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Inspection on 31/01/08 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 31st January 2008.

CSCI found this care home to be providing an Poor service.

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

The staff observed appeared to have a genuine rapport with the people they were caring for. There was a positive, open atmosphere in the home during both days of the inspection. All the people and their relatives spoken to during the inspection said that the staff team were friendly and helpful, and made comments such as " I can`t fault them". The comments received from the people spoken to indicate they knew who to speak to if they had any concerns about their care.

What has improved since the last inspection?

Since the last inspection the treatment room has been up dated and a lockable drug fridge has been provided for the storage of medication. This ensures medication that requires refrigeration is stored securely at the correct temperature. Individuals care plans are securely stored in the locked treatment room, but remain available to staff. This ensures confidential information is protected. Carpets in communal areas were being replaced during the second day of the inspection. This improves the look of the home for people who live there Recruitment practices and records held for staff have improved. This provides evidence that safe recruitment practices are followed to protect people from unsuitable staff.

CARE HOMES FOR OLDER PEOPLE Woodland Park Nursing Home Babbacombe Road Torquay Devon TQ1 3SJ Lead Inspector Rachel Proctor Unannounced Inspection 31st January 2008 9:30 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.V358004.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.V358004.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodland Park Nursing Home Address Babbacombe Road Torquay Devon TQ1 3SJ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01803 313758 01803 313046 Woodland Healthcare Ltd ****Post Vacant**** Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (3), Physical disability (31), Physical disability of places over 65 years of age (31) Woodland Park Nursing Home DS0000028764.V358004.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 1st October 2007 Brief Description of the Service: Woodland Park nursing home is an Edwardian dwelling, established as a nursing home in the Babbacombe area of Torquay. It is located approximately 100 yards from Babbacombe Downs with its excellent views over the bay. There is a small shopping area just a short walking distance away. The original building has been extended is to enable it to accommodate up to 31 resident’s. There are 19 single and 6 double rooms available, some with en suite facilities. The rooms are spread over three levels each being accessed by a centrally located shaft lift. Some rooms have sea views. A stair lift is also provided between the ground and mezzanine floor. The home has been further adapted to meet the needs of the physically disabled resident’s it provides nursing care for. Meals are prepared in a kitchen located in the centre of the home. There are accessible bathing facilities on each level and a mobile hoist that can be moved between rooms. The home has car parking to the front and side of the building and a small walled garden area for residents to sit in, weather permitting. A Registered Nurse manages the home and Registered Nurses are in charge of each shift, supported by a team of Health Care Assistants. The statements of purpose and service users guide are available in the reception area of the home or on request. The fee levels provided on 10.10.07 were up to £516.07. The actual fee is dependent on the needs of the service user and the room occupied. Additional charges are made for chiropody, hairdressing, newspapers and magazines that the service users request. Woodland Park Nursing Home DS0000028764.V358004.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 0 star. This means the people who use this service experience poor quality outcomes. This was a key unannounced inspection with took place over two days, 31st January 2008 between 9:30 am and 4:30 and 11th February 2008 between 11 am and 1 pm. Two inspectors were present for the first day of the inspection. The inspection included a tour of the home, speaking to the people who live at Woodland Park, their visitors and staff. Some documentation relating to care practices and management of the home were reviewed. The medication systems and practices were inspected. Three people had their care followed as part of the inspection. Comment cards were received from two relatives, two people living at the home, and two members of staff. 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? Since the last inspection the treatment room has been up dated and a lockable drug fridge has been provided for the storage of medication. This ensures medication that requires refrigeration is stored securely at the correct temperature. Individuals care plans are securely stored in the locked treatment room, but remain available to staff. This ensures confidential information is protected. Carpets in communal areas were being replaced during the second day of the inspection. This improves the look of the home for people who live there Recruitment practices and records held for staff have improved. This provides evidence that safe recruitment practices are followed to protect people from unsuitable staff. Woodland Park Nursing Home DS0000028764.V358004.R01.S.doc Version 5.2 Page 6 What they could do better: Staffing had not been organised around the care needs of people living at Woodland Park, putting the people at risk of not receiving the care they need. The way staff are deployed and/or the numbers of staff employed at the time of this inspection were not always meeting peoples needs in the way they expected. People commented that there are not always staff available to complete some of the things in their plan of care. Like being able to go out of the home with a member of staff. This means people are not always able to exercise choice over their daily lives. Prior to the publication of the report the provider advised that staffing difficulties had arisen because of necessary changes