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Inspection on 19/07/07 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 19th July 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 very positive open atmosphere in the home during the inspection. All the people and their relatives spoken to during the inspection said that the staff team were friendly and helpful. 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. Those asked said they felt staff understood their care needs.

What has improved since the last inspection?

Some planned improvements to the environment were instigated between the two inspection visits. The information in staff files has improved and all staff have had a police check, although not all information required for staff files had been provided.

What the care home could do better:

The manager had not ensured the recruitment of new staff includes all preemployment checks had been completed prior to them starting work. If the homes recruitment policies are not followed people living at Woodland Park may be at risk from unsuitable staff. This requirement has not been fully met from the previous inspection in January 2007. Repairs and renewals and redecoration of the home environment have continued. However some individual residents rooms have still to be refreshed and redecorated. Carpets in some people`s rooms were stained and some chairs in individual rooms appeared worn and looked dirty. Carpets had been steamed cleaned between the two days of the inspection and some worn chairshad been disposed of. However the ongoing repairs and renewal should continue to ensure that the residents have a pleasant environment live in. The way individuals care needs were recorded for the people whose care was followed did not always reflect their changing care needs. One person who had recently stayed at the home for two weeks following a crisis admission did not have a care plan that recorded their care needs and how staff should meet these. This meant that staff did not have the record of information they needed to meet this person`s care needs.

CARE HOMES FOR OLDER PEOPLE Woodland Park Nursing Home Babbacombe Road Torquay Devon TQ1 3SJ Lead Inspector Rachel Proctor Key Unannounced Inspection 19th July 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.V342712.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.V342712.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 Phyllis Irene Wilton 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.V342712.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 31 Date of last inspection 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 present 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 disabled bathing facilities on each level and 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 resident’s 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 10.01.07 were up to £516.07 the actual fee is dependant 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.V342712.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 19th between 10 am and 3:30 and 23rd July 2007 between 10 am and 1 pm. 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 one relative, one health professional and a GP. 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: The manager had not ensured the recruitment of new staff includes all preemployment checks had been completed prior to them starting work. If the homes recruitment policies are not followed people living at Woodland Park may be at risk from unsuitable staff. This requirement has not been fully met from the previous inspection in January 2007. Repairs and renewals and redecoration of the home environment have continued. However some individual residents rooms have still to be refreshed and redecorated. Carpets in some people’s rooms were stained and some chairs in individual rooms appeared worn and looked dirty. Carpets had been steamed cleaned between the two days of the inspection and some worn chairs Woodland Park Nursing Home DS0000028764.V342712.R01.S.doc Version 5.2 Page 6 had been disposed of. However the ongoing repairs and renewal should continue to ensure that the residents have a pleasant environment live in. The way individuals care needs were recorded for the people whose care was followed did not always reflect their changing care needs. One person who had recently stayed at the home for two weeks following a crisis admission did not have a care plan that recorded their care needs and how staff should meet these. This meant that staff did not have the record of information they needed to meet this person’s care needs. 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.V342712.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.V342712.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): 1,3, 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The revised 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. Although the assessment process and templates are good if these are not completed people will not have their care needs recognised and met. The home does not provided intermediate care. EVIDENCE: Although the Commission had been advised that the statement of purpose and service users guide had been revised this was not easily available for people in the home on the first day of the inspection. The senior representative of the company who was present on both days of the inspection ensured that this was provided by the second visit to the home. Woodland Park Nursing Home DS0000028764.V342712.R01.S.doc Version 5.2 Page 9 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 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. 