CARE HOMES FOR OLDER PEOPLE
Woodlands 33 - 35 Fox Lane London N13 4AB Lead Inspector
Margaret Flaws Key Unannounced Inspection 16th May 2006 09:00 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 DS0000032662.V289909.R01.S.doc Version 5.1 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 DS0000032662.V289909.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Woodlands Address 33 - 35 Fox Lane London N13 4AB 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) 020 8886 8725 020 8886 8725 Mr Hemunjit Ramparsad Mr Hemunjit Ramparsad Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Woodlands DS0000032662.V289909.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service Users The number of persons for whom accommodation and care is provided at any one time shall not exceed 20 older people of either gender who are over 65 years of age. Older people requiring to use wheelchairs may only be accommodated on the ground floor. Specific Service User One specific service user who uses a wheelchair and currently occupies a room on the first floor may continue to do so. This condition will need to be reviewed when s/he leaves the home. Two specified service users who have dementia may remain accommodated in the home subject to regular reviews of their needs. The home must advise the registering authority at such times as either of the specified service users vacates the home. 8th June 2005 2. 3. 4. Date of last inspection Brief Description of the Service: Woodlands is a care home registered to provide care to twenty older people. The home is located in the residential areas of Palmers Green and is a short walk from local shops, public transport links and is close to a park. The home has fourteen single bedrooms and three double rooms located on the ground and first floors. The main lounge and sitting area is on the ground floor however there is a smaller additional lounge on the first floor. There is a passenger lift to enable service users with mobility difficulties to get to the first floor and there is a garden at the rear of the property. The stated aim of the home is to provide a caring home that offers choice and independence, encourages residents to exercise fully their rights and enables them to lead a fulfilling and comfortable life. The provider must make information available about the service, including reports, to service users and other stakeholders. Fees for the home are £360-425 per week. Woodlands DS0000032662.V289909.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day. The Registered Person Mr Ramparsad was present throughout the inspection. The inspector spoke to three service users, three staff and one relative during the inspection and examined service users and staff records, general home records and toured the building with the Registered Person. The Registered Person assisted throughput the inspection. Comment cards were received from fourteen service users, ten relatives and two care professionals. Eight requirements were made , of which one was restated from previous inspections. What the service does well: What has improved since the last inspection?
There have been significant improvements since the last inspection. The home has responded effectively and promptly to immediate requirements issued after the last inspection, meeting all but one requirement, which is partially met. Six immediate requirements were issued at the last inspection relating to staff training, activities, food, service user care plans and risk assessments, a business plan and records of chemicals kept in the home along with a repeated requirement relating to supervision. All were met in July 2005. There have been improvements in service user care records. Care plans and risk assessments are now available for every service user, these are kept up to date and accurately reflect the service user’s current needs. Service user health records are maintained up to date. Service users have been consulted regarding their choice of activities and communication regarding meal choices for the day has been improved. Staff have received training in dementia and now receive regular supervision. A revised business plan that includes information on costs and timescales was submitted to CSCI. The statement of purpose has been revised to include information criteria for admission and therapeutic activities offered by the
Woodlands DS0000032662.V289909.R01.S.doc Version 5.1 Page 6 home. The medication policy has been reviewed to include information that shows that where possible service users are encouraged to administer their medication. Furniture and fittings in the rooms identified have been replaced and significant improvements made. Quality assurance processes have been put in place to consult the service users on their views on the life of the home and how it is run. The laundry floor has been replaced to improve infection control. Records of hazardous chemicals kept in the home are now available. The garden has been improved. 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. Woodlands DS0000032662.V289909.R01.S.doc Version 5.1 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 DS0000032662.V289909.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users can feel confident that their needs will be assessed prior to admission to ensure that the home is the right place for them. EVIDENCE: The home’s statement of purpose and service user guide were examined. The service user guide contains sufficient information and the statement of purpose has been revised to include clear information on the criteria for admission and the arrangements in place regarding therapeutic activities for service users. This meets a previous requirement. There are currently fifteen service users at the home. They meet the conditions of the home’s registration, covering one named service user who has dementia. Another service user with dementia has left the home after reassessment. The Registered Person said that the home was able to meet the needs of the current service user with dementia. A variation to cover named individuals with dementia was submitted to the CSCI and approved in February 2006.
