Inspection on 06/11/07 for Woodland Villa

This inspection was carried out on 6th November 2007.

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

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

Other inspections for this house

Woodland Villa 16/04/08

Woodland Villa 13/02/07

Woodland Villa 24/05/06

Woodland Villa 10/02/06

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Woodland Villa 93 Alma Road Plymouth Devon PL3 4HE Lead Inspector Megan Walker Key Unannounced Inspection 6th November 2007 10:30 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 Villa DS0000064463.V351004.R02.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 Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodland Villa Address 93 Alma Road Plymouth Devon PL3 4HE 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) 01752 669625 01752 250123 Denmax Ltd Mrs Anna Kathryn McGlew Care Home 53 Category(ies) of Old age, not falling within any other category registration, with number (19), Physical disability (5), Physical disability of places over 65 years of age (34) Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Old age, not falling within any other category (19) Physical Disability over 65 years of age (34) Physical Disability (5) There should be no more than a maximum of 5 (five) service users in the home at any one time between the ages of 50 years to 65 years. 13th February 2007 Date of last inspection Brief Description of the Service: Woodland Villa is a care home with nursing that is registered to provide personal care for up to 19 clients, and nursing care for up to 34 clients. It can therefore admit up to 53 clients over the age of 65 years old and of either gender. It has been developed over several years from a row of large terrace houses that have been linked internally, and has been adapted to meet the demands placed upon it by the people living here, many being disabled through illness. Ramping and passenger lifts have been provided to enable people to access to all parts of the home. The home is on the outskirts of Plymouth city centre and is on the bus route to the city centre. There is access also to some local amenities. The program of refurbishment is progressing well to a high standard of finish and includes total rewiring, a new fire detection system and a new nurse call system. The home presently has a residential unit at one end and the nursing home takes up approximately two thirds of the property. The units share the same main kitchen and laundry services. There are shared communal spaces of good proportions at each end of the building. These are attractively decorated and offer several separate areas, including a library, for people to sit in with each other or with their visitors. There is a small outdoor area that has some seating for people to use in times of good weather. The home has a car park available for visitors or there is on-street parking close by. Registered nurses manage the nursing unit 24 hours a day and are supported by care support staff that have received training in providing care safely. Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 5 Fees range from £280.00 to £464.00, (up to £520.00 for ‘continuing care’), and are according to assessment of the person’s personal and nursing care needs. Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was a Key Inspection undertaken by two regulation inspectors. The fieldwork part of this inspection was unannounced and took place over two days, Tuesday 6th November 2007 between 10h30 and 16h45 and on Tuesday 20th November 2007 from 10H00 until 13h15. This visit included talking to people who live at the home, staff, and visitors to the home, observation of interactions between staff and people using this service. There was also a tour of the premises, and inspection of care plans, staff files, medication and other records and documentation. The Registered Manager was present on both days, and the Registered Provider only on the second day. They were able to provide relevant information such as the day-to-day routines as well as the management of the home. The Registered Provider also gave us an update on the refurbishment and redecoration plans for the home. This report also includes references to a random inspection of the home on 14th August 2007. The purpose of that inspection was to look at written communication i.e. record keeping, including care plans and accident records. We also discussed verbal communication between care assistants and registered nursing staff, and between staff of all grades and the Registered Manager. Finally we looked at moving and handling training, and equipment. In addition other information used to inform this inspection: • The Annual Quality Assurance Assessment (AQAA) completed by the Registered Manager • The previous two inspection reports • All other information relating to Woodland Villa received by the CSCI since the last inspection. • “Have Your Say About Woodland Villa” Care Home Surveys were sent out and the CSCI received feedback and comments from – • 0 People living at Woodland Villa • 4 Relatives • 11 Staff • 0 Care Managers • 0 Health/Social Care Professionals in contact with the home Sixteen requirements were made as a consequence of this inspection. What the service does well: The Registered Provider consulted with people living at Woodland Villa about their preference for the colour schemes for their bedrooms thereby offering them a choice. The home is undergoing a major refurbishment throughout and the areas of the home that so far have been upgraded, enhance and improve the facilities for the people living here. Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: 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 Villa DS0000064463.V351004.R02.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 Villa DS0000064463.V351004.R02.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, 2, 3, 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People choosing to use this service and their families can feel confident that their needs will be assessed before moving into the home and that they can have the information they need to make an informed choice about where to live. EVIDENCE: Anyone considering moving in to Woodland Villa is offered an informal tour of the home and an opportunity to talk to people using the service. Their family or friends may do this on their behalf. A copy of the home’s Statement of Purpose (also called a brochure) and scale of care fees are given to everyone moving into the care home. We looked a copy of this and it was up to date. The Registered Provider said that he would provide a copy of the last Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 10 inspection report with the Statement of Purpose and any other information that would be useful for prospective residents in the main entrance of the home. We inspected three care files and found good pre-assessments of care needs, completed by the Registered Manager. People move into the home for a variety of reasons. They may have made a private arrangement, or the local authority may have referred them to the home via the Social Services Department, the RITA scheme (a short term rapid intervention team that enables people during a ‘crisis’ period to have a short respite stay, without the need, necessarily, for hospital admission). Some people are assessed as requiring continuing care and are supported by the local Primary care trust (PCT). The day before this visit someone had moved into the care home. We saw a care plan that had been completed, information entered into the admissions’ book, and there was good detail in the transfer information and pre-admission information. Woodland Villa DS0000064463.V351004.R02.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 adequate This judgement has been made using available evidence including a visit to this service. People living at Woodland Villa can be confident that their care needs will be set out in a plan of care however this does not guarantee they will at all times receive the care appropriate for them. EVIDENCE: Feedback we received from some families was that it was variable being told information about the care and welfare of their relative. Others spoke highly of the support their relative had received from the staff • “My relative is very happy here which I think is great, this in turn is a comfort to me and my family.” “I am very please with the way Woodland Villa staff look after my DS0000064463.V351004.R02.S.doc Version 5.2 Page 12 • Woodland Villa relative” • “Not always dressed appropriately – no slip/vest buttons undone – looks a bit uncared for sometimes” A member of staff told us: • “The home does everything it possibly can to welcome service users and try to settle them in to their new surroundings and will accommodate what it can to make their stay less stressful for the user.” We chose three people, both men and women, to look at their care files and care generally because they were, for example, people with more complex needs (such as health care needs), and/or people with changing needs. Each care file seen had a full assessment of care needs. Two of the three care plans had been reviewed. Daily Records showed that any medical condition was monitored and recorded. There was evidence of recording of waterlow scale, wound assessment and treatment chart, manual handling information,and daily evaluation. In some cases the information recorded was sketchy, e.g. “All care given”. We also saw food and fluid intake charts. The food charts did not give any details about what had been eaten/refused. This information could have, perhaps, indicated to the staff the person’s preferences and given better information overall of what was actuall eaten/refused. We looked at Incident/Accident records. These were kept securely in the person’s care file. We recommended that a copy should be kept on the care file and the originals all kept securely together. This was for ease of auditing to provide the Registered Manager with an overview to monitor accidents and incidents, and take preventative action as necessary. During our tour of the premises we noticed that some people were having bibs put on them. One carer was observed putting one on a resident without saying that she was there or explaining what she was going to do. The carer did however tell the person that there was a drink in front of her. The drink was within reach of the person. We discussed with the Registered Manager and the Registered Provider that we understand there has to be a system to keep peoples clothes clean, but they must be confident that staff are using ‘bibs’ appropriately. We only saw people with them on at mealtimes. A nurse was observed giving out medication in dining room (floor 5 / residential) - she was following correct procedures and stayed with the person whilst they took their medication(the nurse was not aware she was being watched). One person we spoke to keeps one of their medications in their room and administers it themself as prescribed. The Registered Manager said that she had assessed this