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Inspection on 19/04/05 for Woodland House Nursing Home

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

This inspection was carried out on 19th April 2005.

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

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

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

What the care home does well

The new staff appointed since the last inspection had integrated well into the staff group in the home; staff are motivated and sensitive to the needs of the residents and their relatives. Residents and their relatives were being given the opportunity to influence the way care is delivered. The acting home manager has actively involved the residents, their families and staff when planning changes and improvements.

What has improved since the last inspection?

The overall presentation and cleanliness of the home has improved. Some redecoration of communal areas and residents private rooms has been completed, this included new furniture and carpets and washbasin vanity units. This was providing a pleasant environment for resident`s staff and relatives in the areas completed. The majority of staff have received the training required and those that haven`t had dates planned with in the next two months to complete this. The home has achieved a lot since the last inspection and only a few things remain outstanding, in view of this the timescales for completing these improvements have been extended.

CARE HOMES FOR OLDER PEOPLE Woodland House Nursing Home Middle Warberry Road Torquay Devon TQ1 1RN Lead Inspector Rachel Proctor Unannounced 19th April 2005 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 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 D54-D07 S28763 Woodland House Nursing Home V221420 190405 stage 4.doc Version 1.20 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 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 311525 Woodland Healthcare Ltd Vacancy 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 D54-D07 S28763 Woodland House Nursing Home V221420 190405 stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Registered for a maximum of Registered for a maximum of Registered for a maximum of Registered for a maximum of 30 DE(E) 3 OP 30 MD(E) 3 PD(E) Date of last inspection 17/11/04 Brief Description of the Service: Woodland House is a nursing home that provides care to people who suffer from mental health problems, mainly elderly people with dementia. It is located in the suburb of Wellswood, which is approximately one mile from the town centre of Torquay. The home has eighteen (18) single rooms and six (6) shared rooms spread between three floors that are accessible by two shaft lifts. The lower ground floor is actually a modern extension to the main home. There are two lounges (one on the ground floor and one on the lower ground floor) and a medium sized dining room on the ground floor. Woodland House Nursing Home D54-D07 S28763 Woodland House Nursing Home V221420 190405 stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection has introduced “Key Standards” to be inspected over each inspection year. Therefore, unless it is felt necessary by the inspector, some standards will not be inspected. To obtain a full picture of the home it is recommended that previous reports also be taken into consideration. This was an unannounced inspection starting at 10am and finishing at 3pm. The requirements and recommendation set at the last inspection were reviewed. A tour of the home was carried out unaccompanied. The inspection included discussion with residents and their relatives and staff. Some records were seen. What the service does well: What has improved since the last inspection? The overall presentation and cleanliness of the home has improved. Some redecoration of communal areas and residents private rooms has been completed, this included new furniture and carpets and washbasin vanity units. This was providing a pleasant environment for resident’s staff and relatives in the areas completed. The majority of staff have received the training required and those that haven’t had dates planned with in the next two months to complete this. The home has achieved a lot since the last inspection and only a few things remain outstanding, in view of this the timescales for completing these improvements have been extended. Woodland House Nursing Home D54-D07 S28763 Woodland House Nursing Home V221420 190405 stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Woodland House Nursing Home D54-D07 S28763 Woodland House Nursing Home V221420 190405 stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Woodland House Nursing Home D54-D07 S28763 Woodland House Nursing Home V221420 190405 stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3 The comprehensive assessment process enables staff to provide care that meets the resident’s health, social and personal care needs. EVIDENCE: New contracts were provided, these included all information required. These were available for the residents. Resident’s relatives had signed the contracts provided. A comprehensive assessment process is in place, this covers all aspects of health, physical and mental, and personal care. Social interaction is also part of the assessment process. Three relatives confirmed that they had been able to provide information to inform the assessment of their relative. Care plans had been signed by the relative and or the resident. One resident’s social assessment indicated that they liked classical music; this resident was listening to classical music during the inspection visit. A Registered Nurse completes Resident’s assessments. Observations of staff providing care for the resident’s supports they follow the assessments provided. Woodland House Nursing Home D54-D07 S28763 Woodland House Nursing Home V221420 190405 stage 4.doc Version 1.20 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 The way the staff are directed to provide care ensures that the residents health and social care needs are met by a friendly supportive staff team. Attention to returning medication when it is no longer required will enable the medication standard to be met. EVIDENCE: Care planning provided a clear picture of the care needs individual residents required to maintain their health, personal and social care. This enables staff to have details of the actions, which needs to be taken to ensure all aspects of care are met. The involvement of the multi-disciplinary team in the care planning process is clearly recorded. This gives the residents the opportunity to have their care needs monitored by health and social care professionals. Each resident’s plan of care had been reviewed monthly. 3 residents plans viewed had been signed by the resident’s relative. Residents identified as requiring help to eat their meals were being given this. Residents self care abilities had been recorded. 