Woodlands DS0000032662.V289909.R01.S.doc Version 5.1 Page 9 All service users have had annual reviews by placing authorities to ensure that the home is able to meet their needs. One recently admitted service user said that his needs had been fully assessed prior to admission. This was confirmed by an examination of the service user’s file. All staff have completed training in dementia care, meeting a requirement from the previous inspection. The home does not provide intermediate care. Woodlands DS0000032662.V289909.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Improvements have been made in care plans and information on the service users’ needs and service users can feel more confident that the documentation reflects the care they receive. EVIDENCE: Four service users’ files were examined. All now contained up to date care plans and risk assessments. The Registered Person and a senior staff member explain how relatives are involved in the review processes. This was confirmed in discussions with the service users and information from relatives. The inspector spoke to three service users and received fourteen service user surveys. The feedback received was very positive. Service users said that they were happy in the home; that the quality of care was good and that staff treated them with respect. They also said that staff were respectful in providing personal care. Service users who were not British born were pleased with how the home was respectful in dealing with cultural issues. Healthcare visits and regular check-up are now properly recorded. A GP is funded by the home to maintain medical support. Regular visits by the doctor and by district nurses were well documented in the service users’ files.
Woodlands DS0000032662.V289909.R01.S.doc Version 5.1 Page 11 The medication policy has been reviewed to include information that encourages service users to take responsibility for their medication. Medication records were inspected All MAR sheets were in order, corresponding to the blister packs checked. One service user takes a controlled drug, which was correctly stored. Service users spoken said that their privacy was respected when personal care was delivered and gave illustrative examples. Woodlands DS0000032662.V289909.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users can feel confident that their lifestyle choices will be respected and individual activity encouraged. Food in the home is of reasonable quality and the service users are offered reasonable choices. EVIDENCE: After the two previous inspections the Registered Person was asked to review the activities provided at the home in consultation with service users. This has been done. In the review, service users said that they were generally happy with the activities provided (eg. games, keep fit, singalongs) but suggested more activities like painting and music. A new activities schedule was developed based on the service users’ suggestions and a new large television purchased at their request. A karaoke machine has also been purchased and is in use. Outings are planned. Several service users live active social lives outside the home, for example, going to the pub, to church and out shopping. Two service users went out to pursue these activities during the inspection. Relatives surveyed and spoken to said that the home did a good job of supporting their family member’s independence. One said, “the place may be a bit ramshackle but that doesn’t stop doing everything possible for my (relative)”. Service users manage their own finances or work through power of attorney. The home is not responsible for any service users’ finances.
Woodlands DS0000032662.V289909.R01.S.doc Version 5.1 Page 13 Communication with service users regarding the food on offer to them has improved, with a daily menu displayed in that communal area. This meets a requirement from the previous inspection. For two service users in the home whose first language was not English, the staff were observed interacting with basic words in their original languages. Place of origin food choice is supported by offering alternative menu options to the service users and the service users spoken to were happy with these arrangements. The Registered Person also described how service users from religion such as Islam have been supported in the home and how Muslim staff are supported, during Ramadan for example by not being rota-ed on long days. Service users spoken to and surveyed said that they were happy with the food on offer. On the day of the inspection, there were three choices for lunch and dinner was catered individually. A new cook had been recruited for the service and was waiting to start. The kitchen was inspected with the help of a staff member. Food was appropriately stored and kitchen temperatures accurately recorded. Woodlands DS0000032662.V289909.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users can be confident that the home has an accessible complaints policy and procedure that is understandable to them. They can also be confident that staff have an understanding of adult protection issues and are able to ensure their safety and wellbeing is protected. EVIDENCE: Seven staff have now received POVA training and were able to describe the home’s adult protection procedures. The home’s complaints record was inspected. No complaints have been received by the home since the last inspection. However, a number of positive compliments were received, along with very positive feedback from a visiting social worker undertaking a review. Woodlands DS0000032662.V289909.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users can generally be confident with the standard of the physical environment but there are some improvements that still need to be made to protect them and enhance their quality of life. EVIDENCE: There have been improvements in the garden and external living areas. The garden has been cleared of rubbish and flower beds have been prepared for planting. The Registered Person and some service user said that, now the weather has warmed up, the service users were spending time outside in the garden. The home has also made improvements in the interior physical environment. Thirteen new beds have been purchased, along with several new wardrobes, new commodes, new chairs for bedrooms and new lampshades. Curtains have been re-hung where they were disorderly, some rooms have been repainted and replacement carpets fitted.
