CARE HOMES FOR OLDER PEOPLE
Woodlands 50 High Street Earith, Huntingdon Cambridgeshire PE28 3PP Lead Inspector
Dragan Cvejic Key Unannounced Inspection 14th August 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Woodlands DS0000065969.V343775.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. Woodlands DS0000065969.V343775.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Woodlands Address 50 High Street Earith, Huntingdon Cambridgeshire PE28 3PP 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) 01487 841404 F/P 01487 841404 Farrington Care Homes Ltd Mrs Pamela Ellis Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24) of places Woodlands DS0000065969.V343775.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 3rd October 2006 Brief Description of the Service: Woodlands provides care, accommodation and support for up to 24 older people, some of who have a degree of confusion or a form of dementia. The home is situated in the village of Earith, which is approximately 6 miles from the market town of St. Ives; from the rear of the home are good views across the River Great Ouse. Residents’ accommodation is on two floors, the upper floor being accessed via a shaft lift. The home has 18 single, and 3 double rooms. 16 of the single rooms have en-suite toilets, and 4 rooms also have baths, although these are not currently used by the occupants, as they do not have the hoists or other equipment to allow access for people with reduced mobility. The en-suite facilities are separated from the living area in the bedrooms by curtains, or by a screen type wall. There are 4 toilets, all with raised toilet seats, one specialist bath, and a level access shower. Communal areas include 2 lounges, a dining area, and a large conservatory, all of which are available for residents’ use. A pleasant garden area leading down to the river is provided outside. Residents are supported by a team of care staff; the premises are looked after by domiciliary staff and a maintenance person. Three councils were funding some service users, while 12 users privately funded their stay in the home. Woodlands DS0000065969.V343775.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. It was prepared from the communication with the home since the last visit, from the home’s self-assessment, AQAA, and from 14 service users’ questionnaires sent to the inspector. The selfassessment form provided some basic information about the service since the last inspection, but the visit to the service demonstrated evidence for the statements in the self-assessment form. The site visit was carried out from 8.30 in the morning and lasted for 4.5 hours. Nine service users spoke to the inspector, three were case tracked and two staff members and one visitor also spoke to the inspector. Four service users’ files and three staff files were checked along with the records and some policies. The tour of the home provided information about the environment. What the service does well: What has improved since the last inspection?
Care plans were improved and more details were recorded, allowing staff easy access to information about individuals and better effectiveness of their work. Activities were addressed and the frequency of entertainers coming in was increased to 4 times a month. Woodlands DS0000065969.V343775.R01.S.doc Version 5.2 Page 6 Medication process was improved and made safer with blister packs, whereby the risk of potential errors was minimised and recording was better by introducing separate records for prescribed controlled drugs. Regular maintenance and renewal of furniture in some bedrooms took place since the last inspection visit. New bathroom flooring, new kitchen appliances and a new widescreen TV in both lounges improved the environment for service users. 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. Woodlands DS0000065969.V343775.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodlands DS0000065969.V343775.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were assessed prior to admission to ensure that their needs would be met and that they would fit into the existing atmosphere without disturbing themselves or the existing users. EVIDENCE: The home reviewed their statement of purpose, service user’s guide and home’s brochure to provide accurate and up to date information to existing and potential service users. Many users knew the home before they needed residential care and chose this home from personal knowledge or “word of mouth” information. All privately funded service users had contracts with terms and conditions. Those funded by social services had their social services’ assessments in their files.