1 resident’s care plan identified they were able to use the toilet unaided if being prompted. Staff were seen prompting this resident to use the toilet. Woodland House Nursing Home D54-D07 S28763 Woodland House Nursing Home V221420 190405 stage 4.doc Version 1.20 Page 10 Residents care plans had been completed and signed by the Registered Nurse writing them. Community Psychiatric Nurse assessments were provided for the residents. During the inspection a Community Psychiatric Nurse was reviewing 2 residents care. This enabled resident mental heath care needs to have specialist nurse advice and support. This enabled staff working with the residents to understand the actions, which promoted the residents well being. A comprehensive wound care planning system is in place. This identified the wound healing process and the treatments used to achieve this. Pressure relief equipment was provided for residents that required it. One resident’s wound care plan identified how the wound was healing. The residents preferred activities were recorded in the care plan. These had been risk assessed and included risk of falling. The acting manager had accessed a training pack through Torbay PCT from the community dietician, which provided nutritional information for all the residents. In house training had been put in place to disseminate the information to all staff. Resident’s relatives told the inspector that the food is always good and staff listen to the likes and dislikes of the residents. Training records for staff showed that 9 had received medication training. This is in addition to the Registered Nurses who monitor and dispense all residents’ medications. Liquid medications (senna, lactulose) prescribed for 3 residents who were no longer at the home were stored in the medication cupboard. Each of the residents plans seen had a separate record of GP visits and multidisciplinary team involvement. The care plans had been reviewed and changed when this had been recommended by the GP. This provided evidence that health care professionals regularly review the residents. Staff observed speaking to residents were doing so in a friendly, supportive way. One small sitting room had been designated for residents to receive visitors in private. Staff were using the residents preferred name, which had been recorded in their plan of care. Woodland House Nursing Home D54-D07 S28763 Woodland House Nursing Home V221420 190405 stage 4.doc Version 1.20 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 The meal times at Woodland House are a pleasant sociable experience for residents and staff. EVIDENCE: New menus had been provided. The cook had completed a training course through Torbay PCT. She advised that she would be using the information she gained to ensure residents continued to have nutritionally balanced diets. Meals were offered 3 times a day with snacks and hot drinks available in the evening. During the inspection residents were being offered drinks throughout the day. Liquidised/pureed food was presented separately, this allowed residents who required this diet to experience the different tastes of the food they were eating. The mealtimes observed were unhurried and residents were eating their meals at their own pace. Very little wastage seen at the lunchtime meal. Staff assisting residents to eat were doing so in a discreet and sensitive way. 3 staff were assisting residents during the lunchtime meal. Woodland House Nursing Home D54-D07 S28763 Woodland House Nursing Home V221420 190405 stage 4.doc Version 1.20 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 The openness of the staff team enables residents and their relatives to freely express their concerns and wishes in the knowledge that they will be dealt with sensitively and respectfully. The home do not quite complete a robust recruitment process but are keen to rectify this. EVIDENCE: One complaint has been received since the last inspection. This related to the noise 1 resident was making. This resident had been re-assessed and treatment changed. This resident was quiet and relaxed listening to music during the inspection. The manager has responded to complaints and taken action where required to the satisfaction of the Commission. Records of concerns raised by resident’s relatives and the actions taken to address them were provided. The staff had completed adult Protection training. An in-house training booklet for staff to work through, which would enhance their understanding of Adult Protection, is provided. 4 staff had been booked to attend a dementia/challenging behaviour-training day. The training of the staff team in specific clinical practices was enabling understanding of the complex care needs of the residents. Not all new staff had had a CRB completed by the manager of the home. Previous CRB’s from the last employment were on file. This has the potential to put residents at risk. Woodland House Nursing Home D54-D07 S28763 Woodland House Nursing Home V221420 190405 stage 4.doc Version 1.20 Page 13 Woodland House Nursing Home D54-D07 S28763 Woodland House Nursing Home V221420 190405 stage 4.doc Version 1.20 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 24, 25, 26 Although some outstanding redecoration and renewal of furnishings still needs to be completed, once finished this will provide a comfortable and well maintained home. The environment is clean and free from odour making it a pleasant place for the residents and their relatives to visit. Some still need to complete infection control training to ensure they fully understand how to protect residents from infection. EVIDENCE: Several areas in the home had been redecorated since the last inspection. Other resident’s rooms and communal area were in the process of being redecorated. Some resident’s rooms had new furniture fitted. New hand washbasins had been fitted in some resident’s rooms. The lower ground floor rooms had all been redecorated. The corridor had been re-painted new carpeting was on order. All first floor rooms had been redecorated, several of these had new furniture and carpets. Two rooms had wardrobes, which required repair. The manager advised that an ongoing programme of replacement of the old furniture was continuing. Several relatives commented Woodland House Nursing Home D54-D07 S28763 Woodland House Nursing Home V221420 190405 stage 4.doc Version 1.20 Page 15 that they were pleased that the overall look of the homes environment was improving for their relatives benefit. Disabled access toilets and bathrooms are provided for residents use. Each resident has a toilet within close proximity of his/her private accommodation. Disinfectant sluices are provided separately from resident’s toilet and bathing facilities. Separate sluicing facilities were provided and the washing machine meets the specified programming ability to meet disinfection standards. Lockable doors and lockable space are not currently provided. The risk assessment processes include an assessment of a resident’s ability to use and benefit from this. None of the current residents had been assessed as able to use lockable doors or lockable space. The home was fresh and clean in all areas during the inspection. The laundry was tidy and clean and resident’s clothes were folded in individual baskets. 