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 or district nursing teams were also available where these had been completed prior to the admission. However one person who had been admitted for a two-week period following a crisis did not have an assessment of their care needs completed by the home or a plan of care provided. This put that person at risk of not receiving the care they required because staff did not have a clear record of their care needs or how these should be met. The care management assessment, which gave basic information about the person, had been provided by social services prior to their admission; however this did not give sufficient information about their care needs. Three of the four people whose care was followed did not have a record of a reassessment of their care needs as these changed. Plans of care had not been up dated fully to reflect the changes in their care needs. Two people whose care was followed had significantly improved from the information provided in their plan of care. One of these people said staff had spoken to them about their care needs and had been very helpful and they were really pleased with their progress. The home does not provide intermediate care. Woodland Park Nursing Home DS0000028764.V342712.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. Although people reported that they were well cared for and staff understand their care needs. By not having clear care planning that records the persons changing care needs and how staff should met these; people will be at risk of not receiving the care they need. The majority of the medication practices in the home are safe and ensure people receive the treatment they need. However information for people who are able to self-medicate is unclear and does not fully protect them. By not completing risk assessment prior to people managing their own medication staff are putting people at risk. EVIDENCE: People who live at Woodland Park are registered with a General Practitioner (GP). The system for recording GP visits enables staff to identify any changes in treatment the GP may have ordered. Woodland Park Nursing Home DS0000028764.V342712.R01.S.doc Version 5.2 Page 11 A record of the involvement of a specialist nurse for one person had been recorded in their plan of care. The specialist nurse had offered advice regarding the health care and treatment. Some of this had been incorporated into this person’s plan of care. This person advised a specialist nurse had visited and had given them and staff advice on how to help them manage the symptoms of their disease. However the changes recommended by this specialist nurse earlier in the week had not been recorded in the person’s plan of care. The changes in the way their medication should be managed were also unclear both on the person’s medication sheet and their plan of care. Limited self medication had been started however a risk assessment for selfmedication had not been completed and this was not reflected in the care plan or the person’s medication sheet. Information in this persons care plan suggested that the person may have difficulty swallowing and should be observed taking their medication. Not recording clearly and not carrying out a risk assessment for the specialist’s nurse’s recommendation put the person at unnecessary risk. Self-medication for this person was stopped until a risk assessment could be completed and further advice obtained from the specialist nurse. One person who had been identified as at risk of self-harm had not had the risks with in their environment recorded or changes made until this was highlighted during the inspection. The plan of care was updated and agreed with this person and their personal space reviewed before the end of the inspection. Relatives and people who live at the home spoken to during the inspection said that staff understood their care needs and looked after them well. One relative commented that they had helped their relative to settle in the home by valuing their individuality and helping them to continue to express their views. They also said the staff provided good care for their relative. One person who lived at Woodland Park said the staff could not be more helpful and they worked really hard. Two relatives commented on how helpful and approachable the manager was when they had asked her about the care of their relative. A comment card received from a GP stated, “Good Home”. A health professionals comment card indicated that individual’s health care needs are always met by the service. The senior clinical director for the company was at the home on both days of the inspection to do an audit. They advised that a new care planning system had been introduced which recorded peoples plan of care using a computer template. They up dated one person’s care plan whose care was followed with the changes using this system with the nurse in charge of the shift during the inspection. This provided clear instruction for staff regarding the persons health and personal care needs and how staff should met these. The person had agreed their plan of care. Woodland Park Nursing Home DS0000028764.V342712.R01.S.doc Version 5.2 Page 12 However the other people whose care was followed did not have all their changing needs recorded in their plan of care. This may mean that the people who live at Woodland Park will be reliant on staff being available who know and understand their care needs. One person who had been receiving regularly treatment from the physiotherapist had not had their plan of care up dated with the improvement to their mobility that this had enabled