which is what our residents need.’ And feedback from relatives included ’I feel my relative could benefit from a little more mental and physical stimulation.’ Woodland House Nursing Home DS0000028763.V372293.R01.S.doc Version 5.2 Page 16 Those that are able are encouraged to wander around the home, however those that were less mobile appeared to sit for long periods of time in the lounge. Staff told us that a local activities company come in on a regular basis to perform entertainments. Staff also said musical activities are popular. Staff told us that religious activities had been held in the past but the attendance of ministers had stopped. There is a whiteboard on the wall in the lounge, which is 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. Surveys and relatives visiting the home told us that staff generally report any changes in condition to them when it occurs. However, one relative told us when they question staff about events that have occurred, sometimes staff are unaware of the answer and appear vague. Another relative told us that staff are very good at letting them know when any accidents have occurred. Visitors are welcome at the home at any time of the day. One survey read ‘As a visitor I am always welcomed and staff are always willing to discuss my relatives needs/condition.’ Due to the complex needs of people in the home, none have the ability to manage their own affairs and finances. This responsibility is left to family or external advocates. People who use the service are able to bring in small personal possessions with them. A valuable list for this is located in each persons file. People appeared to enjoy the food provided at the home and were able to be flexible about their meal times. Specific dietary requirements such as personal preferences and diets for medical reasons are obtained during the assessment process. All the food is freshly prepared each day by the kitchen using good quality produce. Extras and diet supplements are also provided to improve individual’s nutrition. Monthly weights are recorded for all people at the home. Where an individual is losing weight a referral is made to the dietician and food supplements are prescribed. Staff were knowledgeable about the likes, dislikes and eating habits of people who use the service. People who use the service are offered a choice of meal on the day it is to be served, those that are unable to make this choice are provided with meals according to the menu. Woodland House Nursing Home DS0000028763.V372293.R01.S.doc Version 5.2 Page 17 People were helped with their meals in a sensitive unhurried way. Those requiring a soft diet are provided meals that are presented in an attractive way. People with dementia type illnesses who have a tendency to wander are monitored to ensure they eat. Woodland House Nursing Home DS0000028763.V372293.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. 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. People who use the service and their relatives can be confident that complaints and concerns given to the manager will be listened to and acted on. There are procedures and training in place for the Protection of Vulnerable Adults. The understanding and assessment of restraint is inadequate at the home and needs to be improved to show that it is only used in the best interest of people. EVIDENCE: Relatives we spoke with said they ‘would speak to the manager or the nurse in charge, but the situation has not arisen yet’. Surveys confirmed they knew who to complain to. Staff we spoke to said they felt able to talk to the manager or clinical nurse manager about any worries or concerns. The home also operates a supervision and appraisal system in which staff raised concerns that are discussed, recorded and acted upon. Woodland House Nursing Home DS0000028763.V372293.R01.S.doc Version 5.2 Page 19 There were complaint procedures clearly displayed at each entrance hall, and a copy of the procedure within the Service User Guide. The Commission for Social Care Inspection have received two complaints since the previous inspection. One of which was being dealt with at the time of this inspection. The Home had received three complaints since the last inspection. Records of complaints were maintained by the manager and showed that issues had been dealt with appropriately within set timescales. All staff files inspected contained evidence of CRB (Criminal records bureaupolice check) and POVA (Protection of vulnerable adults) pre employment checks. Three of the staff had received safeguarding adults training and one had been booked onto a course. Safeguarding adult team contact details were on display in the nurses office and all staff spoken to told us they would report any allegations of abuse to either the safeguarding team or Commission for Social Care Inspection. Forms of restraint were being used at the home. In some cases the use of this restraint had been clearly explained verbally by staff and within care records. However, other examples were not as clear. Whilst the reason appeared to be in the best interest of the person records and explanation by staff did not show that the process had been agreed by people outside the home. This could show that restraint is used for the benefit of staff rather than in the best interest of people who use the service. An example of this was the use of a reclining chair for a person who was at risk of falling out of ordinary lounge chairs. The decision to use such a chair did not follow good practice recommendations by discussing and agreeing with health care professionals independent of the home. Some other examples of restraint (bed rails) had been agreed with relatives following an internal risk assessment process. Some records were contradictory. One example stated that a person was immobile but bed rails were used to prevent the person falling and rolling out of bed. Further discussion with staff revealed that this person was mobile in bed and could be protected by bed rails. In some assessments, there was no evidence that alternative methods of keeping a person safe in bed had been considered. In one case a fully adjustable bed could have be considered but the home have a lack of adjustable beds despite people requiring nursing care. The risk assessment did not highlight unsuitability of using bed rails with domestic style divan beds, which increases the risk of entrapment and prevention of using hoists. Woodland House Nursing Home DS0000028763.V372293.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although communal areas of the home are well maintained and tidy, improvements are needed to improve the kitchen and laundry hygiene at the home. People who use the service do not always have access to specialist equipment needed to keep them safe. EVIDENCE: Feedback regarding the home was generally positive with relative surveys. One comment read ‘The cleanliness of patients rooms is second to none.’ Woodland House Nursing Home DS0000028763.V372293.R01.S.doc Version 5.2 Page 21 All bedrooms were very clean, tidy and free from offensive odours. Bathrooms and toilets were also very clean with the presence of gloves, aprons and paper towels for staff readily available. There was no evidence to show that checks recommended by the environmental health kitchen-cleaning schedule had been performed. Food storage was poor and the standard of cleanliness was poor throughout the kitchen. A letter has been sent to the environmental health department informing them of our concerns. The manager gave assurances that this would be addressed as a matter of urgency. (The manager informed us prior to this report being written that a steam clean had been performed following this inspection) The laundry areas were clean and organised despite the small space. Each person has a basket to ensure clothes are returned to the correct place. The member of staff within the laundry told us sheets, towels and other bedding is sent to external companies for laundering. Staff were not able to clearly explain the process for handling foul laundry. It was not clear whether there was a sluice cycle on the washing machine and no evidence to show foul laundry is placed in dissolvable bags. Laundry staff told us they had not received training in infection control. A disinfecting sluice was provided for cleaning of commode pots, however the front of this machine had been removed. The downstairs corridor was being prepared for redecoration at the time of inspection. New furniture and vanity units continue to be introduced on a regular basis. There has been a new carpet within the lounge and corridor since the last inspection. New chairs have been purchased for the lounge and hall since the last inspection. All furniture appeared domestic in style and generally of a good standard. However, there remain many beds in place that are domestic divan beds. Whilst in some cases these beds are appropriate there were a number of beds that were not appropriate for the nursing care people required. Some divan beds had been fitted with bed rails. Another divan bed has a specialist mattress in place, bed rails and an inappropriate assessment for use of the bed rails. The risk assessment did not highlight unsuitability of using bed rails with domestic style divan beds, which increases the risk of entrapment and prevention of using hoists, which places staff and people who use the service at risk. People who use the service are free to wander all areas of the ground floor. Stair gates have been provided to prevent people using the stairs unattended. Each stair gate had a lock, which could be removed without a key in the event of a fire. Woodland House Nursing Home DS0000028763.V372293.R01.S.doc Version 5.2 Page 22 There are shared rooms within the home. Screening is provided within these rooms. People had separate wardrobes and dressers for their personal clothing. Toiletries for individuals had been labelled and stored in separate areas. People who live at Woodland house have access to toilets, which are within easy reach of the lounge, dining room and their individual accommodation. Peoples rooms had been personalised with items of their choice. included photographs, ornaments and small items of furniture. These The staff had access to gloves and aprons for use when attending to personal care for individual people. Staff were using these during the inspection. A Waste Disposal Company disposes of clinical waste for the home. Woodland House Nursing Home DS0000028763.V372293.R01.S.doc Version 5.2 Page 23 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): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The hard working staff group do not always have sufficient time to provide the one to one care that some people need. People who use the service are generally cared for by staff who have had appropriate checks performed. EVIDENCE: On the day of inspection there were 21 people living at the home. There was a manager on duty, one registered nurse and three carers. In addition to this there was a handy man, chef and domestic in the laundry area. Staff duty records showed that these numbers are stable. Staff told us there are now extra staff on at teatime, which helps, but another member of staff on duty would mean that staff do not have to rush and could provide more time which people need. Another member of staff said it generally works well but it only takes one person or one thing to disrupt everything. Woodland House Nursing Home DS0000028763.V372293.R01.S.doc Version 5.2 Page 24 Staff were very knowledgeable about the things that set off behaviours in some residents. During the inspection it was noted that when staff were able to provide spells of one to one time agitated behaviour reduced and the atmosphere became more relaxed. Feedback from staff surveys supported these observations. One member of staff said ‘I feel that staff rotas should take in to account dependency rather than numbers. Woodland House has high dependency residents and I don’t always feel we have enough staff to cover their needs.’ Another member of staff said ‘If we had one more member of staff per shift we could do more 1:1 care which is what our residents need.’ Relative surveys also gave the same feedback. When asked what the home could do better three comments read ‘More 1:1 attention.’ and ‘staff should make the most of the residents alert periods when they do occur. I do appreciate however that the staff work extremely hard and may not always have the time to do this’ and ‘Perhaps more staff on duty’. The manager told us she has ensured there is always a member of staff on duty in the lounge. We asked how this is managed when staff are providing personal care elsewhere in the home and were told the manager provides this observation until care staff are free. This observation is valuable in keeping people safe, especially with the people in the home that display behaviours that may put other people at risk. During the inspection staff were seen to work extremely hard. Staff were polite and responsive to people who use the service. Staff files were organised and well maintained. They showed that staff had received all the pre employment checks before employment and had received an induction prior to work. One staff survey read ‘I feel that I was told a great deal of information. But I have to say that in the most part one can only know every one’s needs by working on the floor with the residents’ Staff told us they were aware there was a training manager for the company and had been given dates for mandatory or specialist training. A poster in the office showed where staff had booked onto this training. The manager told us she had highlighted gaps in training and the training manager was in the process of organising dates. Training records showed that some, but not all, staff had received training in dementia care and challenging behaviour. Staff survey comments read ‘I find the training I have received is both informative and straightforward. The company not only do their own training, they also send us on courses. I feel the benefit of those courses and feel without them I would not be able to do a good job.’ Woodland House Nursing Home DS0000028763.V372293.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in an organised and efficient way. Attention to ensuring training and supervision systems are followed would ensure all staff work in a safe and appropriate way. EVIDENCE: The manager is registered with the Commission as registered manager for Woodland house nursing home. A clinical lead supports the registered manager. The clinical lead is a first level registered nurse who manages the health care needs of people in the home. Woodland House Nursing Home DS0000028763.V372293.R01.S.doc Version 5.2 Page 26 Feedback from staff and relatives regarding the manager was positive. Comments included ‘I feel that I have full support of my manager and staff that I work with. In our home we all have to support each other’ and ‘We have regular supervision staff meetings etc. These are very helpful and it keeps us updated and we know what is right and where we can improve. Also if we are told we are strong in a certain area that is a morale booster’ Supervision records showed that the majority of staff have received formal supervision training although some were out of date. Quality assurance methods performed at the home were formal and robust. The manager comes from an administration background so manages these well. Audits for care plans were performed in July, a random drug audit was conducted in June following a pharmacy inspection in January where shortfalls noted at the last Commission for Social Care Inspection were noted and actioned. A kitchen audit in June 2006 noted that some food products had not been labelled or stored correctly which were also noted at this inspection. A building audit was performed in July 2008. All Requirements set at the previous inspection have been met, including a monthly report of unwitnessed accidents occurring at the home. Three Recommendations are still unmet. One Recommendation is being made a Requirement due to the risk it places on people who use the service. The staff at the home do not manage peoples personal money. The manager told us that if people require any personal items which the family are unable to provide, this is purchased using petty cash and the families or representatives are then invoiced. The AQAA told us that equipment and services at the home are regularly serviced using contractors of external companies. This included gas services, waste management, hoist and lift servicing. Staff told us they were aware there was a training manager for the company and had been given dates for mandatory or specialist training. A poster in the office showed where staff had booked onto this training. The manager told us she had highlighted gaps in training and the training manager was in the process of organising dates. One member of staff said she was up to date with mandatory training. Another member of staff said some training was due but was booked. Some ancillary staff had not received training in infection control. The training matrix for 2008 was seen which identified gaps in training. Woodland House Nursing Home DS0000028763.V372293.R01.S.doc Version 5.2 Page 27 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 2 8 3 9 2 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 1 1 3 3 3 3 1 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 2 3 2 Woodland House Nursing Home DS0000028763.V372293.R01.S.doc Version 5.2 Page 28 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 OP18 Regulation 13(7&8) Requirement The Manager must ensure that people are not subject to restraint unless it is in the best interest of the person and the decision is clearly documented. The Manager must ensure arrangements are in place to prevent the spread of infection, by ensuring systems introduced by the environmental health department are followed. The Manager must ensure those people that need nursing care are provided with suitable beds to enable use of a hoist and specialist equipment. Timescale for action 17/12/08 2. OP19 13(3) 16(j) 17/12/08 3. OP24 13(5) 17/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The manager should ensure staff plans show how small marks and small bruises are treated, monitored, prevented DS0000028763.V372293.R01.S.doc Version 5.2 Page 29 Woodland House Nursing Home 2. 3. 4. OP7 OP9 OP12 and reviewed. The manager should ensure care plans are clear to follow and do not contain contradictory information. To minimise errors, the manager should encourage nursing staff to obtain two signatures on Medication sheets when hand written entries are included. People living at Woodland House must be provided with adequate opportunities for stimulation through leisure and recreational activities that have regard for their care needs and abilities. Where forms of restraint are used (bed rails and recliner chairs) good practice guidelines should be followed to show that. 1.The decision is based on ensuring the persons safety and not for the convenience of the home 2.A suitably qualified, competent and trained individual has assessed and identified the need for such equipment 3.The decision has been made in consultation with the person 4.Where there are capacity issues are considered, wider consultation are considered 5.Risk management strategies are in place 6. In care homes, the assessment has been performed by a health care professional who is independent of the home 7. Relevant records are maintained and the process documented 8. The use of the equipment is kept under review The manager should ensure laundry staff are aware of how to correctly handle foul laundry and should consider requesting the health protection agency to come and perform audit for guidance and advice. 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. The manager should ensure the supervision programme continues The manager should ensure the training system is robustly managed to ensure all staff are up to date with mandatory DS0000028763.V372293.R01.S.doc Version 5.2 Page 30 5. OP18 6. OP26 7. OP27 8. OP30 9 10. OP36 OP38 Woodland House Nursing Home training. Woodland House Nursing Home DS0000028763.V372293.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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.V372293.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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