in the staff rota, which resulted in some staff leaving. They confirmed that this was a short-term problem, which has now been resolved. The majority of medication practices in the home are safe and ensure people receive the treatment they need. However, morning medications were not given until late morning on the first day of the inspection. This put people at risk. Two people who were left to take medication unobserved did not have a risk assessment completed to show they were able to do this safely. By not completing risk assessments for these people they may be at risk of not taking the medication given. Prior to the publication of the report the acting manager confirmed that medication management has changed to ensure people receive medication on time. Risk assessments had not been completed for people who were able to use the hot water in washbasins in their rooms or disabled toilet/bathrooms independently. Four rooms with en-suite facilities have a bath. The bath did not have the hot water temperature regulated to a safe temperature. This could put people at risk of scalding. Since the inspection the registered person has confirmed that risk assessments have been completed. And the hot water to the four en-suite baths has been turned off. Risk assessments completed for bed rails in use on four beds identified that they needed wedges to make them safe. No record that these had been put in place or checked by the registered nurse had been recorded. One of the four beds where this was identified as required had a gap between the mattress and bed rails over 10 cm. This could put the person at risk of entrapment. The other bed rails were correctly fitted and did not need additional wedges to make them safe. Since the inspection the registered person has confirmed that these have been completed. Please contact the provider for advice of actions taken in response to this Woodland Park Nursing Home DS0000028764.V358004.R01.S.doc Version 5.2 Page 7 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.V358004.R01.S.doc Version 5.2 Page 8 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.V358004.R01.S.doc Version 5.2 Page 9 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 good. This judgement has been made using available evidence including a visit to this service. The statement of purpose and service users guide has sufficient information to allow people to make an informed choice about the home and it’s services. The way peoples care needs are assessed and recorded should ensure that staff have sufficient information to provide the care people need. The home does not provide intermediate care. EVIDENCE: The homes statement of purpose and service users guide was easily available within the homes communal hallway. This was seen to contain the required information about what services the home could offer, to allow someone and/or their advocate to make an informed choice regarding whether or not the service could meet their needs. A copy of the homes own contract was provided with the statement of purpose. Woodland Park Nursing Home DS0000028764.V358004.R01.S.doc Version 5.2 Page 10 Some people spoken to stated that the home had fully met their needs and had enabled them to have a better quality of life. An example of this is a person who stated that on arrival at the home they had been unable to walk, but due to the physiotherapists involvement provided by the home and by staff following their instructions they had now become fully mobile. Each of the three assessment viewed were followed with a plan of care that guided staff how the persons care needs should be managed. Risk assessments for manual handling, nutrition and pressure sore development had been completed in each of the care plan assessments viewed. Copies of discharge assessments from hospital and district nursing teams continue to be available where these had been completed prior to the admission. The information contained in individual assessments had been up dated since the last inspection to reflect the changes in care needs. The home does not provide intermediate care. Woodland Park Nursing Home DS0000028764.V358004.R01.S.doc Version 5.2 Page 11 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 poor. This judgement has been made using available evidence including a visit to this service. Overall the way people’s care was assessed, planned and recorded has continued to improve since the last inspection. Staff have clear information about a person’s health, personal and social care needs and what is important to them. However the number of staff on duty has not always allowed some people’s care needs to be met in the way the care plan identifies. The majority of the medication practices in the home are safe and ensure people receive the treatment they need. However by not ensuring morning medication is given at the right time people are being put at risk. EVIDENCE: There were some concerns over the personal care made available to some residents during our inspection. This was because staff were very busy due to inadequate staffing levels. For example, the morning medications, usually given at nine oclock were still being administered at midday. However people spoken to were very complimentary about the staff and the way they provided Woodland Park Nursing Home DS0000028764.V358004.R01.S.doc Version 5.2 Page 12 care for them. They said that nothing was too much trouble and they felt that the staff would always do their best to meet their needs. Two comment cards received from people living at Woodland Park indicated that staff always listen to them and act on what they say. Two relative comment cards indicated that their relative usually receives the care they need. One relative commented that this depends on the number of staff available. Comments received during the inspection from people living in the home and their representatives indicated that they felt there were insufficient staff on duty at times. And that sometimes they didnt always receive help in a timely manner. During the inspection call bells were ringing for up to 10 minutes before staff answered them. One person whose care was followed liked to smoke. The care plan gave information for staff about how the person should be assisted to continue smoking if they