Inspection on 02/03/09 for Woodlands

This inspection was carried out on 2nd March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Woodlands 04/09/07

Woodlands 23/08/06

Woodlands 06/01/06

Woodlands 29/06/05

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Woodlands 7 Nostell Lane Ryhill Wakefield West Yorks WF4 2DB     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Gillian Walsh     Date: 0 9 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Woodlands 7 Nostell Lane Ryhill Wakefield West Yorks WF4 2DB 01226722652 01226722652 woodlands.residentialhome@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Woodlands Residential Homes Ltd care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 19 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Learning disability Code LD, maximum number of places: 19 Date of last inspection Brief description of the care home Woodlands Residential Home is registered to provide care for 19 adults under 65 years with a learning disability, with a variation to provide care for three adults with a learning disability who are over the age of 65 years. The homes registration consists of one main house offering 16 places including four shared rooms and the remainder of bedrooms providing single accommodation plus a bungalow with three single rooms. Woodlands is situated close to the centre of Ryhill where there are shops, pubs, clubs, Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 19 Brief description of the care home churches and a small library. The home is set back from the main road within a walled garden with lovely views over Wintersett Nature Reserve. Woodlands provides comfortable accommodation, particularly in the communal areas which are furnished in keeping with the age and style of the property. The bungalow accommodation is also comfortable and offers people a degree of independence whilst being supported from the main house. Most people who live at the home attend the homes day workshop, which is within a very short walking distance from Woodlands. Others undertake other activities including paid work in the home and voluntary work. The home manager said, on 9 March 2009, that the current weekly fees for the home range from £403 to £935.14 (the higher figure being for a person assessed as requiring extra care). Extra charges are made for hairdressing, newspapers, homeopathy, trips out and other incidentals. Information about the home is made available to people through the Statement of Purpose and Service User Guide, both available on request at the home. Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support peterchart Concerns, complaints and protection Environment Staffing Conduct and management of the home Poor Adequate Good Excellent How we did our inspection: The key inspection was brought forward from planned timescales due to the Commission receiving some concerns about the service. An investigation is currently being conducted by the local authority and the police into allegations of abusive practice at the home. On this occassion we had not asked for the home to complete and return an Annual Quality Assurance Assessment (AQAA) and we did not send surveys to people who live at the home. During the visit we spent time speaking with the manager, people who live at the home and some staff. Care Homes for Adults (18-65 years) Page 6 of 36 We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 36 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not move into the home without an assessment of need being completed to make sure that their needs can be met. Evidence: There have not been any recent permanent admissions to the home. People who have come to the home for a period of respite care have had an assessment of their needs undertaken by the manager. The manager said that in addition she always obtains a copy of the assessment completed by the social worker. The manager said that the homes procedure for any person coming to stay or to live at the home would be for them to come and have a look around and spend some time with the people already living there. The manager said she would, if appropriate, visit the person in their current environment to make an assessment of their needs, or if this was not possible she would do this during their visit to the home. Contracts have recently been updated to include the statement that fees do not cover the costs of homeopaths, medical requisites (other than medications by Care Homes for Adults (18-65 years) Page 10 of 36 Evidence: prescription). However the contract does not reflect that people will routinely pay for supplements such as cod liver oil tablets (many of which are available free of charge on prescription) deemed appropriate by the management rather that the persons General practitioner. Inspectors had some concerns about the placement of a person receiving regular respite care at the home who appeared to be much younger than all of the other people at the home. However this had been agreed with the social worker and was felt to be appropriate. The manager showed inspectors the homes revised contracts which now include the statement that fees do not cover the costs of homeopaths, medical requisites (other than medications by prescriptions) However the contract does not state that it is the practice of the home to routinely charge for health supplements (many of which are available on prescription) or consultations with a homeopath deemed appropriate by the management of the home. Contracts seen for people who currently live at the home state that the person shall from their own resources and or personal allowance provide medical requisites (other than medications by prescriptions) Again the contract did not reflect that supplements and consultations with a homeopath would routinely be paid for by the individual and breakdowns of costs for these services were not seen to be included in the contract. Care Homes for Adults (18-65 years) Page 11 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and risk assessments detail peoples needs and in some areas preferences but do not give indication that people are fully involved in making choices about their care. Evidence: Each person living at the home has a care plan which is divided into various sections including health, personal care, eating, communication, leisure, behaviour and household tasks. Individuals strengths and needs are then identified under each heading. Care plans contain clear detail and instruction to carers on how to meet the persons identified needs. They are updated regularly by the manager. However there is no evidence that the the individual concerned, or their representative, has had any input into their care plan or that they have agreed the content. No short term or emergency care plans are in place to instruct staff on the actions Care Homes for Adults (18-65 years) Page 12 of 36 Evidence: thay need to take in situations such as acute illness i.e infection or during situations such as seizure or choking. Care plans include little information about how people should be encouraged, or are supported to make decisions about their lives or how they receive care. This is particularly relevant to some of the treatments, remedies and over the counter medications that people living at the home are prescribed . Also to body weight control and restricted diets which care plans focus on but again do not contain any evidence that the individual has any choice about. The Record of Expenses/Purchases charts for people living at the home included entries such as pants and tops USA. When asked about this the homes administrator explained that a director of the home often buys clothing in America and then brings it back for the people who live at the home. The administrator said that if the person likes the clothing, they pay the director back for the clothing. This practice means that people do not always go out shopping for and choose their own clothing. These charts also