CARE HOMES FOR OLDER PEOPLE
Woodland Park Nursing Home Babbacombe Road Torquay Devon TQ1 3SJ Lead Inspector
Clare Medlock Unannounced Inspection 2nd July 2008 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.V366811.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.V366811.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 Manager post vacant Care Home with Nursing 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.V366811.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 31st January 2008 Brief Description of the Service: Woodland Park nursing home is an established nursing home in the Babbacombe area of Torquay. The home is located approximately 100 yards from Babbacombe Downs with far reaching views over the bay. There is a small shopping area just a short walking distance away. The original Edwardian building has been extended to enable it to accommodate up to 31 people. 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 people it provides nursing care for. Meals are prepared in a 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 people 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 and on request. The fee levels provided in July 2008 started at £489. The actual fee is dependent on the needs of the person and the room occupied. Additional charges are made for chiropody, hairdressing, newspapers and magazines that the person requests. Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes.
This inspection was unannounced and took place on Wednesday 2nd July 2008. Prior to the unannounced inspection we sent surveys to people who use the service. We received five back. We also sent surveys to staff and received three back. We also received one survey from a healthcare professional. The visit to the home took place over one day. During our visit we spoke to four people who use the service, the manager, five staff members and three relatives. We case tracked three people who use the service. Case tracking means we looked in detail at the care three people receive. We spoke to staff about their care; looked at records that related to them, spoke with them and made observations. We looked at three staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the systems work and what this means for people who use the service. All this information helps us to develop a picture of what it is like to live at Woodland Park Nursing Home. What the service does well:
The procedures followed prior to admission ensure people have enough information to decide whether Woodland Park is the right place for them to be. The process also enables staff to assess whether they can meet their needs and prepare equipment that will be needed. The statement of purpose and service user guide are informative and contain the required information about what services the home offers to allow a person and/or their advocate to make an informed choice regarding whether or not the service could meet their needs. People like the staff at the home and say staff listen and act on what they say. People also receive the medical support they need. One health care professional wrote ‘Kind and Caring, helpful attitude, patient safety, quality in the delivery of healthcare needs.’
Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 6 People know how to complain and who to complain to. When this happens, complaints and concerns are dealt with appropriately. People at the home are looked after well and access their GP, specialist nurse and NHS services when necessary. Staff identify risks for people at the home and plan ways to minimise these risks. Care plans are reviewed to show what care needs each person had and how they are be met. Record management at the home is organised. People living at the home can see visitors at any time of the day. Visitors are always made to feel welcome at the home. The home is in general reasonably well decorated, comfortably furnished and reasonably well maintained. People like their rooms and the facilities provided and are pleased small items can be bought in to make the room feel more like home. There is good kitchen hygiene with a record of the heat of the food served, a daily cleaning rota and a daily record of the fridge temperatures. The laundry service at the home is ‘good’ with people telling us that they ‘get their clothes back quickly’. There are robust recruitment procedures in place at the home to ensure all staff have the necessary pre employment checks. CRB (Criminal record Bureau-police check) and POVA (Protection of vulnerable adults) pre employment checks are performed before staff are able to work. This shows that staff are checked before working with vulnerable people. Staff are encouraged to do NVQ training which means they will be provided with the skills to care for people in an appropriate way. The interactions between staff and people who use the service are positive. What has improved since the last inspection?
Many things have improved since the last inspection, although the manager is aware that more needs to be done. A new call bell system has been introduced to ensure staff can hear the bell wherever they are in the home and know immediately who and where the person is. This has meant delays answering call bells have been reduced and staff can always know who is requiring help. New staff have been employed which relatives and people say has improved the atmosphere in the home. A supervision and training programme has been identified for all staff, yet not fully introduced. The numbers of staff on duty has also increased, although not adequately.
Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 7 The medication system has improved since the last inspection. Improved storage facilities and stock control means medication is appropriately stored. A new instruction for the timing of some medication has been introduced and is generally followed by staff at the home. Day staff now give medications at 08.00 to enable night staff to help get people up who chose to. Staff are better at identifying risks in the home. These have included environmental risks, health care risks and general risks. Assessments are carried out to show that steps have been taken to try and reduce risks and protect people. Baths with un regulated water temperatures have been made inactive to reduce risks to people who use the service. Improved bed rail assessments have also been introduced. Record management has also improved. Lockable filing cabinets have been provided to ensure confidential records are safely stored. Other records, paper work and information is now clearly organised within the office area enabling quick reference. Care plans are organised and reviewed. The environment has also improved with the replacement of many carpets and decoration in some parts of the home. New pictures have been purchased to provide a brighter place for people to live. Action plans have been written to provide further improvements at the home. The manager has identified staff who need training and has delegated supervision which is starting to be introduced. What they could do better:
The improvements, which have taken place at Woodland Park, must continue. The organisation should start looking at the way it manages shortfalls that are noted at each inspection, and to introduce ways of identifying them before they are raised. The safety of people must be seen as a priority at the home. Staffing numbers must be systematically reviewed, equipment must be available, the environment should be risk assessed and life at the home should be under continual review. Many issues regarding care are affected by lack of or inappropriate equipment at the home. There must be sufficient hoists, lifting belts and training for people to be moved in a safe way. Training for staff must be given to ensure staff are aware of how to use new pieces of equipment. Staff must be given sufficient information within care plans to know how to meet the individual needs of each person in the home. The Manager must ensure staff are able to follow these handwritten instructions and records. Staffing levels should be kept under review to ensure the choices of people are not restricted because of workload. There should be enough staff to enable
Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 8 people to get up and go to bed when they choose. Staffing levels should also be sufficient to enable a social activities programme to take place and to enable care to be given at a pace that is right for people in the home. Where staffing shortages are expected, such as in the kitchen, provision should be made to ensure staff making up the absences does not affect other areas at the home. The Provider should also look at the hours that staff work to ensure the quality of care and safety of the person is not affected due to excessive working hours. The Provider must also look at the workload of the manager when she is expected to be the only registered nurse on duty. Systems must be in place to enable to manager to fulfil both roles. This will enable the manager to provide nursing care and medications on time to people at the home. People who use the service must be consulted about their life at the home. Any changes to menus should be discussed with people before they are introduced. The home should ensure it listens to the feedback people give regarding the food. The environment should be a safe place for people to live. Any risks should be identified and reduced or removed. This should include replacing flooring in bathrooms which become slippery when wet. The protection of people must be seen as a priority at the home. The Provider must show that allegations of abuse are dealt with appropriately and correctly. Staff must be aware of how to recognise and report abuse and should be provided with information and training to make this happen. People must also be cared for by a skilled and trained group of staff. Mandatory training in subjects such as first aid, fire safety, moving and handling and health and safety must be up to date. New staff should be employed using equal opportunities and be issued with the General Social Care Council Code of Practice, to provide them with guidelines of what is expected of them. 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.V366811.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The robust procedures followed prior to admission ensure people have enough information to decide whether Woodland Park is the right place for them to be. EVIDENCE: The statement of purpose and service user guide was available within the communal hallway. This contained the required information about what services the home offers to allow a person and/or their advocate to make an informed choice regarding whether or not the service could meet their needs. A copy of the homes contract was provided with the statement of purpose. Relatives told us that they had an opportunity to visit the home prior to their relative moving to the home. One person said they had been too unwell but
Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 11 knew their family would make the right decision. On the day of inspection one person was moving to the home to be closer to family. Each person is assessed before coming to the home. The Manager told us where distance prevents this happening a detailed telephone assessment is performed. This assessment is then followed with a plan of care that shows staff how the persons care needs should be managed. Risk assessments for manual handling, nutrition and pressure sore development and general risks are also completed. Copies of discharge assessments from hospital and community nursing teams are also used in the care plan for reference. The information contained in individual assessments had been up dated since the last inspection to reflect the changes in care needs. The manager told us that the pre admission process also ensures the hospital checking that the home have sufficient specialist equipment in place before a person is discharged from hospital. The home does not provide intermediate care. Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally the care provided is adequate. Any issues regarding care practices are due to lack of appropriate equipment, lack of staff or due to the many interruptions to the manager. Poor record keeping could mean that care is not provided according to the needs or wishes of the person. EVIDENCE: Surveys sent to people living in the home told us that life at the home had improved in recent months. All respondents said staff listen and act on what they say and that they receive the medical support they need. One person commented ‘Things in general have improved, but response times for medicines is still sometimes slow’. Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 13 Surveys from healthcare professionals also supported the view that improvements had been made since the present manager had been at the home. One comment read ‘Since the manager has taken charge, the quality of care has improved’. When asked what the service does well one health care professional wrote ‘Kind and Caring, helpful attitude, patient safety, quality in the delivery of healthcare needs.’ Staff surveys told us ‘There has been a lot of changes in the short time and they have been for the better of the home, residents and staff’. People at the home looked well cared for with the finer details of care being provided such as appropriate footwear, glasses, eye care and access to call bells. We were told people see their GP when is necessary and see specialist nurses according to their need. Records showed that out patient appointments and podiatry treatment is also accessed by the home. Each person has a nutritional assessment, which in the people we case tracked showed that the risk was high. Records showed that weight loss was noted for thirteen people that were weighed in June eleven had lost weight, including the three people we case tracked. The manager told us the scales were giving inaccurate readings and new scales had been requested twice but refused because the home was over budget at present. People at the home each had an A4 folder with set of risk assessments and care plans, which had been reviewed and generally showed what care needs each person had and how they were to be met. Bed rail risk assessments had improved since the last inspection. Some care plans and records had been typed. Some care plans and lifestyle records had been handwritten. Some of these handwritten records were illegible. We asked three care staff to try and read what had been written but they were unable to read what a person’s care needs and individual preferences were. This means that information that needs to be passed on relies on informal verbal communication, which can missed or not provided accurately, especially when agency nurses are used. Illegible handwriting, which is not clear or legible and not able to be scrutinised, is not within Nursing and Midwifery Council record keeping guidelines. Staff told us they have a ‘handover’ session at the beginning of each shift. This is an opportunity to share any changes in care needs of the people in the home. Staff told us equipment in the home needed replacing. Staff told us that one person was being transferred with inappropriate equipment and that new equipment had been requested but not yet provided.
Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 14 People we spoke to said they often felt rushed. They told us staff were extremely kind but because they were so busy sometimes they ‘worked too quickly’ and felt as if they must be ‘a slow coach’. We were told that staff were never rough or cruel just too quick. People told us that bells were answered more quickly but sometimes there was still a delay because of lack of staff. The management of medicines has improved at the home. Records have improved to show that medicines needed at set times were generally given on time. One person said this had improved but that the manager was sometimes late because she has so much else to do where as the other registered nurses do not have the extra administration tasks. People told us that staff were ‘very good’ at protecting their privacy. People were able to have a telephone in their room if they chose and wear their own clothes that are washing at the home. The interactions we saw between staff and people who use the service was very positive. Laughter was heard at the home and appropriate terms of address used. Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Lack of staff means people do not have access to activities. The process of consulting and listening to people about food and their life at the home is poor. EVIDENCE: Some people told us they were ‘bored’ living at the home and that ‘there was nothing going on’; whilst others told us they preferred their own company. Surveys asked are there any activities you can take part in? Two people said usually, one person said sometimes and two people said never. Comments included ‘I would like more sing song type of entertainment in the day room’ whilst another wrote ‘It would be nice to do more activities with staff on a one to one. For example: go out for coffee, a trip to the rose garden, or to the precinct to shop’. One person said she would like to do some knitting or crotchet but this had not been arranged and she had no visitors to help. Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 16 People told us that staff only just had time to get people up and dressed, so there was no extra time to give 1:1 time or arrange activities. People also said they sometimes did not have a choice of when to get up or go to bed, as this was dependent on what staff were available. Staff told us there is an expectation to get a certain number of people up and washed at certain times, to help with the routine, although it was only people who wanted to get up that were assisted. People living at the home told us they had visitors at any time of the day. Visitors told us they were always made to feel welcome at the home. Visitors were able to see their friends and family in their rooms or communal areas according to the wishes of the person. We were given mixed feedback about the food. Some people said it was good with comments such as ‘the afternoon refreshments are particularly good’. The majority of feedback was that it was ‘dull’ and ‘sandwiches are often stale and unimaginative’ and ‘the menu lacks interest and variety’. We were told that the company had introduced a new menu. The people we spoke with were unaware of this new menu and said they had not been asked about what they wanted. One person said if they asked me I would have asked for more fresh fruit. One survey said they wanted ‘less food from the freezer and more fresh vegetables and fruit’. One person said they were sure their constipation was mainly down to a poor diet. One relative said the portion sizes of fruit and vegetables do not meet the 5 a day suggestions. Discussion with staff showed that the new menu had been introduced but some foods were not provided because they were not on the supplies list. Many items on the menu were frozen meals, including donuts, vegetables and desserts. On the day of inspection braised meat, fresh suede, frozen French beans and frozen potato wedges were being prepared. The alternative of sweet and sour chicken was not being prepared as kitchen staff said people who use the service do not like this. The people we spoke with were unaware there was an alternative and said they ‘never know what is coming.’ Meals were an unhurried affair and were taken in a pleasant setting with those that need help getting this individually. For those people who required pureed food, each portion was individually presented to ensure that the people got the most pleasure from their food as possible. Staff prepare and give out peoples breakfasts, some of which are given out early by the night staff to help the day staff with their workload. Some people who have an early breakfast stated that they did not mind this, as they knew staff were very busy. The chef on duty was the relief cook, who works two days a week in the home. At other times the housekeeper acts as chef, but this takes her away from her role which has an impact on care staff who need to answer call bells and provide hot drinks. Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 17 There is good kitchen hygiene with a record of the heat of the food served, a daily cleaning rota and a daily record of the fridge temperatures. Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 18 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can be confident that concerns will be dealt with appropriately. Inadequate systems, knowledge and training in the protection of vulnerable adults is placing people at risk. EVIDENCE: A complaints procedure is displayed in the entrance hall and also contained within the homes documentation. There was a record of in-house complaints and of how these have been resolved, although the manager, or Commission for Social Care Inspection have received no complaints since the last inspection. Surveys from relatives and people who use the service told us that people knew who to speak to if they had any concerns. Complaints received are recorded and actions taken to address the concerns raised are recorded. One relative said a while ago they would have been wary of complaining because of fear of reprisals but these fears have gone since the many changes that have occurred at the home. People told us they felt safe living at the home and relatives told us they felt their relatives were cared for in an appropriate way although staffing levels would improve this. People told us that staff were ‘never rough or cruel just too quick at times’.
Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 19 Staff told us they had undergone CRB (Criminal record Bureau-police check) and POVA (Protection of vulnerable adults) pre employment checks before they were able to work. One member of staff said they had received POVA training with a previous employer as part of the NVQ training. Another two members of staff were unclear what this training was and told us they had never heard of it. Staff told us they would report any concerns to the manager but were unclear of how they should report allegations of abuse in the absence of the manager. One member of staff had written a statement regarding an incident of abuse that had occurred some time ago in the home. She was unaware of the outcome or correct reporting procedures and was unclear of who allegations should be reported to outside the home. The manager told us the Responsible Individual had dealt with the incident but no records were present to show the reporting procedures had been followed. Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 20 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21,22,24,25,26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Woodland Park generally meets peoples needs and provides a homely environment. However, improvements are still needed to provide people with more suitable and safer facilities. EVIDENCE: The home is in general reasonably well decorated, comfortably furnished and reasonably well decorated. Some rooms have been re decorated since the last inspection and many carpets have been replaced. The downstairs hall way had been re decorated. Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 21 The maintenance man for the organisation was present replacing a curtain track that had fallen down the day before. The maintenance person’s responsiblity includes some of the homes health and safety aspects. People we spoke with told us they liked their rooms and the facilities provided. Small items were bought in to make the room feel more like home. There remain some beds which are not adjustable or suitable to use with lifting equipment. One person had two matresses on his bed as the bottom one was ‘not very comfortable’ Cleaning staff were present and now have rotas to follow to ensure the home is kept clean and tidy. The home appeared clean with no obvious odours. Communal areas were well decorated. A new carpet had been repalced within the sitting room and the dining area was decorated with table cloths. There were many bathing facilities within the home, although staff told us the majority of these are not used because of lack of access and inability to use appropriate moving and handling equipment. One bathroom on the ground floor that had been highlighted at the previous inspection was still out of use, although delays to turn this into a shower room was due to timescales of local builders. Two bathrooms within the home that are used have unsuitable flooring, this is reported on in the management section of this report. Some bathrooms without fail safe devices to prevent scalding were still out of use. Risk assessments are now in place and the tap head have been removed to prevent scalds by removing the opportunity for people to turn the tap on rather than installing fail safe devices. People told us they have a set day for a bath which they have now got used to. One person said a request for more frequent baths has been acted upon. A new call bell system has been installed at the home. Staff now carry pagers which ring when a person requests assisstance. The staff member can immediately know who is calling for help. People told us the call bells are answered ‘much quicker but sometimes a delay in inevitable when staff are busy’. Sluicing machines for cleaning commode pots and urine bottles were provided on each floor, but staff told us they needed more commodes for those people who could not want to walk to toilets at night. A clinical waste disposal system is in place and staff have access to gloves and aprons when providing personal care for people. Staff were aware of the infection control best practices to reduce the risk of infection. But two of the staff spoken to were out of date with update training. Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 22 Staff told us that foul laundry is sent to a company to be cleaned. People who use the service have their clothes washed in the home. One person said this service is ‘good’ and that they ‘get their clothes back quickly. Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 23 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Although the quality of staffing has improved at the home, the insufficient number of staff is having a detrimental impact on the quality of life for people at the home. Robust recruitment policies mean that that people are protected from being cared for by unsuitable staff. EVIDENCE: On the day of inspection there were nineteen people at the home with one admission during the afternoon. There was one Registered nurse on duty with three carers, a chef, housekeeper and cleaner. All staff were very professional polite and cooperative throughout the inspection. Feedback from people who use the service and their families was very positive about the staff. Comments such as ‘they are gems’ and ‘they are very good’ were heard. Surveys told us that people thought staff were ‘very helpful’ but more of them were needed. It was noted that staffing had improved since the last inspection. People who use the service were safe but the continued lack of staffing at this inspection meant that people did not always have choice and control over their lives and
Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 24 were limited regarding activities and quality of care. Therefore a new Requirement was issued. At the previous inspection staff had left the home leaving them short on numbers. At this inspection, although there were more staff, the needs of people had increased and different staff were absent which had an impact on the service as a whole. There was no evidence to show that these changes had been monitored. During the inspection it was noted that many aspects of life were affected by lack of staff. The lack of a regular chef meant that sometimes the housekeeper had to cook, resulting in care staff answering the door and dealing with housekeeping duties. The lack of care staff meant that people often felt rushed or were got up when they may not have chosen to get up. Lack of care staff meant that time could not be spent chatting to people or organising activities, resulting in people feeling bored or neglected. During the inspection, the manager was the only registered nurse on duty for the day. It was noted that she had to deal with our inspection, have an unannounced meeting with local primary care staff, assist GP’s visiting the home, administer medicines, speak with relatives and people in the home, liaise with three visiting tradesmen, deal with numerous telephone calls and admit a new person ensuring their safety and wellbeing. The manager had no administration support at the home on the day of inspection and