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Inspection on 01/10/07 for Woodland Park Nursing Home

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

This inspection was carried out on 1st October 2007.

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

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

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

What the care home does well

There was a positive open atmosphere in the home during both days of the inspection. All the people and their relatives spoken to during the inspection said that the staff team were friendly and helpful. " The existing staff are excellent". The staff observed appeared to have a genuine rapport with the people they were caring for. The comments received from the people spoken to indicate they knew whom to speak to they had any concerns about their care. They also indicated that they felt staff would deal with this to their satisfaction.

What has improved since the last inspection?

The care planning information for people admitted in an emergency has improved since the last inspection. One person admitted four days earlier had a full assessment and care plan in place to guide staff how their care should be provided and what was important to them. The information in people`s plans of care has improved giving clear information for staff about peoples care needs and how these should be addressed. Flooring has been replaced in one section of the hallway and a new dining area created for people living at the home. The flooring is easily cleanable and gives easier access to the dining area for people who use their wheel chairs independently.

What the care home could do better:

Staffing had not been organised around the care needs of people living at Woodland Park putting the people at risk of not receiving the care they need. The way staff are deployed and/or the numbers of staff employed at the timeof this inspection were not always meeting peoples needs in the way they expected. People commented that there are not always staff available to complete some of the things in their plan of care, for instance, being able to go out of the home with the support of a member of staff. This means people are not always able to exercise choice over their daily lives. The company`s robust recruitment policy for all staff did not appear to have been followed. Evidence to support all the pre employment checks had been carried out were not available at the home. This means that people may be put at risk from unsuitable staff. The majority of the medication practices in the home are safe and ensure people receive the treatment they need. However at this inspection insufficient lockable space for medication which required refrigeration was being provided. If individuals` medication is not be securely stored at the correct temperature it may not available for them when they need it. If people are not given their medication, or refuse it, the reasons for this must be stated, to ensure people receive the right support from the registered nurse team and other health professionals when this occurs.

CARE HOMES FOR OLDER PEOPLE Woodland Park Nursing Home Babbacombe Road Torquay Devon TQ1 3SJ Lead Inspector Rachel Proctor & Stella Lindsay Unannounced Inspection 1st October 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Woodland Park Nursing Home DS0000028764.V351408.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 Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodland Park Nursing Home Address Babbacombe Road Torquay Devon TQ1 3SJ 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 313758 01803 313046 Woodland Healthcare Ltd ****Post Vacant**** Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (3), Physical disability (31), Physical disability of places over 65 years of age (31) Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Registered for max OP 3 Registered for max PD 31 Registered for max PD (E) 31 Date of last inspection 19th July 2007 Brief Description of the Service: Woodland Park nursing home is an Edwardian dwelling, established as a nursing home in the Babbacombe area of Torquay. It is located approximately 100 yards from Babbacombe Downs with its excellent views over the bay. There is a small shopping area just a short walking distance away. The original building has been extended is to enable it to accommodate up to 31 resident’s. There are 19 single and 6 double rooms available, some with en suite facilities. The rooms are spread over three levels each being accessed by a centrally located shaft lift. Some rooms have sea views. A stair lift is also provided between the ground and mezzanine floor. The home has been further adapted to meet the needs of the physically disabled resident’s it provides nursing care for. Meals are prepared in a hotel type kitchen located in the centre of the home. There are accessible bathing facilities on each level and a mobile hoist that can be moved between rooms. The home has car parking to the front and side of the building and a small walled garden area for residents to sit in, weather permitting. A Registered Nurse manages the home and Registered Nurses are in charge of each shift, supported by a team of Health Care Assistants. The statements of purpose and service users guide are available in the reception area of the home or on request. The fee levels provided on 10.10.07 were up to £516.07. The actual fee is dependent on the needs of the service user and the room occupied. Additional charges are made for chiropody, hairdressing, newspapers and magazines that the service users request. Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection with took place over two days, 1st October 2007 between 10 am and 3:30 and 10th October 2007 between 11 am and 3 pm. Two inspectors were present for the second day of the inspection. The inspection included a tour of the home, speaking to the people who live at Woodland Park, their visitors and staff. Some documentation relating to care practices and management of the home were reviewed. The medication systems and practices were inspected. Three residents had their care followed as part of the inspection. Comment cards were received from seven relative, seven people living at the home and two one health professionals. Some of the opinions expressed in the comments cards and comments made during the inspection have been represented in this report. What the service does well: What has improved since the last inspection? What they could do better: Staffing had not been organised around the care needs of people living at Woodland Park putting the people at risk of not receiving the care they need. The way staff are deployed and/or the numbers of staff employed at the time Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 6 of this inspection were not always meeting peoples needs in the way they expected. People commented that there are not always staff available to complete some of the things in their plan of care, for instance, being able to go out of the home with the support of a member of staff. This means people are not always able to exercise choice over their daily lives. The company’s robust recruitment policy for all staff did not appear to have been followed. Evidence to support all the pre employment checks had been carried out were not available at the home. This means that people may be put at risk from unsuitable staff. The majority of the medication practices in the home are safe and ensure people receive the treatment they need. However at this inspection insufficient lockable space for medication which required refrigeration was being provided. If individuals’ medication is not be securely stored at the correct temperature it may not available for them when they need it. If people are not given their medication, or refuse it, the reasons for this must be stated, to ensure people receive the right support from the registered nurse team and other health professionals when this occurs. 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 Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6, Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The statement of purpose and service users guide has sufficient information to allow people to make an informed choice about the home and it’s services. The way peoples care needs are assessed and recorded should ensure that staff have sufficient information to provide the care people need. The home does not provide intermediate care. EVIDENCE: The statement of purpose and service users guide had been revised this was available for people in the reception area of the home. A copy of the last inspection report was also provided in this area. People spoken to during the inspection reported that they had been given information about the home prior to their admission. And this had helped them make up their mind about whether the home would be able to meet their Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 9 needs. All those asked said they or their relative had been able to speak to a senior member of staff about the home before their admission. The organisation has developed a clear assessment process for people who live at the home. Four people had their care followed as part of the inspection. One of these had been admitted to the home less than five days. Copies of completed assessments were available in their care plans. This included their health; personal, and social care needs. Risk assessments were an integral part of the care planning process. Copies of discharge assessments from hospital and district nursing teams were also available where these had been completed prior to the admission. The information contained in individual assessments had been up dated since the last inspection to reflect the changes in care needs. Each of the four assessment viewed were followed with a plan of care that guided staff how the persons care needs should be managed. The home does not provide intermediate care. Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall the way people’s care is assessed, planned and recorded has improved since the last inspection. Staff have clear information about a person’s health, personal and social care needs and what is important to them. However the number of staff on duty has not always allowed some people’s care needs to be met in the way the care plan identifies. The majority of the medication practices in the home are safe and ensure people receive the treatment they need. However, insufficient lockable space for medication which required refrigeration was being provided. If individual’s medication is not securely stored at the correct temperature it may not available for them when they need it. Not all aspects of the storage or administration of medication were good for the promotion of residents health. Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 11 EVIDENCE: The four people whose care was followed had a plan of care recorded, which guided staff in how their needs should be met. One person admitted four days earlier had a full assessment of their care needs and a plan of care for their care needs in place. The care planning process at Woodland Park uses a core care plan template, which staff up date and personalise for individuals. Although this person had the care plan in place this had not been personalised. The nurse in charge advised that care plans are updated over the first few days after some one is admitted to give them time to get to know the person. Each of the four peoples plans of care seen during this inspection had been reviewed monthly or sooner if their care needs have changed. The changes to the care plans had been signed and dated by the person updating the plan of care. The amount of information in individual people’s plans of care had improved since the last inspection. The four care plans viewed gave clear information for staff about how they should provide care for an individual and what was important to them. Identified care needs for the four individuals whose care was followed had a plan of care in place to address these. Social care plans had been provided, which stated what the person liked to do and how staff could facilitate this. Two of the people spoken to during the inspections said a senior member of staff had spoken to them about their care needs and what was important to them. They went on to say that staff were very friendly and supportive. However they commented that on occasions that werent enough staff and they had to wait for staff to answer their call bell. One person whose care plan identified one-to-one support to allow them to go outside the home had not had this. The nurse in charge advised that the agency they were using had let them down at short notice, which meant they were short staffed. Risk assessments were an integral part of the care plans. This included a risk assessment for the prevention of pressure sores. The nurse in charge advised that high dependency pressure relief mattresses are provided for those people who have been assessed as needing them. Continence assessments had been completed. These showed any problems the person was experiencing and the type of aid or assistance the person needed. Continence aids were provided for people who required them. However the comments received indicated that they did not always get the assistance they needed in time to use the commode or toilet as staff sometime took a long time to answer their call bell. People asked said they did not want to complain as the staff were very good and helped them when they could. Falls risk assessments were completed as part of the ongoing risk assessments for each person. These identified the level of risk. One person who had been Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 12 identified as at risk of falling had a plan of care completed, which guided staff how to reduce the risk. Where it had been identified that a person was at risk of falling from bed, a risk assessment for the use of bed guards had been completed. One person asked said staff had spoken to them about the use of bed guards on their bed. A completed bed guard risk assessment for this was in their plan of care. However the person had not signed this. Multi disciplinary visits were recorded. These included opticians, chiropodist, specialist nurses and GP. Where health professionals had made recommendation for care this had been incorporated into their care plan. One person living at the home said they were unsure if staff fully understood their condition. They went on to say that they had regular contact with a specialist nurse who knew all about their illness and the medication they needed. A record of this specialist nurse visits was being kept in the persons care plan. This provided advice for staff caring for this person. One health professional commented in a survey returned to the CSCI, “nursing needs met very wellnot frightened to ask for advice.’ Four people’s medication record sheet were viewed. Two of these did not have the reason why their medication had not been given. One person had not had one item of their prescribed medication given for three days. Another had not had one item of their prescribed medication given for two days. The reasons for this were not explained in their plan of care or their medication record. The nurse in charge advised that these are normally completed with the reason for medication not being given. If people are not given their medication, or refuse it, the reasons for this must be stated, to ensure people receive the right support from the registered nurse team and other health professionals when this occurs. On the first day of this inspection, insulin was being stored in an unlocked small fridge in the kitchen. Eye drops were being stored in a locked tin in the same fridge. The nurse in charge transferred the insulin to the lockable tin. However the tin was not large enough to store all the medication that required storage. Records of the fridge temperatures were not easily available. On the second day of the inspection insulin was being stored in a locked tin in the small kitchen fridge. However other injections were also being stored in an unlocked container in this fridge. This small fridge in the kitchen was also being used to store staff sandwiches and people’s drinks. A record of medication disposed of was being kept. The nurse in charge advised that one of the registered nurses had taken responsibility for this. A record of checks made for medication delivered to the home for individuals was recorded on the medication record. A clinical waste disposal company continues to takes responsibility for removing the medication from the home. Medication was being stored in a locked cupboard in the treatment room and a locked medicine trolley. A system for recording and disposing of controlled Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 13 drug medication was in place. The controlled drug medication was checked against stock held for one person as correct. The nurse in charge advised that none of the people living at Woodland Park were managing their own medication. A system for risk assessing selfmedication was in place. One person who had been self medicating at the last inspection was no longer able to do this. During both days of the inspection people were receiving personal and health care in the privacy of their own rooms. Staff were observed knocking on individual bedroom doors