wished. When this person was spoken to they said the staff helped them to go outside in their wheelchair to smoke. They understood that the home had a no smoking policy. However they said they were not always able to have a smoke when they wanted to because the staff were not available to help them. Another person whose care was followed was due to move to a different room. The person expressed concern about the need to move during the inspection. No record of how staff should manage the move for the person to reduce their anxiety had been recorded in the care plan. The person’s relatives had been informed and were in agreement for the move. On the second day of the inspection the person had moved rooms. They said they were finding it difficult to settle in the new room. The manager spent time talking to them about this during the inspection. Each of the three peoples plans of care seen during this inspection had been reviewed monthly or sooner if their care needs have changed. The changes to the care plans had been signed and dated by the person updating the plan of care. The amount of information in individual people’s plans of care had improved since the last inspection. Social care plans had been provided, which stated what the person liked to do and how staff could facilitate this. Medication storage has improved since the last inspection with additional storage space and a lockable fridge being provided in the treatment room. The medication records were viewed for three people whose care was followed. Where medication had not been given the reason for this had been recorded. The registered nurse in charge advised that some people, on the day of inspection would have to have their lunchtime, tea time and suppertime medications delayed due to the fact that morning medications were so late in being administered. This practice could put people at risk. One person spoken to relied on their medication being given at set times to control the symptoms they experienced. On the day of this inspection it was Woodland Park Nursing Home DS0000028764.V358004.R01.S.doc Version 5.2 Page 13 noted that this person had received their morning medication at the right time. The person said the registered nurses usually make sure they have their medication at the right time. However, another person who said they were experiencing pain had not received their morning medication until late morning. Staff were noted as being respectful, thoughtful and sensitive to peoples needs. A visiting occupational therapist was spoken with who confirmed that the Torquay North Intermediate Care team often had cause to visit the home, due peoples needs on admission. She confirmed that the team had no concerns with the care provided and that the staff seemed to be delivering appropriate care. It was noted that there were no privacy locks throughout the home including to bedrooms and communal toilets and bathrooms. This could have the effect of compromising a person’s right to privacy. For example it was noted that for the downstairs communal toilet, unless the person had been observed going in, it would be impossible for anyone else to be aware the toilet was in use. Woodland Park Nursing Home DS0000028764.V358004.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. Giving people information about the menu for the day in advance would give people more choice. Although the care plans provide information about the social activities people like; the staff are not always able to do this, so people do not always have their social needs fulfilled. Information about the planned activities available is not always provided for the people living at the home in a way they can understand. EVIDENCE: The lunch served on the day of inspection was hot and appetising. It consisted of leek soup, followed by beef pie, vegetables, potatoes and gravy, followed by apple pie and custard. Very little wastage was seen form the lunchtime meal. People stated that they knew there was a choice of meal but they didnt know what and in fact they did not know what the main meal of the day was to be until they got to the dining room and it was brought to them. One staff member was asked at 11:30 a.m. what was for lunch and their reply was: I Woodland Park Nursing Home DS0000028764.V358004.R01.S.doc Version 5.2 Page 15 havent got a clue. There was no menu board within the home displaying the days meals. However people stated the food was generally good and on inspection of the homes menus there appeared to be a good variety of nutritious well-balanced meals provided on a three-week rota. Meals were an unhurried affair and were taken in a pleasant setting with those that need help getting this individually. The home employs a cook to provide lunch and tea each day of the week including weekends. 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. One person said they had changed from wanting their breakfast at six oclock to seven oclock and this had been facilitated. The chef on duty was the relief cook, who works two days a week in the home. He was very knowledgeable about the peoples dietary needs and it was pleasing to note that 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. The chef was noted as maintaining excellent kitchen hygiene with a record of the heat of the food served, a daily cleaning rota and a daily record of the fridge temperature, whilst it was also noted that there was a nice homemade cake available for afternoon tea. Some people were aware that activities take place within the home and stated that they enjoyed them when they were on. However people did not always know what entertainment was taking place on what day and there was no evidence of any activity programme being displayed. One relative commented that their relative just sits in a chair all day and staff don’t seem to have enough time to sit and talk to them. They also commented that their relatives voice was getting frailer. During the inspection a local entertainment provider who undertakes a regular programme of entertainment within the home, was able to state that some people had now begun to enjoy the sessions, which also evidenced that these took place regularly. The entertainer was also knowledgeable about the peoples abilities to join in and at what level. People stated that their visitors are welcomed into the home at all times and indeed on the day of inspection several visitors were seen coming and going quite freely to and from the home. There was a visitors book available. One relative spoken to said the new manager was helpful and approachable and was doing her best to improve what was provided. Woodland Park Nursing Home DS0000028764.V358004.