Woodlands DS0000065969.V343775.R01.S.doc Version 5.2 Page 9 All four checked files contained the home’s assessments, carried out by the manager, showing the level of assessed needs prior to admission. Recently four service users were admitted, following the closure of a nearby residential home. One of these files was checked and showed that the manager carried out the assessment prior to admitting a user, to ensure not only the home’s ability to meet her needs, but also that the existing and the new users would be able to get on. A user commented on how the home was meeting his needs: “yes, very much so”, adding his views on staff: “Always there when I need them.” Woodlands DS0000065969.V343775.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improved care plans needed to be signed to show involvement of service users. The home needed all necessary equipment, including sit-on scales, to ensure complete healthcare was offered to service users. EVIDENCE: Care plans were improved since the last inspection in views of the quality and quantity of the information recorded for each individual. However, the risk assessments looked at in 4 checked files still needed to address some risks, despite having been expanded since the last inspection. An example was introducing a Kylie sheet for a service user but not mentioning the reason or risk that determined this higher level of support in the risk assessment. Some care plans and risk assessments were not signed by service users who were able to sign them. Two of these, however, confirmed that they were
Woodlands DS0000065969.V343775.R01.S.doc Version 5.2 Page 11 aware of care plans and reviews. A visitor also confirmed that his relative’s care plan was sent to him, although it was not signed in the file when checked. The manager reported that the home organised dental check ups and visits to opticians usually with help from relatives and registered all service users with a GP. Those users who showed unstable body weight were monitored, but the lack of sit-on scales reduced accuracy in the monitoring of their weight. Medication process was improved. The home negotiated with the local pharmacy and managed to arrange to get users’ medication packed in blister packs, thus increasing safety and minimising potential errors. Introducing separate recording for controlled drugs also helped improve the safety of handling medication. Privacy and dignity were respected and this was confirmed in questionnaires, in the home’s self-assessment and was observed during the site visit to the home. Woodlands DS0000065969.V343775.R01.S.doc Version 5.2 Page 12 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 excellent. This judgement has been made using available evidence including a visit to this service. Although activities were the area for further improvement, respect for autonomy, choice and catering arrangements determined the excellent scoring of this group of standards. EVIDENCE: “My relative needed more structured activities that would stimulate him”, commented one of the relatives in the questionnaires. In the home, several service users commented to the inspector that the activities could be better. The manager presented achievements in this area: increased number of organised entertainment visits to 4 a week, a boat trip, a barbeque for users and guests, but recognised that this area ought to be constantly looked at and that new activities needed to be added constantly to satisfy all service users, including those with dementia. Community contacts were very good and service users benefited from location in the local community they knew before admission to the home. The home
Woodlands DS0000065969.V343775.R01.S.doc Version 5.2 Page 13 met the religious needs of service users and the manager stated that they would meet the needs of potential new users belonging to different faiths. Users’ autonomy was highly promoted. The fact that only people with mild to moderate dementia were in the home and that there was no one with severe dementia, helped the home introduce working practices that promoted autonomy and independence. The home did not deal with service users’ money. At the time of the site visit, it was a matter for relatives, or legal representatives, usually solicitors, to help users with their finances. Food was rated as excellent in most questionnaires and during the site visit. The visitor that spoke to the inspector also emphasised the excellent catering service. Menu showed variety and respect for users’ choices of food. The cook was very organised, not only in food preparation, but also in records related to food. It was agreed that she would record the names of users when they chose alternative meals. Woodlands DS0000065969.V343775.R01.S.doc Version 5.2 Page 14 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. Complaints procedure contained appropriate instructions for how to complain, but most users relied on common sense and the manager as the final point for receiving complaints. Protection of service users was ensured through policies and procedures and good, safe working practice. EVIDENCE: There were no formal complaints since the last inspection, but the home dealt with concerns and recorded their actions. The complaints procedure was explained in the service user’s guide. However, the questionnaires indicated that most service users and even some relatives would say to the manager if they were not happy with something, but did not show knowledge of how to take things further, if they were not satisfied with the manager’s response in the first instance. The manager agreed to reinstate the whole procedure at the users’ meeting. The manager stated that only 2 staff members had not attended POVA training, but there was a plan for their attendance. The home recognised all forms of potential abuse and had a procedure for dealing with it to protect service users. Woodlands DS0000065969.V343775.R01.S.doc Version 5.2 Page 15 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): 19,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users could enjoy the old style and design of the building that was made safe, regularly maintained and offered a pleasant environment. EVIDENCE: The location of the home was appropriate for users needs and most of them benefited from the rural area where they used to live before admission to the home. The home was in an old building that was reasonably maintained and offered comfort to service users. Some features, such as toilets on small, step-size platforms, were part of the initial design and the manager stated that risk assessment would cover any potential problem related to this issue and that