before entering the room. One person said staff very rarely knock before entering the room although they did say they were a little hard of hearing. A visiting GP saw one of the people living at the home in their own room during the inspection. Individual’s personal mail was seen being given to them unopened. One person was heard to ask a member of staff to open their letter for them and tell them what it was about. The laundry in the home continues to provide a system that returns peoples own clothes to them. People were wearing their own clothes, which were clean and pressed. The staff observed speaking to people they were caring for were using their preferred form of address, which had been recorded in their plan of care. The people spoken to said that staff were friendly and helpful towards them. One commented, ‘I can’t fault them’. Three comment cards received from people living at Woodland Park indicated that staff always listen to them and act on what they say. Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13,14,15, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The mealtimes appeared to be a pleasant experience for the people living at Woodland Park. The activities provided did not appear to always be provided in consultation with the people living at the home. Although several activities are provided for people, not all felt that the activities provided were meeting their needs. EVIDENCE: Although peoples interests are recorded and form part of their plan of care, they do not always have their social care needs met. One person’s care plan identified one to one support for visits outside the home once a week, which had been agreed with them. However at the time of this inspection the person had been unable to do this as often as they would have liked. On both days of the inspection people were seeing visitors in the privacy of their own room or the communal lounge. On the second day of the inspection two people went out of the home with relatives and two others went out Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 15 independently. One visitor commented that staff are always helpful and keep them informed. People asked said they do have activities brought into the home, which they liked. A record of external entertainers/ activity providers was being kept. Two of the groups visiting provided a record for the home of the activities undertaken and who had participated. These were provided for inspection. However one person commented “they were pleased with the attention they get, and the food is very good, but there is ‘an awful lot of sitting around’, and no exercises.” Information for people living at the home and their relatives was available in the reception area of the home. Visitors spoken to said staff were approachable and friendly. However they did comment that staff seemed to be very busy and did not appear to have time to chat to them. People’s individual plans of care were being stored on a shelf in an unlocked office with the door open. During the inspection this office was unoccupied on several occasions. People asked said staff had spoken to them about their care needs. One person whose care was followed had signed their plan of care. However they commented that there are not always staff available to complete some of the things in their plan of care. Like being able to go out of the home with a member of staff. People asked said the food was usually good, although two said they would have liked more variety. A visit to the kitchen in the home revealed that the lunchtime meal had two main courses people could choose each day. The chef advised that people are asked what they would like, and if they did not like what was on offer an alternative would be found. A list of people’s likes and dislikes and dietary preferences was recorded in the kitchen. One person seen in their own room at lunch time told a carer they did not like the lunch time meal. The carer politely asked what they would like. An alternative the person did like was then provided for them. Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at Woodland Park feel able to express their concerns and wishes freely and are satisfied with the way their concerns are handled by the manager. The homes recruitment policy must be followed to ensure that people living at Woodland Park continue to be protected from unsuitable staff. EVIDENCE: The people spoken to during the two days of this inspection said they felt able to express their concerns and wishes to the staff who cared for them, commenting that staff listened to them. Two comment cards received from people living at the home indicated that staff listened to them and acted on what they said. However one comment card received from a person living at the home indicated that they were unaware how to make a complaint. During the tour of the home the complaints policy was seen displayed on the doorway of individual peoples rooms and in the reception area of the home. Two complaints have been received since the last inspection. Both related to emergency short-term admissions and the understanding of staff regarding the person’s health and personal care needs. The care planning information for people admitted in an emergency has improved since these complaints were made. One person admitted four days earlier had a full assessment and care Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 17 plan in place to guide staff how their care should be provided and what was important to them. One person said that she had been ‘left on a commode for an hour’. This person did not know how to make a complaint, and did not want to – ‘You must all give and take’, they said, and thought the ‘nurses are wonderful’. Another said they would ‘tell the Sister if they were worried about anything, or would go higher if necessary’. Their call bell had been left out of their reach, but they had not noticed. The organisation has recently appointed a training manager who had been providing core training for the homes staff team. This included the protection of vulnerable adults. Staff spoken to were aware of the homes whistle blowing policy. A copy of this policy was on display in the office of the home. Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,24,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment at Woodland Park generally meets peoples needs and provides a homely environment. However some of the carpets and furniture are worn and stained. Routine cleaning has not always maintained the cleanliness of the carpets and furniture in the home to a satisfactory level. The refurbishments, renewal and redecoration of the environment should continue to ensure that people have a pleasant well-maintained environment in which to live. EVIDENCE: A tour of the home was completed as part of this inspection. Carpets in some people’s rooms remain stained. A staff member advised that some carpets had been replaced since the last inspection and others were due to be replaced. The member of housekeeping staff spoken to said that although they were regularly cleaned not all the stains could be removed. Some worn chairs had Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 19 been replaced since the last inspection. A business plan provided in July 2007 showed the planned improvements to the environment, furnishing and furniture over the next 12 months. Individual people’s rooms have a bed, wardrobe and chest of drawers available. Some furniture looked damaged and worn in individual rooms, while others had had new furniture provided. The majority of beds are divan style, which had been raised to allow hoist access under the beds. One person had a hospital style bed, which was not adjustable. The wheels were missing from the bottom of the bed frame and the carpet was torn under these bed legs. When asked the nurse in charge said that the bed is lifted away from the wall to allow access both sides of the bed. This person’s plan of care indicated that they required a hoist for all transfers. A relative commented that they were concerned about staff having to lift the bed because it did not have any wheels on it. Some rooms have en suite facilities provided and all rooms have hand washbasins. One bathroom on the ground floor had a clear glass door and window, which overlooked the rear garden. No screens or curtains were at these windows to provide privacy for people using this bath. The nurse in charge advised that they were not using this bathroom at present because the bath was difficult for the current people living at the home to use. A bathroom on the second floor had two hoists stored in it that had foam pads, which were breaking up and looked soiled. These would not be easily cleanable and may pose an infection control risk. The nurse in charge advised that these were not used at present. Staff were observed using a manual hoist for those people who needed this. One person said the electric hoist staff used to assist them had been repaired recently. However they said that it had broken down in the past and were concerned that it is not reliable. The call bell system has a display in the treatment room with an audible bleep, which shows the number of the room the call bell was activated in. The call bell monitor could not be heard or the display seen when on the first floor of the home. The nurse in charge advised that staff have to look at the display to find out which person had used their call bell. A common theme throughout this inspection was that people said they could wait for up to 40 minutes for their call bell to be answered. If staff are unable to hear the call bell system when they are working up stairs this could mean they would be unaware of other people requesting assistance until they looked at the call bell display or heard the bleep in the treatment room on the ground floor. On the second day of this inspection one member of the housekeeping team was doing laundry and cleaning the home. They said they had been unable to empty some of the waste bins in people’s rooms, as there was a lot of laundry to complete and a delivery to put away. The senior housekeeper was on leave during the week of the second visit to the home. No additional cleaning or laundry staff had been organised to cover this. At the first visit staff said it Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 20 was difficult to keep the home clean with two cleaning staff on duty each day. Some peoples rooms entered on the second day of the inspection had not had their room bins emptied and some carpets and furnishing in people’s rooms appeared dusty. One relative commented that their relative’s room is not vacuumed very often because staff are too busy. Another person commented that their room had been cleaned and vacuumed more often since the inspection in July 2007. Staining on the carpet also appeared to be less. They said the housekeeping staff were very helpful and tried to make sure their room was cleaned regularly. One relative commented, “Tissues and food left lying around about for long periods should be cleared more regularly on hygiene grounds”. Sluicing machines for cleaning commode pots and urine bottles were provided on each floor. A clinical waste disposal system is in place and staff have access to gloves and aprons when providing personal care for people. One person was being barrier nursed during the inspection all the staff spoken to were aware of the infection control best practices to reduce the risk of infection. Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 21 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 poor. This judgement has been made using available evidence including a visit to this service. The staff team work hard to ensure the people they care for feel supported and cared for. They are good listeners and generally have the interests of the people they care for at heart. The way staff are deployed and/or the numbers of staff employed at the time of this inspection were not meeting peoples needs in the way they expected. The number of staff on duty or the way they are deployed does not appear to have allowed time for the one to one support identified in individual’s plans of care. The company’s robust recruitment policy for all staff did not appear to have been followed; this means that people may be put at risk from unsuitable staff. EVIDENCE: The staff team at Woodland Park are committed and caring. Staff said they agreed to the increased hours so that the people living at Woodland Park would receive care from staff that knew them. Ten people living at the home spoken to said that staff did their best but there weren’t enough of them. From the observations carried out during the morning, it was noted that peoples’ personal care needs could not always be met in good time, as not enough staff were available to meet these needs promptly. Staff working Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 22 upstairs were unable to hear the call bell, and were not aware that someone needs help until they come down to the treatment room. The rota showed that one member of day staff on the duty rota for the previous week had worked up to 66 hours in one week. And one of the night staff was due to work a 2 – 8pm shift that week, followed by an 8pm-8am waking night duty, which is likely to lead to a hazardous level of fatigue. Another member of night staff was due to cover 8 pm – 10 am the next day, then work from 2pm –8pm the same day. One resident said that a member of night staff had been argumentative, made them hurry with tablets and insisted that a pad was not wet when in fact it was. Fatigue could exacerbate stresses. More evidence about inadequacy of staff is in the Health and Personal care section. One staff member commented, “Sometimes when you do too many hours it shows you are tired and not your normal perky self, ” The nurse in charge confirmed that there are 10 people who require two people to provide their care. Staffing the home with two carers and a registered nurse for the morning shift will not be sufficient to meet the needs and dependency of the people living at Woodland Park. The number of permanent staff employed makes it difficult to cover all the shifts with the homes own staff. The nurse in charge advised that the agency the home uses for staff have let them down at the last minute on several occasions. When asked how the home could improve one relative commented, “ Can improve by employing more staff- to help the existing staff who are excellent in all areas”. One of the managers in the group had been assisting with some management tasks following the previous manager’s departure. The staff records seen during this visit were still incomplete and one person appointed since the last inspection in July 2007 did not have a personal folder at the home. The Operations Director confirmed that a copy of this person information had been sent to head office with a copy of their police check. They also advised that all the information required for staff had been obtained; however some information was being kept at head office as staff had worked in other homes in the group in the past. The lack of information for one person and incomplete information for one other staff member made it difficult to evidence that the home recruitment policy had been followed. The organisation has recently appointed a training manager. They have taken responsibility for ensuring all staff have mandatory training for manual handling, fire staff and health and safety. A training matrix showed the training staff had received and the training they had planned. Copies of training certificates for manual handling were seen in the staff files viewed. Staff said their access to training had improved since the last inspection. One said they were planning to start their NVQ in care. Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37, 38, Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has an open atmosphere where people who live at Woodland Park, their family and friends feel valued. However some aspects of management have not fully protected people. By not ensuring staff are deployed in a way that meets peoples needs in a timely manner people may be at risk of not receiving the care they need. People’s personal care plan records are not securely stored, this may mean that their personal details are not fully protected. Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 24 EVIDENCE: The registered manager has left since the last inspection. The organisation has appointed a clinical lead who is a first level registered nurse, to ensure people’s health care needs are meet. Staff reported that things had improved since this appointment and they felt the home was more organised. One commented, “We have a new manager who is very supportive and explains everything to us, glad she’s here.” One health professional commented “ more staff required but new matron very good”. Two relatives said they were disappointed that the manager had left because they were always approachable and listened to them. They said the new clinical manager had spoken to them and they felt they could discuss any concerns they had with them. Information was available for staff in the office or treatment room regarding conditions and diseases that affect the people at the home. However one person living at the home said, “they did not feel all staff caring for them understood their condition.” The company has a system in