as being appropriate. This was documented in the person’s care plan. Correct procedures were in place for procurement, Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 13 recording and disposal of medicines. The storage on floor 5/ residential is not ideal but the Registered Provider is having a new kitchen built. This means that the medication kept on this side of the home will be moved to the treament room and all of the medicines will then be kept in one place. The treatment room had a domestic fridge that was not locked. There was no evidence of its temperature being recorded. It had several medications in it and also some flavored water and a yoghurt. This was discussed witht the Registered Manager, the Registered Provider and the deputy manager. They agreed to consider buying a proper drugs’ fridge and providing a domestic fridge for the staff to use. On each visit to the home the treatment room was wide open and access to it was easy. This meant that people living in the home were at risk because they could wander in there or visitors to the home could go in there unsupervised. We observed some staff did not knock before they entered people’s bedrooms. There was an element of bewilderment and confusion caused by the surprise of the entry. There were also interactions between staff in front of people living in the home that were inappropriate and should have taken place in private. Woodland Villa DS0000064463.V351004.R02.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. People who are independent find the lifestyle offered in the home matches their expectations and preferences and satisfies their interests and needs. People are supported to continue to enjoy familiar supportive relationships with family and friends. There is a choice offered at mealtimes. EVIDENCE: Throughout this visit people using this service were seen either in communal areas of the home or in their bedrooms. They told us they could usually come and go as they wished. We also saw families coming into visit people in the home. Everyone we spoke to was complimentary about his or her room. They told us that they were comfortable. The bedrooms we saw in the “residential”/floor 5 part of the home were personalised with peoples’ possessions. On the nursing side they were more clinical and institutional. Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 15 During this visit observation of interaction between the staff and the people living at the home saw the staff mainly assisting with daily living activities such as assisting to and from the dining room. There was very little engagement in ‘chit-chat’ with the residents or encouragement for peer interaction either. A relative wrote on their survey returned to the CSCI: “Would like provision for residents to have occasional trip out i.e. moors, on the Hoe or just an outing of some sort as a group” Three members of staff wrote in their survey returned to the CSCI: • “I would like the service users to have more activities in the afternoons. We do have an OT trained member of staff and the service users love it when she has time for these activities.” “The physical side of care is excellent and the staff generally work really hard. It’s the mental stimulation that I feel could improve.” “Most days are very busy, to be able to spend more time with the service use” • • A member of staff told us that in-house activities were arranged on a regular basis – exercise to music twice a week; “Interact” (movement and reminiscence) once a week, a ‘sing-a-long’ provided by two different organisations that alternated weekly visits to the home. There was a member of staff who held arts and crafts sessions and we were told was recently helping people to make Christmas bonnets. Bingo sessions were also organised “if there were sufficient people downstairs”. This same member of staff confirmed that there had not been any external outings for the past couple of years, partly because even when trips were arranged people declined to go on them. There was no formal activity provided on either day we visited. On the first day of this visit one of the sitting rooms was being used for a staff training event. Only five staff members attended this. We were told that another training day was planned for the following day. The people who would usually use this room therefore spent the two days in their bedrooms, including having their meals taken to them there. We talked with the Registered Manager about the implications of this and recommended that future training, particularly for small groups, should be held elsewhere so that people’s choice is not restricted. The food was varied and the new chef seemed to genuinely want to make meals special for individuals - he knew their likes and preferences. We watched the chef preparing individualized sandwiches for teatime. Each sandwich had good amounts of filling and was served with a small salad on the Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 16 side. Presentation at lunchtime was good and all the staff we saw serving food were conscientious in this task. (They were unaware that we were watching them.) A relative told us that they felt there was a good variety of food available. Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 17 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 poor. This judgement has been made using available evidence including a visit to this service. People can feel confident that their complaints and concerns will be taken seriously and acted upon by the Registered Manager. Staff not attending training and a recruitment process that does not show robust checks have been done puts people using this service at risk. EVIDENCE: A random inspection took place on the 14/08/07 that resulted in two requirements. Since this random inspection there have been further complaints or concerns raised about care practices by staff. We discussed with the Registered Manager during this visit a recent complaint made to CSCI about the care of someone living at the home. We advised the Registered Manager to ask the complainant to meet with her and the person concerned when the next review was due, to discuss the care plan together. We suggested that if relatives or advocates were invited to attend care plan reviews this could perhaps avoid misunderstandings and/or perceptions about levels of care. Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 18 Complaints were recorded but we didn’t see any evidence of a standard complaints form. It not therefore always possible to see the outcome of a complaint. A requirement was made at the last inspection for an ongoing programme for training staff about safeguarding vulnerable adults. We looked at six staff files and only two of them had attended a training course in the past two years. It was unclear if staff had been offered this training or if they had not turned up for it. Training in general was an issue that the Registered Manager told us about and one that she was struggling to resolve. Some staff told us that their training was variable: • • • • “Some” “Sometimes” “Limited basic training – statutory courses” “Provides training but the employees are expected to carry out training on their days off and it can be short notice.” “That new members of staff are given more time to be trained (i.e. working with a member of staff) without being counted and used as a normal member of staff” • We looked at six staff files in detail and a random selection of others. The recruitment checks had been completed for two people including police checks. Three people only had one written reference and one person did not have any references on their file. The staff who had come to work at the care home from overseas had visas however some of these were student visas, not work permits. Some of the staff complained about a high turn over of staff. There was also staff feedback that new staff were expected to “get on with the job” without any formal induction and supervision when they started work at the home. [See: Staffing] Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 19 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, 24, 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People’s private accommodation was comfortable and clean, however areas of the home were institutional rather than homely. Health and safety measures must also be attended to, to ensure that it is a safe home for people to live in. EVIDENCE: Woodland Villa is undergoing a major refurbishment and the work already completed enhances and improves the facilities for the people living in the home. It is an old Victorian building and the Registered Provider has encountered many major unexpected difficulties that have added cost and time to the planned works. One of these is the heating system. As we walked around the building we found that some radiators were too hot to touch (they were not covered) and others were cold. The Registered Provider was aware Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 20 that the heating was variable. He told us that two new boilers are planned for installation next summer. In the meantime a temporary boiler has been installed within the grounds of the care home to act as hot water booster. We also saw unfixed portable heaters on roller wheels that did not lock. We talked to one person about this as these were hot to touch and one was unsteady on a carpet. This person told us that they liked to have the heater nearby in the sitting room and in their bedroom. The heaters had not been tested for electrical safety (PAT). There was no evidence of risk assessments for the general use of these appliances. We also found that this person’s bedroom door was blocked open with a towel, again because the person liked to do this. Both these practices introduce risks and every effort should be made to minimise risks. The en-suite for a double room on the ground floor we found could be opened from both sides. On the other side was the room used by the hairdresser. This arrangement was to provide a toilet within easy reach for people with hair appointments. The Registered Provider said that he would arrange for the door to be blocked so that access would be from the bedroom only thereby ensuring the privacy and dignity of the people using the bedroom. A number of the bedroom doors (identified to the deputy manager at the time of this visit) were not self-closing. This introduces a fire safety risk and every effort should be made to minimise risk. Some hot water taps were not regulated (identified to the deputy manager at the time of this visit) and we were told that the windows that were not restricted were part of an ongoing fittings programme. The Registered Provider told us that he had involved the people living in the home with choosing colour schemes for their bedrooms. He had bought new bedroom furniture that we saw. The chest of drawers had a lockable drawer. One person commented about the new bedroom furniture – “A man’s taste”. Someone else told us that they were pleased with their new furniture. The Registered Manager told us that more new furniture was due to be delivered for the dining room and sitting room. Bedrooms had matching bedspreads and matching curtains so they were uniform in style. Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although the Registered Manager and Registered Provider are taking steps to ensure people receive a safe basic level of care, staffing arrangements are not robust enough to assure people that suitable and competent staff that can meet their existing and changing needs will look them after. EVIDENCE: On the first day of our visit there were fifty (50) people living/staying at Woodland Villa (including people on short stays). Thirty-four (34) people needed nursing care, and sixteen (16) people needed personal care without nursing care. The long term plan is to take more people on respite stays and have a mix across the care home i.e. nursing and non-nursing care through out the home. All the medication and care records will be kept in one place after the completion of the refurbishment of the building. There is now one sister in charge instead of two trained nurses on each floor. The nursing sister in charge has responsibility for the duty rota and she delegates the staffing arrangements for the day. All the staff, trained nurses and care support staff, are moved around each day. This is so they will know everyone in the home and be able to respond accordingly. Two extra support staff have been introduced on the rota early morning to help the night staff with feeding, Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 22 washing and dressing. A twilight shift from 19:30 to 22:00 has also been introduced to allow people more choice about what time they go to bed. On the first day of our visit we were told that, including the Registered Manager and the deputy manager, there were ten care staff, two domestic staff, the laundress and the chef on duty. When we arrived at the home the front door was open. It took us some time to find a member of staff and we had to walk around the building looking for someone. (We had tried ringing the doorbell however this had not achieved any response; hence we had let ourselves into the building.) On the second day staff saw us coming into the building (again the front door was open) however they continued with their duties. Nobody asked if they could help us or questioned why we were visiting the home. Later on during the visit when we walked around to look at the building, we saw one person cleaning bedrooms, the laundress and the chef, both of whom we spoke to as they continued working. The deputy manager was at work however she supposed to be on sick leave, which raised questions of insurance in the event of an accident, and health and safety at work practices. On the first day the Registered Manager was attending the training course being run in the home. We saw two trained nurses and two care support staff. Later in the day we saw two more staff members taking their break. The building is large and it is possible that we didn’t see the other four care staff allegedly on duty. The staffing levels did not reflect the fact that the building is so large and that people are spread around the home in their rooms. This is particularly a risk at night when less staff are on duty, and was a matter of concern the days people had to stay in their rooms due to training sessions being held in the sitting room. We looked at six staff files. The recruitment checks had been completed for two people including police checks. Three people only had one written reference and one person did not have any references on their file. The staff who had come to work at the care home from overseas had visas however some of these were student visas, not work permits. We discussed this with the Registered Provider who uses a recruitment agency to provide staff to the home. A student visa by law allows the person to work in paid employment for up to twenty hours a week whilst they are studying on a validated further education course. The Registered Provider was unaware that a student was supplementary to the rota when they were working in excess of twenty hours so they could not be included as part of the overall staff numbers on duty. We also questioned their competence and experience for caring for older people with complex care needs if they were only at the home for a short period of “orientation” before moving onto a university or college of further education (part of the arrangement with the recruitment agency). Some of the staff were unhappy about the high turn over of staff and that new staff were expected to start immediately without any lengthy induction or supervision. The feedback we received from the staff was that they felt they worked hard however handovers could be improved by including care support staff. Some Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 23 of the trained nurses responded that they did not need to have supervision. We were told that there were not regular staff meetings however there was a plan to introduce them. We found the attitude of some of the trained nursing staff was stand-offish. They did not engage with us at all and did not take seriously any feedback from the Registered Manager that could improve their practice. During our tour of the premises we found on two separate occasions that confidential information written as hand over notes had been left out for anyone to read. The hand over diary also contained too much confidential information about individuals and this could compromise the staff if any of this information was needed for just one of those individuals. Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 24 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, 36, 37, 38 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The Manager is endeavouring to put robust systems in place for the benefit of the people using this service, however the combination of a high staff turnover and a strong element amongst the staff team that is reluctant to change, is making her job very challenging. EVIDENCE: During this visit the Manager was found to be approachable. She was keen to promote the welfare and general well being of the people living at the home with no discrimination or pre conceptions. We found that some staff were unapproachable, they were reluctant to attend training and they did not feel that their nursing practices needed any supervision or improvement. This Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 25 resulted in a tension between the different levels of staff and an indication that the Registered Manager was being undermined by some of the staff. Additionally the overall management of the home was not clear and transparent, for example, the use by the Registered Provider of a recruitment agency taking on overseas’ staff on student visas for an “orientation” period before they moved on to further education courses elsewhere in the country. The Registered Manager was expected to supervise these staff even though they should have been supernumerary to the full time paid staff rota, and because they had not actually started on any education course they should not have been in paid employment working at the care home. We had additional concerns about recruitment checks generally and particularly because this concern had not been addressed even though it was identified at the last key inspection. People using this service and their families are sent a survey about the service they receive every year. The Registered Manager told us that action would be taken over any issues arising from these surveys. Complaints were recorded but there was no standard complaints form so we were not able to see outcomes of some complaints. We were also advised about some actions taken to resolve complaints and this had not been recorded either. A Care Co-ordinator deals with personal finances. This was seen kept in a lockable cupboard in the manager’s office. Details were recorded to show any money spent, receipts kept for cross reference and all the personal monies were checked by two people on a regular basis. People could ask for their money at any tie and also to check it for themselves (with a relative if appropriate). Only the sister in charge has a key to this cupboard. It also used to store medication. We had concerns about health and safety matters (some of these issues had been resolved by the second day of our visit): • Portable heaters that were potential trip hazards because they were not fixed or able to be made secure, • Electrical items that had not been tested for electrical safety, • Doors that did not self close properly so were a fire safety risk, • Unrestricted windows that presented a safety risk, • Clean bedding/ linen and general dressings stored on ‘back’ trolleys (one of which near a toilet) that presented a cross-infection risk, • Radiators that were too hot to touch and hot water taps that were not regulated so people were at risk of scalding/burning themselves, • A dustbin that was overflowing and was situated at the entry into the car park of the home near a bench we saw being used by staff during their breaks. Incidents that affect the health, safety and/or well being of people using this service are not reported to the CSCI as required by Regulation 37 of the Care Homes Regulations 2001. Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 26 We had concerns about confidentiality of individuals, for example, we saw hand written notes with personal information about people left out in corridors, accidents/incidents had been recorded but then the personal details were written on the page stub, and the hand over diary was left on the reception desk which due to this not being attended at all times, anyone could read. The Fire Log book was up to date and fire alarm tests were recorded. A fire saftey lecture was held at the home at the end of September 2007 that most staff had attended. The last Environmental Health Officer’s (EHO) inspection was in March 2007. The overall outcome from that visit was “satisfactory”. The Registered Provider was aware that the Building Control department needed to be involved with the proposed new kitchen and the EHO had requested to be advised when this work was underway. By the second day of our visit most staff had attended the infection control training being organised across Plymouth by the Health Protection Agency. Each bedroom had a soap dispenser and a hand towel dispenser fitted as a preventative measure for cross-infection. Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 27 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 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 2 2 Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 28 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 13(2) Requirement Timescale for action 10/01/08 2 OP10 12 (4)(a) All medicines must be stored securely in accordance with the current storage regulations to prevent unauthorised access so potentially leading to nonavailability of medicines for people in the home. This includes any medicines that require refrigeration. The registered person shall make 20/11/08 suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users” In particular: - All staff must knock on bedroom doors before entering. - Discussions with individual staff about their practices must take place in private. Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 29 3 OP12 16(2,n) Sch 1(9) “The registered person shall having regard to the size of the care home and the number and needs of service users (m) consult people about their social interests, and make arrangements to enable them to engage in local, social and community activities; (n) consult service users about the programme of activities arranged by or on behalf of the care home, having regards to the needs of service users, activities in relation to recreation, fitness and training.” 31/01/08 4 OP16 22 Sch 4(11) 5 OP18 13(6), 19 6 OP18 19(5)(b) In particular: - Staff must ensure that activities are suitable for the assessed needs of each individual; - Staff must ensure that activities take into account the wishes and personal preferences of each individual. - Staff must record what people choose to take part with and also if they decline. The recording of complaints 31/01/08 made about the home must be robust to provide a clear audit trail of the complaint, the action taken and the outcome of the complaint. Recruitment and training records 31/01/08 must show clearly that staff recruitment is conducted in accordance with Regulation 19 of the Care Homes Regulations 2001 to ensure the protection of people using this service is being adhered to. Staff must be suitably qualified, 31/03/08 competent and have the skills and experience necessary to ensure they are not putting people using this service at risk. DS0000064463.V351004.R02.S.doc Version 5.2 Page 30 Woodland Villa 7 OP27 Sch 2 Sch 4 8 OP28 18(1)(c) 9 OP29 19(1)(5) Schedule 2 10 OP30 18 11 OP31 9 In respect of the above the Registered Provider must ensure that copies of information and documentation in respect of people working in the care home specified in Schedule 2 are kept in the care home to meet Schedule 4 requirements for records that must be kept in the care home. The home must be able to provide clear evidence of any training undertaken that will include those who have achieved a National Vocational Qualification in care. The Registered Person shall not employ a person to work at the home unless he has obtained in respect of that person the information and documents specified in Paragraphs 1 to 7 of Schedule 2. The staff files seen did not hold this level of information. This requirement is outstanding from the last inspection (Due by 14/08/2007) The Registered person must ensure that a clear and comprehensive training programme is in place for all staff and that all staff attend at least all mandatory training arranged for them. The Registered Person must ensure that there are clear lines of accountability within the home and that professional relationships are maintained between the staff and manager. 31/01/08 31/01/08 31/01/08 28/02/08 31/01/08 Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 31 12 OP33 12 Sch1 (10) 13 OP36 18(1) 14 OP37 12(4a) 15 OP38 37 12 13 The Registered Person shall establish and maintain a quality assurance system that will identify shortfalls in meeting the Regulations and establish the residents’ level of satisfaction with the care services they receive in the home. This must also be extended to all visitors to the home including health and social care professionals, to establish their level of satisfaction with the care services being provided in the home. The results of all the surveys undertaken must be published and available to prospective residents and the CSCI. This requirement is outstanding from the last inspection (Due by 14/08/2007) The Registered Person must keep records as evidence of any induction training undertaken by staff. Confidential information about residents must be kept secure and recorded on their individual care records. This requirement had been met by the time of the second day of this visit – this practice must continue to ensure people’s privacy and dignity. The Registered Person must inform the CSCI of all incidents that affects the health, safety and welfare of the residents. This requirement is outstanding from the last inspection (Due by 14/08/2007) 31/05/08 31/01/08 20/11/07 31/01/08 Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 32 16 OP38 13(4) The registered person shall 31/01/08 ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; unnecessary risks to the health or safety of service users are identified and as far as possible eliminated. Subject to regulation 4(3), the registered person shall not use the premises for the purposes of a care home unless the premises are suitable for the purpose of achieving the aims and objectives set out in the statement of purpose; In particular: • Hot water from outlets accessible to people using this service must be restricted to 43c. • A risk management strategy must be compiled to eliminate any accidents by people choosing to use freestanding heaters. • Windows on the first floor must be restricted to prevent anyone from falling from them. • Doors must close securely to ensure that people’s fire safety is not compromised. Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Woodland Villa DS0000064463.V351004.R02.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Region 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 Villa DS0000064463.V351004.R02.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!