them to achieve. New goals had not been agreed with the person and recorded. Each of the four people whose care was followed had a record that the plan of care had been reviewed monthly. However these were not clearly linked to the care plan for the individual. Where an element of the persons care had changed this was not always recorded as part of the review. The changes to the plan of care were not dated in one persons plan seen. The senior clinical director for the company advised that they would be reviewing and re-writing the care plans with the registered nurses in the home during their visit using the computer template. Pressure sore risk assessments had been completed for the people whose care was followed. One person identified at high risk had an air flow pressure relief mattress provided. The plan of care for this person included a wound care plan. 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 drug medication was in place. This was checked against stock held for one person as correct. Two staff had signed the records of medication disposal. However the medication for disposal was being stored in an open box in a locked cupboard. This had not yet been recorded in a drug disposal record or placed in the container provided for this. The nurse in charge of the shift advised that the registered nurse on night duty co-ordinates this and they usually wait until there are several lots of medication for disposal before completing the drug disposal record and placing the medication in the container provided. A clinical waste disposal company takes responsibility for removing the medication from the home. The nurse in charge of the shift advised that a system for disposing of controlled drugs using a recognised disposal system was in place. They further advised that one nurse had taken responsibility for ordering medication on a monthly basis from the pharmacy using the GP repeat prescription. Two peoples medication records were viewed. These had been completed and signed by the registered nurse administering the medication. The laundry system continues to allow people to receive their own clothes. Named individual storage baskets were seen in the laundry room. 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. Two of the people spoken to said that staff are friendly and helpful towards them. Woodland Park Nursing Home DS0000028764.V342712.R01.S.doc Version 5.2 Page 13 Woodland Park Nursing Home DS0000028764.V342712.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: Two of the comment cards received indicated that they felt people at Woodland Park do not have enough varied activities to meet their needs. Two people who live at Woodland Park asked about the activities said different things had been arranged and they liked some of these. One person said they were disappointed that they had been unable to get out more. The company representative advised that one to one time would be allocated for people on a regular basis. They commented that it was hoped that this would allow activities the person enjoyed to be facilitated for them. One person who had Woodland Park Nursing Home DS0000028764.V342712.R01.S.doc Version 5.2 Page 15 their plan of care reviewed during this inspection had arranged to go out to the sea front for an hour weekly. Staff would facilitate this. On the first day of this inspection an entertainer was organising a quiz, several people were taking part and appeared to be enjoying this. Garden furniture had been provided in the front of the home, visitors and people living at the home were making use of this. The owner advised that they planned to make this a more attractive area to sit by separating the area from the car park with decking. One person said that the TV control in the lounge had been broken for some time and they were disappointed that the TV only had four channels. The TV was on during the inspection and a few people were watching this. Further activities for the people who live at Woodland Park were organised during the inspection. The people whose care was followed had social care plans (Support workers assessments) included in their care plans. One of these was fully completed and identified the things the person enjoyed doing and what their preferences were. The inspector was told that these would be up dated as part of the care plan reviews taking place. Visitors were coming in going throughout the inspection. They were seeing people in the privacy of their own rooms or one of the communal areas. One relative spoken to during the inspection said the staff are always friendly and helpful and keep them informed. They also commented that they were very happy with the care and support their relative was receiving. Four of the people living at Woodland Park spoken to said the meals had improved recently and they enjoyed the food provided for them. One person commented that although the food they were given was well prepared they would like the opportunity to eat different foods and found some of the meals a little bland. The lunch time meal observed was unhurried with people eating their meals at their own pace. Those that required assistance to eat their meals were being given this in a sensitive supportive way by staff. The meals seen were attractively presented and nutritionally balanced. Nutritional risk assessments had been completed as part of the risk management care planning for all the people whose care was followed. On the second day of the inspection the dining area had been moved around to allow easier access for people who used wheel chairs. This gave more room in the communal lounge as well as improving access to the dining tables for wheel chair users. The owner advised that they intended to buy different style tables that would give more space and increase the number of people able to use the dining area. Woodland Park Nursing Home DS0000028764.V342712.