5 staff had received infection control training. The manager advised another course is booked for the 17th May. Three residents relatives said the cleanliness and presentation of the home had greatly improved since August. Woodland House Nursing Home D54-D07 S28763 Woodland House Nursing Home V221420 190405 stage 4.doc Version 1.20 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28, 29, 30 The reliance on agency registered nurses to provide the professional support for residents does not always allow continuity care. EVIDENCE: Five healthcare assistants had achieved NVQ Level 2 training, of these; two were in the process of completing Level 3. The acting manager advised three other healthcare assistants were awaiting registration for the award. The home is working towards 50 of its staff completing NVQ Level 2 or above. TOPPS certified training is now provided; only 2 staff have still to complete this. A training matrix was provided that showed the training staff had received and planned training for the next three months. Examples of the induction/foundation training staff had received were available. Staff spoken to report that they are given training that helped them care for the residents. Resident’s relatives were positive about the staff saying that they understood their relatives care needs. Not all the information required to be kept on staff files was available. Although the inspector confirmed that all staff had a CRB check completed some of these were from a previous employer. One part time member of staff did not have a copy of an up to date work permit on their staff file. This was provided soon after the inspection. One staff file did not have copies of the references the manager confirmed she had received on their file. The Woodland House Nursing Home D54-D07 S28763 Woodland House Nursing Home V221420 190405 stage 4.doc Version 1.20 Page 17 inspector was given a spreadsheet that identified recruitment process and information required checked for each member of staff. Registered mental health nurses are supplied by the agency. Resident’s mental health care needs are monitored by a visiting senior nurse from with in the group and the Community psychiatric nurse allocated to the resident. Woodland House Nursing Home D54-D07 S28763 Woodland House Nursing Home V221420 190405 stage 4.doc Version 1.20 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 37, 38 Although the management of the home and the way the care is delivered has improved under the direction of the acting manager, a registered manager to take the home forward and continue the improvements made is still required. EVIDENCE: The home does not have a Registered Manager. Despite and active recruitment campaign with adverts in the local press, a candidate suitable to manage the home has not come forward. The relatives spoken to advised that the acting manager had made improvements to the overall management of the home. However they would like the home to have a permanent manager appointed who could continue the good work already started. Not all staff records had all the information required contained, 1 did not have references, others did not have an up to date CRB. The inspector was provided with evidence that the home is working towards completing all the required records. Recruitment policy needs to be followed fully to protect residents from unsuitable staff. Woodland House Nursing Home D54-D07 S28763 Woodland House Nursing Home V221420 190405 stage 4.doc Version 1.20 Page 19 The majority of training the home staff had been required to undertake had been completed. Health and Safety training for staff had been booked with a training agency, confirmation of this was provided. The home was clean and fresh and free from odour and a new housekeeper had been appointed since the last inspection. Several relatives commented that the homes cleanliness had improved since August and there no longer notices odours when they visited. Service and maintenance records not available at the last inspection were provided. This confirmed that equipment used by staff for residents was in good working order. Woodland House Nursing Home D54-D07 S28763 Woodland House Nursing Home V221420 190405 stage 4.doc Version 1.20 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x 2 3 3 STAFFING Standard No Score 27 x 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 x x x x x 2 2 Woodland House Nursing Home D54-D07 S28763 Woodland House Nursing Home V221420 190405 stage 4.doc Version 1.20 Page 21 NO Are there any outstanding requirements from the last inspection? 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 18 Regulation Schedule 2 (7)(a) Requirement Timescale for action 31.05.05 2. 24 3. 4. 5. 26 29, 37 38 6. 31 Criminal Records Bureau checks must be completed for all new staff employed prior to rhem starting work 23 (2)(b) The registered person must ensure that service users rooms are furnished as detailed in standard 24. The planned programme of repairs and renewals started must continue 18(c )(i) All staff must complete infection controll training 19(4)(b) All staff must have the required information provided with their staff file 13(4)(b)(c The registered person must ) provide evidence that safe working practices. Heath and safety training( as listed in standard 38) ensures the heath and safety of all service users 8,18,9 The registered providor must register with the commission a manager for the home 01.09.05 31.05.05 31.01.5 extended 31.05.05 31.05.05 extended 09.08.05 31.05.05 carried forward from previous inspection Woodland House Nursing Home D54-D07 S28763 Woodland House Nursing Home V221420 190405 stage 4.doc Version 1.20 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard 9 19 37 Good Practice Recommendations All medication which service userss no longer require should be returned or disposed of with in guidance. Areas with in the home that have been identified as in need of redecoration and repair should be completed. All records required should be available for inspection Woodland House Nursing Home D54-D07 S28763 Woodland House Nursing Home V221420 190405 stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Woodland House Nursing Home D54-D07 S28763 Woodland House Nursing Home V221420 190405 stage 4.doc Version 1.20 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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