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 good. 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. Recruitment practices in place should protect people from unsuitable staff. EVIDENCE: There was a complaints procedure, which was displayed and was also contained within the homes documentation. There was a record of in-house complaints and of how these have been resolved. Comment cards received indicated 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 commented that they had confidence in the new manager as she had helped to resolve a concern they had about their relatives care. They also said she was kind and understanding. There was evidence of some staff attending vulnerable adult training. There was confidence in the staff with some stating: Its their kindness that makes all the difference. Two staff spoken to confirmed that they had received training for protection vulnerable adults. Two staff files viewed contained copies of a workbook relating to this. The home has a robust recruitment policy. Staff files seen had copies of pre employment checks including a police check proved. This evidenced that good recruitment practice had been followed prior to staff starting work. Woodland Park Nursing Home DS0000028764.V358004.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,26 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. The refurbishments, renewal and redecoration of the environment should continue to ensure that people have a pleasant well-maintained environment in which to live. The way the call bell system works may mean that staff are unaware of people needing help when they are providing care on the first floor until they return to the ground floor and look at the display. This could mean that people have to wait for longer time to have their call answered. EVIDENCE: A tour of the home was completed as part of this inspection. The home is in general reasonably well decorated and some of the people spoken with during the inspection stated that they liked their rooms and the facilities provided. On inspection the home was comfortably furnished and reasonably well decorated. A cleaner was working and the environement was clean and Woodland Park Nursing Home DS0000028764.V358004.R01.S.doc Version 5.2 Page 18 pleasant with no obvious odours. There was a rip in the carpet in one persons room, which could pose a trip hazard. On the second day of the inspection the hall stairs and landing carpet was in the process of being replaced. The manager confirmed that worn carpets in indivudual peoples rooms were also due to be replaced as part of the on going refurbishment of the home. The home employs a maintenance person whose responsiblity includes some of the homes health and safety aspects. However they was absent on the day of on inspection and so was not availabe for consultation. One of the radiators in the home,within a communal hallway was of the high temperature surface type and was not protected. This was pointed put to the manager who advised that the cover had recently dislodged and the maintenence man would replace this. One bathroom on the ground floor had a clear glass door and window, which overlooked the rear garden. No screens or curtains were at these windows to provide privacy for people using this bath. The nurse in charge advised that they were not using this bathroom at present because the bath was difficult for the current people living at the home to use. The manager confirmed that this bathroom was to be refurbished. The hot water taps servicing four en-suite baths baths and the hand basins within the peoples bedrooms had not been fitted with water temperature thermostats to ensure safe delivery of hot water and, at time of the inspection. No risk assessments were available to ensure those who could access these water outlets were deemed to be able to do safely. Both of these shortfalls place the people who live at the home at risk. The call bell system display had been moved form the treatment room to a corridor wall close to the managers office since the last inspection. The call bell system has an audible bleep, which shows the number of the room the call bell was activated in. Although the monitor display was easier for staff to access and see, the monitor could still not be heard or the display seen when on the first floor of the home. The nurse in charge advised that staff have to look at the display to find out which person had used their call bell. If staff are unable to hear the call bell system when they are working up stairs this could mean they would be unaware of other people requesting assistance until they looked at the call bell display or heard the bleep on the ground floor. Sluicing machines for cleaning commode pots and urine bottles were provided on each floor. A clinical waste disposal system is in place and staff have access to gloves and aprons when providing personal care for people. The staff spoken to were aware of the infection control best practices to reduce the risk of infection. Information on a training course staff had completed for infection control was provided in the office. The home was free from odour and appeared clean on both days of the inspection. People spoken to said their rooms were usually kept clean. Woodland Park Nursing Home DS0000028764.V358004.R01.S.doc Version 5.2 Page 19 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 staff team continue to work hard to ensure the people they care for feel supported and cared for. They are good listeners and generally have the interests of the people they care for at heart. The way staff are deployed and/or the numbers of staff employed at the time of this inspection were not meeting peoples needs in the way they expected. The time taken to respond to call bells may mean people do not get assistance when they need it. Staff deployment does not appear to have allowed time for the