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 manager must follow recruitment policy to ensure that people living at Woodland Park continue to be protected from unsuitable staff. EVIDENCE: The Commission has been made aware of three complaints since the last inspection. These have related to the way care was delivered for individuals. One of these was not substantiated; the others have not yet been concluded. A record of complaints received and the actions taken to address the concerns raised by the complainants was being kept. The company representative advised that complaints about the service are passed to head office and where appropriate these are responded to by a senior person with in the organisation. The complaints policy is easily available for people living at the home and their representatives. Prior to the visit to the home two relatives whose relatives had been at the home for a short emergency stay felt that their concerns about the way care was being provided were not taken seriously by the manager and changes agreed were not implemented. However people living at the home and their relatives spoken to during the inspection said they knew who to Woodland Park Nursing Home DS0000028764.V342712.R01.S.doc Version 5.2 Page 17 complain to. One person advised that the manager had dealt with a concern they raised swiftly and to their satisfaction. The training information provided during the inspection indicated that staff had received vulnerable adult training. Since the last inspection the company had appointed a training manager. The company representative advised that they would be organising all the training for staff. A new personal development plan template introduced for staff lists the mandatory training and specialist training with the dates completed in the last 12 months. Four staff records reviewed during the inspection-contained information about the training they had completed. Copies of certificates were available on the file. All four staff files contained a job application form. However not all the records listed in Schedule 2 were available in two of the staff files viewed. One did not have confirmation of their professional registration another did not have a copy of their work permit. References obtained for two staff were not from a previous employer or were addressed to whom it may concern. There was no record that these had been followed up prior to their employment. Although a matrix, which showed the information for staff files had been obtained these were not complete in two files viewed. One staff members file contained a copy of the CRB check provided by their previous employer who had completed this less than 12 months earlier. By not ensuring robust recruitment policies are followed including obtaining all pre employment checks for staff; people continue be at risk from un-suitable staff. Woodland Park Nursing Home DS0000028764.V342712.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): 19,26 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 were stained. A staff member advised that these were due to be replaced and although they were regularly cleaned not all the stains could be removed. Four chairs in different peoples rooms were covered in a worn Woodland Park Nursing Home DS0000028764.V342712.R01.S.doc Version 5.2 Page 19 tapestry fabric that looked soiled. One relative raised concerns about how these chairs were cleaned. The owner confirmed that these chairs and carpets were due to be replaced. A business plan was provided this showed the planned improvements to the environment, furnishing and furniture over the next 12 months. The new chairs in the homes lounge were domestic in character, easily cleanable and suitable for peoples needs. This had improved the overall look of the lounge. One person said they thought the new chairs looked much better and they were comfortable to sit in. On the second day of the inspection the dining area in the lounge had been moved. This gave more room in the lounge and easier access to the dining tables for independent wheelchair users. Individual peoples rooms have a bed, wardrobe and chest of drawers available. The majority of beds are divan style, which had been raised to allow hoist access under the beds. Some rooms have en suite facilities provided and all rooms have a hand washbasin. Where rooms are large enough for individuals to share screening is available. The edges of carpets in corridors and individual peoples rooms were dusty. Some carpets in individual’s rooms did not appear to have been vacuumed. One person asked said the cleaner did not vacuum their room very often. Dust was also seen on furniture in some rooms. A member of staff advised that the number of hours available for cleaning had been reduced when they took over the cooking after the chef left and they were finding it difficult to catch up. During the inspection contract cleaners were organised to steam clean the carpets and furniture. On a second day of the inspection all the rooms entered had been cleaned. Carpets have been steam cleaned and the majority of the staining had been removed. Dust around the room edges and on furniture had been cleaned. Overall the home looked much cleaner and fresher on the second day. One person said the owners and the staff had worked very hard over the weekend cleaning the home. Another said they liked the