place to quality assure it’s services on a regular basis. A copy of the results of the resent service users survey was provided for the Commission prior to this inspection. Copies of visits by the company (Regulation 26 notices) are forwarded to the Commission; these provide information on the quality audit review for that period. The organisation had not ensured that the all staff pre employment checks were available with their personal information. This means people who live at Woodland Park may be at risk from unsuitable staff. The company continues to have a policy which means service users money was not held on their behalf, an invoicing system had been adopted for individual people. One person asked said their relatives help them with any finances they need help with. A record of accidents was being recorded in individual peoples daily records. Fully completed accident records were also being kept separately in the home. The way accident records are being kept would allow them to be audited. The home also reports falls to the falls register when a person has fallen. Medication records had not been completed to show why two people had not received their prescribed medication. The peoples care plans did not contain information about why the medication was not given. Individual peoples plans of care were being stored in an open office on a shelf. The nurse in charge advised that during the day the office isn’t always occupied. This may mean people’s personal information is not being stored confidential. Cleanliness of the home had not been fully maintained on the second day of the inspection, although the housekeeper was ensuring peoples laundry was Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 25 being done and communal areas were clean, not all individual peoples rooms entered had been cleaned. The housekeeper said the senior housekeeper was on leave and they had to complete all the domestic tasks on their own, which they were finding difficult. Comments received from relatives and people living at the home said the home is usually kept clean. Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 2 X X X 2 STAFFING Standard No Score 27 1 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 2 1 Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 18(13(2) Requirement Sufficient lockable space for medication, which required refrigeration, must be provided. A record of the fridge temperatures where medication is stored must be available to show medication was being stored at the correct temperature. This refers to the need to ensure that all medicines both those requiring refrigeration and those requiring ambient storage, are stored within the temperature range as specified by the medicine manufacturer. The reasons why a person’s prescribed medication is not given must be recorded. To ensure people receive the right support from the registered nurse team and other health professionals when this occurs. 2. OP18 13(2)23(4 )(c) The registered person shall not employ a person to work at the home unless he has obtained in DS0000028764.V351408.R01.S.doc Timescale for action 10/10/07 31/12/07 Woodland Park Nursing Home Version 5.2 Page 28 respect of that person the information and documents specified in schedule 2. Proof that these have been carried out must be available in the home. Requirement from the last inspection not fully met time scale extended from 30.11.05 31.07.06 and 31/03/07 3. OP27 18(1)(a) The registered person must ensure that at all times suitability qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of the service users. 10/10/07 4. OP29 19(1b)Sch The registered person shall not 2 employ a person to work at the home unless he has obtained in respect of that person the information and documents specified in schedule 2. Proof that these have been carried out must be available in the home. Requirement from the last inspection not fully met time scale extended from 30.11.05, 31.07.06 and 31/03/07 31/12/07 Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 29 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 The manager should ensure that staff have the information they need about the care of people living at Woodland Park relating to their illness/disease. Care should be provided in a way that promotes and encourages people to maintain continence. The manager should ensure that people have the opportunity to take part in the social and recreational activities recorded in their plans of care. The manager should ensure that people have the opportunity to exercise choice and control over their daily lives. Registered person should having regard to the number the needs of the service users ensure that the premises to be used as the care home are of sound construction and kept in good state of repair externally and internally. The routine maintenance and redecoration of the home should continue until all areas have been refreshed The aids, hoists and assisted Bathrooms should be capable of meeting peoples needs. Suitable screening should be provided in bathrooms that will protect privacy The manager should ensure that equipment (hoists, beds) people need are suitable to meet their needs. Peoples rooms should be kept clean and fresh There should be a registered manager for the home who has completed a recognised management award People’s personal care planning information should be stored securely to protect people’s personal information. The manager should ensure that people’s health safety and welfare is protected by the management systems in the home. 2 3 4. OP12 OP14 OP19 5. OP21 6. 7. 8. 9. 10. OP22 OP26 OP31 OP37 OP38 Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Woodland Park Nursing Home DS0000028764.V351408.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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