one to one support identified in people’s plans of care. Robust recruitment policies had been followed for the employment of staff. This should ensure that people are protected from unsuitable staff. EVIDENCE: The home has a team of registered nurse who monitor peoples health care 24 hours a day seven days a week. A registered nurse was available for each shift. At the commencement of the inspection we were greeted by the registered nurse informing us that she was in charge of the shift as the manager was on her day off. She also said that the home was short staffed, consequently the registered nurse could not spend time to discuss management issues or the running of the home. Woodland Park Nursing Home DS0000028764.V358004.R01.S.doc Version 5.2 Page 20 This registered nurse was working with two carers to provide care for 20 people the majority of whom needed help with all aspects of personal care. An hour before the commencement of the inspection the rota showed that there was only one carer on duty with the registered nurse as the other had only commenced shift at 9.00.am. It was also noted on the rota that after 3.00 p.m there was only going to be two staff members on duty again. The registered nurse on duty was trying, throughout the morning, to contact the newly appointed manager to ensure it would be in order for her to use an agency staff member. It was only much later, after 12.30 p.m that the nurse spoke to the Companys Director who confirmed she could contact an agency and ask for cover. Therefore people were put at risk when there was only two staff members on duty between 8.00 am and 9.00 am. There was no written protocol in place regarding what the registered nurse in charge should do in the event of a staffing shortfall of this nature. Staff were noted as being particularly busy, with very little time to do anything other than provide for the fundamental aspects of care. This meant that peoples needs were not being fully met. For example as stated previously the morning tablets did not get administered until midday and two residents within the communal lounge were unable to get staffs attention as they were too busy within individual bedrooms getting people up to be visibly available. The registered nurse stated that some people were still not ready at 11 oclock and that this had happened before. She also commented that the night registered nurse and carer had helped more people to get up and dressed before they went off duty because they knew they would be short staffed that morning. This was confirmed by the staff on duty spoken to when they told us that the night staff try to help them by getting up several people before they got off duty at 8.00a.m. This means that for some people their day starts very early and there was no evidence, within the care plans, that this was what people want themselves. It appeared the homes routines are centred around how staff are deployed rather than around peoples wishes. Relatives spoken to also stated that they felt the staffing levels were too low. Two relatives informed the Commission that they had discussed staffing levels with the manager previously who had assured them the levels would be raised. Staff spoken to stated they were busy. Discussion with the manager revealed that an active recruitment drive was taking place and two new staff were due to start work once all their pre employment checks and references had been returned. Four people spoken to stated that sometimes it does take time for staff to get to them. There had been some change in staffing lately within the home with one long-standing member having already left and another due to leave Woodland Park Nursing Home DS0000028764.V358004.R01.S.doc Version 5.2 Page 21 shortly. Two relative and two people living at the home who returned comment cards all indicated they felt that more staff were needed, when asked what could be improved. A newly appointed staff members details were checked; recruitment process was noted as in order. Two other staff files seen had all the recruitment and pre employment information in their staff file including a police check. Recent training provided within the home has included manual handling, fire awareness, vulnerable adult training, dementia training, food hygiene, and infection control, COSHH. The owners have appointed a training manager to assist with training for staff in the homes in this area. A record of training they had provided and had planed was available in the office. The manager confirmed that the company is committed to training and staff are encouraged to complete an NVQ (National Vocational Qualification) in care. Two of the staff spoken to said they had completed an NVQ in care. Woodland Park Nursing Home DS0000028764.V358004.R01.S.doc Version 5.2 Page 22 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 poor. This judgement has been made using available evidence including a visit to this service. The home has an open atmosphere where people who live at Woodland Park, their family and friends can feel valued. However some aspects of management have not fully protected people. By not ensuring staff are deployed in a way that meets peoples needs in a timely manner people may be at risk of not receiving the care they need. People able to access hot water independently could be at risk of scalding if risk assessments are not completed, which show they can do this safely. By not following up risk assessments of bed rails with actions to reduce identified risk, people were put at risk. Woodland Park Nursing Home DS0000028764.V358004.R01.S.doc Version 5.2 Page 23 EVIDENCE: The management of the home has changed with the appointment of a new manager who has yet to be registered with the Commission. Some staff reported that they found the new manager hard to communicate with and to approach. She has made changes, which have affected some staff’s long established working hours. The consequence of this is that staff have chosen to leave, as they were unable to comply with these new working hours. However some relatives and some people living at the home stated that they found the manager hardworking and felt she was doing her best. Supervision has not been provided for all staff, so staff have not had an opportunity to speak personally