changes that had been introduced in the lounge. A hoist in one room, which was dirty on the first day of the inspection, had been cleaned. One room had new curtains and bedspread provided on the second day of the inspection. The company’s representative advised that they were in the process of replacing the curtains and bedding for all individual peoples rooms. The laundry room is sited away from food preparation areas. There were individual laundry baskets for each person’s personal clothing in the laundry room. During both days of the inspection people were wearing their own clothes, which were clean and pressed. People asked said staff looked at their clothes well and made sure they had their own clothes to wear. The washing machines are capable of disinfecting sluice wash. The housekeeper advised Woodland Park Nursing Home DS0000028764.V342712.R01.S.doc Version 5.2 Page 20 that personal clothing for individuals are washed in a home and bedding is contracted out. Disinfecting sluices are available on each floor for disposal of waste and cleaning of commode pots. Hand wash facilities and gloves were available for staff to use in these areas. Woodland Park Nursing Home DS0000028764.V342712.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 adequate This judgement has been made using available evidence including a visit to this service. The people in Woodland Park are cared for by a staff team who treat them with respect and value their opinions. However by not following the company’s recruitment policy for all staff, people may be put at risk from unsuitable staff. EVIDENCE: A duty rota showing the names of the staff, what capacity they were employed in and their hours of work for each shift was available. This showed that a registered nurse was available to direct the care of the people who live at Woodland Park over a 24 hour period 7 days a week. A team of Health Care assistants supports the registered nurses. The clinical director visiting the home confirmed that the homes staffing levels had improved reducing the use of agency staff. She further commented that this has enabled people to be cared for by staff that know and understand their care needs. Comment cards received from relatives and visiting professional indicated they did not feel sufficient staff were on duty to provide all the care people needs. One comment stated, “ There is not enough staff to cope.” Another comment said “ generally it is a well run home, unfortunately as patient numbers drop the staff is cut accordingly and this can at times put great pressure on remaining staff”. Two people commented that they would like more one to one Woodland Park Nursing Home DS0000028764.V342712.R01.S.doc Version 5.2 Page 22 time with staff to enable them to do the things they like. The clinical director for the company advised that she would be reorganising how staff worked to ensure people had one to one time. This was done for one person during the inspection. Their plan of care reflected what had been agreed with them for one to one time. The housekeeper raised concerns that not enough hours were available to complete all the cleaning needed in the home. The clinical director advised that she would be looking at work responsibilities and looking at the number of hours needed. An external company was arranged to steam clean all the carpets and furniture in the home. This had been completed by the second visit to the home. The company had appointed a training manager since the last inspection to coordinate all the training staff required. A template introduced since the last inspection for annual staff training and development showed which mandatory and specialist training they had completed. The clinical director advised that a new induction process had been introduced, which used a training book linked to the Skills for Care recommendations. This would be used for all new staff that join the staff team in future. The commitment to NVQ training for staff was confirmed; the home is working towards having 50 of its care staff achieving an NVQ 2 in care. Four staff files were viewed during the inspection. One did not have a record that their professional registration had been confirmed. Two others did not have references from their previous employer on file; references were provided by work colleagues or were addressed to whom it may concern. The manager had not recorded that she had checked the references with the referee prior to the person stating work. All staff files seen had a police check completed. It was confirmed that all staff have a police check completed prior to them starting work at the home. The status of work permits for one foreign staff member was unclear. Although the clinical director advised how this had been checked a written record had not been made by the manager regarding this. The records available in the staff files did not confirm that all the relevant pre employment checks had been completed and some did not contain all the information required listed in Schedule 2 of the National Minimum Standards 2001. The information available in staff files had improved since the last inspection and all staff now have police checks therefore the time scale to meet this requirement has been further extended. Woodland Park Nursing Home DS0000028764.V342712.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): 31,33,35,38 Quality in this outcome area is adequate. 