Woodlands DS0000065969.V343775.R01.S.doc Version 5.2 Page 16 staff were present to ensure the safety of service users during or before the use of toilets, in most cases. The attractive garden faced the riverbank and Fens’ on the other side of the river, the peaceful and relaxing scenery creating such an atmosphere in turn. The manager explained that many items of furniture were replaced, as part of the programme of regular maintenance. A door at the top of the stairs could not be made fireproof due to the structure of the landing, but this was addressed in the risk assessment. Another potential risk, a sloping ceiling in the corridor, did not endanger current users, but the manager was aware of the potential risk for blind people or those with poor eyesight, if any such person was admitted. The self-assessment presented the dates of regular checks of the home by other regulatory authorities, such as environmental health, or the fire department. A visitor commented: “The laundry service is very good, I know I was professional in that area.” He confirmed that his relative was also very happy with the laundry service. Woodlands DS0000065969.V343775.R01.S.doc Version 5.2 Page 17 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 home concentrated efforts to improve training and to reach the minimum standards as the next step of their actions to improve services and provisions. EVIDENCE: “The staff are always friendly with my family and friends that visit me and they always make them feel welcome at any time of the day or night”, commented a user in his questionnaire. Another relative commented: “As an occasional visitor, I am impressed by the continuity of staffing and their knowledge of, and relationship with long term residents. The atmosphere is caring.” As the home did not have a turnover of staff, the service users benefited from the continuity and stability of care processes. The NVQ training was promoted, but the home was still just under 50 of staff being NVQ trained. There were no new staff employed since the last inspection. Recruitment procedure was clear. Three checked files confirmed that appropriate checks were carried out as a part of the recruitment. Woodlands DS0000065969.V343775.R01.S.doc Version 5.2 Page 18 Staff training was improved, but the manager stated that this was a task for further improvement. A new induction programme was prepared and introduced for new staff. With two more staff to complete POVA training, the home had almost met this minimum standard. Woodlands DS0000065969.V343775.R01.S.doc Version 5.2 Page 19 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): 31,33,35,36,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Safe working practices were in place to ensure safety for service users. Supervision for staff was planned to become regular, while the manager’s supervision was not arranged. EVIDENCE: The experienced and skilled manager had been running the home for a number of years. She gave clear direction to the staff and her friendly approach to service users made them comfortable to say whatever they wanted to her. In terms of external management, the manager had not had regular supervision and it is up to the owners to ensure this aspect of support is introduced.
Woodlands DS0000065969.V343775.R01.S.doc Version 5.2 Page 20 The home carried out quality assurance review and asked users and visitors about their satisfaction with services and provisions in questionnaires. As part of the review, policies and procedures were reviewed and the equal opportunities policy had been updated to picture a new equality approach according to official government guidance. Service users families supported them in handling their finances. Staff supervision was not up to date, but the manager was fully aware of this and had a plan to bring this aspect of service up to the minimum standard. Safe working practices were in place. The home had records of visits by environmental health, the fire department and by the health and safety executive. The regular maintenance of equipment was recorded and the hoist checks, water temperatures and fridge/freezer temperatures were recorded and checked during the site visit. Woodlands DS0000065969.V343775.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 3 Woodlands DS0000065969.V343775.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Service users and/or their representatives must sign care plans to show that they were involved in care planning. The sit-on scales must be obtained to ensure appropriate and safe weight control for service users whose care requires weight monitoring. Appropriate, stimulating activities must be offered to service users regardless of their conditions, and include users suffering from dementia and other specific conditions that limit their ability to fully enjoy the activities already provided. At least 50 of staff must be NVQ trained. All staff must be trained in Protection of Vulnerable Adults The manager must receive regular supervision from the owners to ensure her skills are kept up to date in the home’s aim to meet the needs and protect service users. Measures must be put in place to ensure that staff receive formal
DS0000065969.V343775.R01.S.doc Timescale for action 31/10/07 2. OP8 13(6) 31/10/07 3. OP12 16(n) 31/10/07 4. 5. 6. OP28 OP30 OP31 18 18 21 01/03/08 02/01/08 01/11/07 7. OP36 18(2) 31/10/07 Woodlands Version 5.2 Page 23 supervision at least 6 times a year. This was a requirement resulting from the last inspection; failure to comply with this requirement may result in further action being taken against the service. This was a requirement set previously with time scale for compliance set to 31/01/06. As the plan was made, now the staff must be supervised regularly as per their plan and records kept to show compliance. 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 Woodlands DS0000065969.V343775.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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
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