told us she does not have days where she can just deal with administrative tasks. As a result people told us that during office hours their medication was sometimes slightly late. Relatives said the manager was hardly around and when she was she was too busy. All comments about the changes that have occurred since the new manager has been in post were positive. One relative told us that new staff have come in recent months and some staff had left. Relatives said the atmosphere was much better and less intimidating. Records showed that agency staff are used when needed to fill in for staff absences. Off duty records show that staffing levels have been consistent for a while but the dependency and needs of the people in the home have increased. Staff said they felt they were working as hard as they could and as safely as they could but they were beginning to get tired. Off duty records showed that some staff were working excessive hours 66 per week). Although these staff had signed disclaimers about working hours, it may mean that staff who are tired may affect the level of care. Registered Nurses should ensure they are aware and at all times accountable that working excessive hours may affect their competence. The manager told us she is currently recruiting new staff but problems have arisen because some staff do not want to work with certain staff. The Provider
Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 25 should ensure the recruitment process is based on equal opportunities not because of restrictions from other staff. There are robust recruitment procedures in place at the home. Each file showed that each staff member had a photograph, proof of identification, two references, home office information where appropriate, evidence of CRB and POVA checks, health declarations and evidence registered nurses are on the Nursing and Midwifery Council register. There was no evidence to show that care staff had been issued with the General Social Care Council Code of Practice. All files contained some evidence of an induction, although staff told us this involved a more informal process rather than a robust national recognised process. Staff told us they were aware there was a training manager for the company but had not yet been given dates for mandatory or specialist training. The manager told us she had highlighted gaps in training and the training manager was in the process of organising dates. However staff had not been made aware of these dates. Staff were encouraged to do NVQ training by the Manager. The manager told us one member of staff is doing an NVQ 3 and two staff are doing NVQ 2. Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 26 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The management of the home is improving however, support for the manager and improvements are still needed to provide a safe place for people to live. EVIDENCE: Feedback regarding the manager was generaly positive. One comment from a health care professional read ‘Since the manager has taken charge the qulaity of care has improved’. One survey from a person living at the home read ‘Things in general have improved’ whilst another wrote ‘Since she has been in post (albeit in an acting position) the home has improved in every way. She has and is doing a good job and we have every confidence in her ability to
Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 27 manage the home’. One negative comment read ‘Matron is missing half the time and we only see her for a few minutes. Staff said the manager was very supportive and approachable. One member of staff said she was not always ‘backed up’ by the organisation. One comment we received was that ‘one or two staff are causing waves’ One survey from a member of staff read ‘The manager, I feel, does not get enough support from senior team members which is quite disheartening to her as the home, when she took over, had been run down for a long time. I feel she is doing a great job and these things take time. The manager is a registered general nurse who has many years experience of working in nursing homes. She has not yet started the process to become registered with the Commission for Social Care Inspection. Staff told us requests for equipment have not been acted upon, which causes staff to have problems at the home. Staff said they were currently using inappropriate lifting equipment to move one person with specific needs because specialist belts had not bee provided despite request by the manager. No evidence was seen in staff files that staff had received regular supervision sessions although care staff said the seniors were in the process of booking this with everyone. Records within the home have improved since the arrival of the manager. Files were clearly labelled and lockable filing cabinets had been purchased for confidential staff files. The home has undertaken quality assurance monitoring however, had introduced a new menu to the home without prior consultation of people who use the service. The home does not hold peoples monies and only holds small amounts for the day-to-day operation of the home. One person said he had a friend who helps him manage his finances and shopping. Staff told us scales at the home were inaccurate and requests to repace these had been rejected by the company, despite people being identified as high nutritional risk and losing weight. Two bathrooms within the home that are used have unsuitable flooring. Staff told us that this flooring is slippery when wet and could cause staff or a person to fall. The manager told us a request to have this replaced has been submitted but not yet actioned. Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 28 Staff told us the hoists within the home were coming to the end of their days and needed replacing. Also training in the use of some equipment had not yet been provided. Staff told us there was a training manager for the organisation but they had not been given dates for mandatory training that was out of date. None of the staff spoken to had received training since they had worked at Woodland Park. One member of staff said she had last had mandatory training over 5 years ago and needed to arrange more. Only one of the three files contained evidence that staff had received recent mandatory training. Risk assessments have improved within the home. Bed rail risk assessments have improved. Risk assessments are available for those people who may be at risk of scalding. However, rather than installing fail-safe devices, the tap heads have been removed. Fail safe water regulators had been fitted to the disabled access baths, which are used most often. Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 3 3 2 2 x 2 2 3 STAFFING Standard No Score 27 1 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 x 3 2 3 1 Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) 13(4c) 12(1)a,b Requirement You must ensure that the care plan is written in a legible way to enable it to be used as the basis of providing care. You must ensure that where a need is identified, provision is made to meet the health and welfare needs of people who live at the home. This should include: • Ensuring accurate weights can be performed in people who are identified as at risk of losing weight. You must consult people about their social interests and hobbies and enable access to a programme of activities appropriate to their needs and requests. You must ensure people are consulted about new menus introduced at the home and should ensure the meals are wholesome and nutritious. You must ensure people are protected at the home by: • Providing evidence that the incident that was reported
DS0000028764.V366811.R01.S.doc Timescale for action 10/10/08 2. OP8 10/10/08 3. OP12 16(2)m,n 10/10/08 4 OP15 16(2)i 10/10/08 5 OP18 13(6) 10/10/08 Woodland Park Nursing Home Version 5.2 Page 31 6. OP27 18(1)(a) by a care staff at the home was correctly reported to the Commission for Social Care Inspection and safeguarding team • Ensuring staff are aware of the correct reporting procedures if an allegation of abuse needs to be made in the absence of the manager • Providing staff with training in the Protection of vulnerable adults, so they are aware of the signs, how to recognise and how to report abuse. You must ensure that at all times 10/10/08 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. The Provider must ensure: • There are sufficient staff to provide care in a way that is respectful to people. • When staff are absent regularly this does not impact on the other departments within the home • The Manager has support to fulfil her role when working as the only registered nurse on duty, especially issuing medicines • Keep staffing numbers under review to show they change with fluctuations in dependency and need. • Lack of staff is not a reason that people do not have access to activities and recreational stimulation
DS0000028764.V366811.R01.S.doc Version 5.2 Page 32 Woodland Park Nursing Home 7 8 OP38 OP38 13(5) 13(4) 9 OP38 18(1)a,c You must ensure staff have suitable equipment to move people in a safe way You must reduce risks by addressing them once they have been identified. This must include: • Ensuring hoists and equipment is maintained and appropriate • Replacing unsuitable, slippery flooring in the bathrooms • Ensuring staff are aware how to use transferring equipment You must ensure all staff have the necessary skills and training to perform their roles in a safe way. This must include ensuring staff have received mandatory training in: • Moving and handling • Fire safety • First Aid • Food hygiene • Infection control 10/10/08 10/10/08 10/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP15 Good Practice Recommendations The manager should encourage staff to write notes in a consecutive way without leaving gaps. The Provider should improve the meals at the home by: • Listening to peoples request for more fresh fruit, vegetables and meals • Ensuring people know what is for the meal each day • Ensuring people are aware they have an alternative of meal
DS0000028764.V366811.R01.S.doc Version 5.2 Page 33 Woodland Park Nursing Home 3 OP14 The manager should ensure that people have the opportunity to exercise choice and control over their daily lives, and are socially fulfilled. The manager should ensure there are sufficient assisted bathrooms to meeting people’s needs. The manager should ensure that sufficient equipment (hoists, beds, commodes) people need are available to meet their needs. The Provider should continue to ensure adjustable beds are provided for those people who are receiving nursing care. The Provider should continue to either make the taps without fail-safe devices safe or continue with the discussed changes to the rooms to benefit the people in the home. The Manager should ensure staff are safe when working large amounts of hours and ensure Registered nurses on the Nursing and Midwifery Council register are aware they are accountable for their practice and competence when they are working a high number of hours. The Manager should ensure all care staff are issued with a General Social Care Council Code of Practice. There should be a registered manager for the home who has completed a recognised management award The Provider should ensure any changes at the home occur after consultation with people living there The manager should ensure that all care staff receive formal supervision at least six times a year 4. 5. 6. 7. OP21 OP22 OP24 OP25 8. OP27 9 10. 11 12 OP29 OP31 OP33 OP36 Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Woodland Park Nursing Home DS0000028764.V366811.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