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 records required are up to date and accurate people may be at risk of not receiving the care they need. EVIDENCE: The registered manager has several years experience managing a care home. Information provided confirmed that she would start the NVQ level 4 in management in September 07. Information was available for staff in the office or treatment room regarding conditions and diseases that affect the people at the home. Woodland Park Nursing Home DS0000028764.V342712.R01.S.doc Version 5.2 Page 24 The Annual Quality Audit Assessment had not been returned to the Commission prior to this inspection as required. The company has a system in place to quality assure it’s services on a regular basis. 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 manager had not ensured that the all staff had received the appropriate pre employment checks before they started work. This could put the people who live at Woodland Park at risk from unsuitable staff. The clinical director advised that the organisation had adopted a policy, which meant service users money was not held on their behalf, an invoicing system had been adopted for individual people. They also confirmed that no one in the home acts as appointee for any of the people who live there. The records available for fire extinguisher checks were unclear however the maintenance man was able to confirm these had been completed. The maintenance man was completing a record of water temperature checks. The owner advised that they had arranged for a plumber to check the water temperature restrictor system because hot water in the hand wash sinks in some rooms was hotter than they would like it to be. Health and safety policies and procedures were available for staff in the office of the home. Training records indicated that staff receive fire and manual handling training. A record of accidents was being recorded in individual peoples daily records and a record sent to the falls register when a person had fallen. However accident records were not being kept in a way that would easily allow audit and show trends. The clinical director advised that this had been changed and additional accident records would also be kept separately in the home. Woodland Park Nursing Home DS0000028764.V342712.R01.S.doc Version 5.2 Page 25 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 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 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 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Woodland Park Nursing Home DS0000028764.V342712.R01.S.doc Version 5.2 Page 26 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 OP3 Regulation 14(2) 15(1) 12(1) 13(4)(c) Requirement Each person admitted to the home must have a plan of care, which has been based on a care needs assessment. Psychological Health must be monitored and preventative and restorative care provided. Instruction given by health care professionals must be clearly recorded and followed to ensure people receive the health care they need. Risk assessments must be completed prior to people managing their own medication to reduce risk. Changes in the way prescribed medication is given must be recorded in the persons plan of care and on their medication sheet. A record must be kept which makes it clear that changes made have been agreed by relevant health care professional including the persons GP. Woodland Park Nursing Home DS0000028764.V342712.R01.S.doc Version 5.2 Page 27 Timescale for action 20/08/07 2 OP8 20/08/07 3 OP9 12(1)(b) 13(2) 14(2) 20/08/07 4. OP18 13(2)23(4 )(c) The registered person shall not 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 The manager must provide confirmation of CRB checks being completed for all staff Requirement from the last inspection not fully met time scale extended from 30.11.05, 31.07.06 and 31/03/07 30/09/07 5. 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 The manager must provide confirmation of CRB checks being completed for all staff Requirement from the last inspection not fully met time scale extended from 30.11.05, 31.07.06 and 31/03/07 30/09/07 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 monthly reviews of people care should be clearly linked to the changing care needs of individuals. All those admitted to the home including emergency short stay should have a plan of care which sets out their care needs Woodland Park Nursing Home DS0000028764.V342712.R01.S.doc Version 5.2 Page 28 2 OP12 People should be consulted and given choice of activities arranged for them. People should have their interests recorded as part of their plan of care. How people are given support to exercise choice and control over their lives should be clear in their plan of care The manager should ensure that people who raise concerns about the facilities and services provided understand and feel their concerns taken seriously. 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 All part of the home should be kept fresh and clean for the people who live their Domestic staff should be employed for sufficient hours to keep the home clean, hygienic and free from dirt. A minimum of 50 of health care assistants employed should have a NVQ level 2 or above. The manager should complete a recognised management award Copies of the completed quality audit should be made available for the people who live at Woodland Park The AQUAA (Annual Quality Assurance Assessment) should be returned to the Commission with in the timescales set 3 4 5. OP14 OP16 OP19 6 7 8 9 10. OP26 OP27 OP28 OP31 OP33 11. OP38 The manager should ensure that people’s health safety and welfare is protected by the management systems in the home. Woodland Park Nursing Home DS0000028764.V342712.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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