Woodlands DS0000032662.V289909.R01.S.doc Version 5.1 Page 16 The shower installed on the ground floor which the inspector was unable to view on the last inspection, is appropriate for the service users’ needs. The flooring in the laundry has been replaced but a requirement to purchase a washing machine with a sluice cycle has not yet been met. The Registered Person said that he has obtained a quote for the new machine, which is very expensive, but said he will arrange for purchase. The requirement is restated. The Registered Person said that the kitchen is due to refurbished but the washing machine purchase was the first priority. The loft was inspected. This is a large space completely filled with old furniture, records and general miscellaneous items. In this condition, it would present a hazard in the case of fire. A requirement is given to clear out this space. The home now has a new large screen television which the service users had requested. A fire door was found propped open, which is unacceptable and a requirement is given. There was no acceptable hot water supply in some bedrooms inspected and it is required that this be remedied. The home was clean and tidy on the day of the inspection. There were no offensive odours. A cleaner works in the home six hours daily. Woodlands DS0000032662.V289909.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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 from evidence gathered both during and before the visit to this service. Service users can be confident that there are sufficient staff in the home to meet their needs and that they are properly recruited. They can generally be confident that staff are trained to care for them, although gaps in night staff training leave them vulnerable. EVIDENCE: Three care staff were on duty during the inspection. The home has a relatively stable staff team and no agency staff are used. There were sufficient staff on duty at the time of the inspection. Three staff files were inspected, including the files of two staff who were recruited in July 2005. Recruitment processes were good. All staff had all the pre-recruitment checks accurately completed and had Criminal Records Bureau checks on file. However, the application form used requires updating to enable the home to check new staff for gaps in employment and a requirement is made responding to this. New staff had been fully inducted and checklists completed. A new staff member spoken to said that she had been inducted fully prior on starting the job. Staff training files were inspected. All staff have completed training in adult protection and dementia and most staff have completed training in first aid, health and safety, medication, food hygiene, infection control and moving and handling. However, some night staff and bank staff have not received all statutory training in a timely manner nor has medication training been done annually. Requirements are given to cover these areas. Another requirement is
Woodlands DS0000032662.V289909.R01.S.doc Version 5.1 Page 18 given that a training matrix be produced to help the home manage statutory training in a timely manner. Woodlands DS0000032662.V289909.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users can have considerably more confidence than in the past that they are living in a safe, well managed home. EVIDENCE: A quality assurance exercise has been undertaken. Service users were surveyed in July 2005. The questionnaires were inspected and were all positive. The home also held meetings with the service users to consult on food and activities in the home. The home has acted on the service users’ views. This meets a previous requirement. In response to requirements, the home has reviewed its policy on service user’s property and money. The policy encourages service users to administer their finances. The Registered Person or staff no longer act as an appointee for service users.
Woodlands DS0000032662.V289909.R01.S.doc Version 5.1 Page 20 A satisfactory business plan was submitted to the CSCI last year and the home now has completed inventories of the service users’ personal belongings, which are held on each service users’ file. This fulfils a previous requirement. Staff supervision takes place every two months. This was documented in detail on each staff members’ file examined and confirmed by staff in interviews with the inspector. Previous outstanding requirements in this area are met. Information has been obtained about hazardous substances kept in the home. These datasheets have been made available to staff and meets a previous requirement. Portable appliance testing was carried out in July 2005 meeting a previous requirement. The most recent satisfactory fire officer’s visit was in March 2006 and fire drills are held two monthly. Fire equipment checks, environmental health, gas safety, electrical wiring, emergency lighting checks have all been satisfactorily done, along with recent inspection of the nurse call systems and the lift. Woodlands DS0000032662.V289909.R01.S.doc Version 5.1 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 2 Woodlands DS0000032662.V289909.R01.S.doc Version 5.1 Page 22 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 OP26 Regulation 13(3(4) (23(2(b(k ) Requirement The Registered Person must ensure that the washing machine available in the home has the option of a sluice cycle. This requirement is restated. Previous timescale of 15/07/06 not met. The Registered Person must ensure that the cluttered loft is cleared out to minimise fire risks. The Registered Person must ensure that fire doors are kept closed at all times. The Registered Person must ensure that the hot water supply is maintained to the service users’ bedrooms. The Registered Person must ensure that the home’s recruitment application forms is amended to monitor gaps in previous employment. The Registered Person must ensure that night and bank staff are trained in all statutory training areas. The Registered Person must ensure that all staff who administer medication have
DS0000032662.V289909.R01.S.doc Timescale for action 31/07/06 2. OP19 13(4) 31/07/06 3. 4. OP19 OP19 13(4) 23(2) 31/07/06 30/06/06 5. OP29 19(1) 30/06/06 6. OP30 18(1) 31/07/06 7. OP30 18(1) 30/06/06 Woodlands Version 5.1 Page 23 8. OP30 18(1) training annually. The Registered Person must ensure that a training matrix is produced. 30/06/06 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 DS0000032662.V289909.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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