with the manager about their concerns. The home has undertaken quality assurance monitoring including undertaking pharmacy audits, care plan audits and obtaining feedback from staff and people living at the home via meetings. From this an annual development plan had been complied. A manager from a sister home attended to allow the inspectors to check finances held in the homes safe. The home does not hold peoples monies and only holds small amounts for the day-to-day operation of the home. This manager also brought the keys to the staff filing cabinet as the nurse in charge of the shift did not have these keys. Serious health and safety shortfalls include the lack of risk assessments were noted. These were in relation to a hot surface within the homes downstairs corridor and the hot water provision to peoples’ sinks and en-suite baths. Temperature restrictors had not been fitted to the hot water taps in washbasins in individual rooms and toilets. Three people were able to use these independently. However no risk assessments had been completed, that showed they were able to use the hot water safely. The temperature checks showed that water regulators had been fitted to the disabled access baths. However four en-suite rooms, which had baths in them did not have the water temperature regulated. (The Commission has been notified since the inspection that these are not used by any of the people living in the home and so the hot water taps had been disabled.) A record of checks on the bed rails in use in the home had been completed. This appeared to show that wedges were needed to be fitted to four of the beds to make the bed rails safe. On the second visit to the home the four beds identified with bed guards attached were checked with the manager. One required refitting because the gaps between the bed mattress and the bed rail had more than 10 cm gap on one side. The manager advised that this would be made safe that day. Other bed rails identified as needing wedges were fitted correctly and did not require wedges. Woodland Park Nursing Home DS0000028764.V358004.R01.S.doc Version 5.2 Page 24 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X X X 3 STAFFING Standard No Score 27 1 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 1 Woodland Park Nursing Home DS0000028764.V358004.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 18(13(2) Requirement Medication prescribed must be given in accordance with the prescriber instructions. Giving medication later than the prescriber intended will mean that the symptoms people experience from their health problems will not be as well controlled. 2. OP27 18(1)(a) The registered person must ensure that at all times suitability qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of the service users. The way staff are deployed in the home must enable people to receive the care they need. Deployment of staff must be arranged around the assessed needs of individuals. 10/05/08 Timescale for action 10/05/08 Woodland Park Nursing Home DS0000028764.V358004.R01.S.doc Version 5.2 Page 26 3. OP38 4 OP38 13(4)(a)(c The registered manager must ) ensure the health and safety of service users and staff including. (Risks from hot water/surfaces (i.e. temperature regulated close to 43 C); The hot water in en-suite baths must be a safe temperature to reduce the risk of scalding. People who are able to use unregulated temperature (hot) water in wash basins in their own rooms or communal bathrooms and disabled access toilets independently must have a risk assessment completed to assess if it is safe for them to do so. All parts of the home to which service users have access are so far as practicable free from hazards to their safety. Unnecessary risks to health or safety of service users are identified and so far as possible eliminated. 13(4)(a) The registered manager must ensure the health and safety of service users and staff including. All parts of the home to which service users have access are so far as practicable free from hazards to their safety. Unnecessary risks to health or safety of service users are identified and so far as possible eliminated. Risk assessments completed for bed rails, which show a possible risk must be followed up with action to remove the identified risk. 11/02/08 11/03/08 Woodland Park Nursing Home DS0000028764.V358004.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP8 Good Practice Recommendations The registered person should ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. The way staff are deployed should ensure that sufficient staff are available to meet people assessed care needs. The manager should consider ways of ensuring people who are able to access toilets independently have their privacy and dignity maintained. The manager should ensure that people have the opportunity to take part in the social and recreational activities recorded in their plans of care. The manager should ensure that people have the opportunity to exercise choice and control over their daily lives, and are socially fulfilled. Registered person should having regard to the number the needs of the service users ensure that the premises to be used as the care home are of sound construction and kept in good state of repair externally and internally. The routine maintenance and redecoration of the home should continue until all areas have been refreshed. The aids, hoists and assisted bathrooms should be in good working order and capable of meeting peoples needs. Suitable screening should be provided in bathrooms that will protect privacy. The manager should ensure that equipment (hoists, beds) people need are suitable to meet their needs. There should be a registered manager for the home who has completed a recognised management award The manager should ensure that all care staff receive formal supervision at least six times a year DS0000028764.V358004.R01.S.doc Version 5.2 Page 28 2 OP10 3. OP12 4. OP14 5 OP19 6. OP21 7. 8 9 OP22 OP31 OP36 Woodland Park Nursing Home 10 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.V358004.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection 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.V358004.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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