include detail of substantial expenditure on consultations with a homeopath, and over the counter medications recommended by a director or the manager of the home. Again there is no evidence available to show that people have any choice or have reached an informed decision in this expenditure of their personal money. Risk assessments are included in each persons care file covering various areas for example going out, using public transport or choking. These contain relevant detail about actions staff should take to minimise any perceived risks. No evidence was available to demonstrate that people living at the home have a say in the running of the home or the development of policies relevant to their daily lives. Care Homes for Adults (18-65 years) Page 13 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Institutionalised practice means that people are restricted in their lifestyles. People do not receive a nutritious diet of their choice. Evidence: The manager said that some of the people living at the home have previously undertaken college and other educational courses although nobody was doing so at the moment. She explained that this is largely due to restrictions in the educational system which limits the number of courses people can undertake. One person helps out at events organised by the local church and another works on a voluntary basis at a local day centre. Many of the people who live at the home attend a workshop owned by the home. Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: The manager said that those who wish attend local churches and events organised by the church. Some people attend local groups such as the local Derby and Joan club. Some people have regular contact with their families and friends and spend periods of time away from the home with them. However there is little evidence of peoples families being encouraged or invited to become involved in daily routines and activities within the home. Prior to the inspection the Commission had received concerns that people were being restricted in how they spend their days and their freedom to access facilities within the home. The inspectors talked to the registered manager, care staff and some people who live at the home. They observed daily routines, mealtimes and written records within the home. They were in the home when visiting care managers met with individuals to discuss their care and life at the home. It was quickly apparent that people live within an institutional regime that includes unacceptable and degrading practises that are apparently led by the manager and one of the home owners. These include: People beinggrounded or sent to their room by the owner. People not being allowed to go out unaccompanied because they may speak to outsiders. People being allowed only water for whole days in order to assist with weight loss. Set shower days with women on a Monday and men on a Tuesday. The manager advised that additional showers could be taken but staff and service users stated that optional times were not allowed. Restrictions on where the majority of men can eat and spend their communal time. A weekly system of putting oil in peoples ears without any indication as to why or whether the GP has been consulted. Restrictions on food choices and food provision and variances between what men and Care Homes for Adults (18-65 years) Page 15 of 36 Evidence: women are allowed and when. Providing people with food that is out of date in some cases by months and years. Minimal use of fresh produce and excess use of frozen produce much of which was beyond its use by dates. The absence of any snacks in between meals and restricted provision of supper meals. Excessively long periods in between meals and evidence that people go to bed and get up hungry. Inadequate nutrition and fortification of food for people who are underwight or who can only manage soft diets. A lack of individual choice at each mealtime, inadequate menu rotatation and content and a failure to serve well presented and appetising food in adequate quantities. Restrictions and unfair distributions of and controls over treats such as sweets and with holding treats as punishment. A regime where people must queue at the kitchen to receive their meals and respond to a bell sounding when medications are given out. These and other findings are being urgently investigated further together with the Local Authority Safeguarding Team and the police. Freezers contained large amounts of frozen food including long life skimmed milk, biscuits, margarine, bread, pies and huge amounts of pre cooked meats. The majority of meat had ice on the inside of the bags it was stored in and had freezer burn. The sausages which inspectors were informed were for the sausage pie to be served for the evening meal had already been cooked and then frozen. As these were still in the freezer at lunchtime, the manager decided to buy fresh sausages for that day. She also bought fresh bread for lunchtime sandwiches. Care Homes for Adults (18-65 years) Page 16 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights to dignity, choice and healthcare are not protected by some of the practices within the home. Systems relating to medication are not safe. Evidence: The inspectors identified significant restrictions in the way people are cared for and in the control they have over their lives. For example rigid timetables and rules for showering, mealtimes and food choices. Clothing is bought for people without them having the opportunity to do their own shopping or make their own choices regarding clothing. Inappropriate emphasis is placed on peoples body weights resulting in some people worrying about gaining weight. Everybody is weighed weekly and their weights are discussed at staff meetings and recorded on the meeting notes. The majority of the food provided is low in fat and calorie content. Dinner plates are not available for use. Instances where people have been humiliated and treated badly where described to the inspectors and these are now subject to further investigation Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: Further concerns about the excessive and widespread use of homeopathic, herbal and other alternative remedies and over the counter supplements were identified. All of the people who live at the home receive remedies prescribed by a visiting homeopath for which they pay varying amounts every six weeks. However no evidence could be found to demonstrate that people have consented to these treatments or payments or for the homeopath to have access to their personal details or be involved in their care. It was of further concern that people regularly pay for and receive supplements such as cod liver oil, zinc and other over the counter supplements and medications. Some unacceptable practise that may well have caused distress and discomfort was identified and confirmed by the manager who gave assurances that this had now ceased. No evidence could be found to demonstrate that peoples doctors were aware of the alternative remedies and treatments they were receiving and again no evidence of people consenting to these treatments or consenting to pay for them could be found. It was confirmed that alternative therapies are sometimes used in preference to seeking medical assistance in emergencies such as choking. Conditions such as constipation and fungal infections have been treated by both the GP and the homeopath. However there is no evidence to show that the GP was aware of other remedies being used either in conjunction with conventional treatment or in isolation. In addition detail of alternative medications are not routinely provided to hospital staff. the hospital would be unaware of all the treatments being taken by the person. Inspectors observed a lack of immediate and appropriate staff action in response to medical emergencies. This included the manager who failed to telephone emergency services and instead called the GP who advised she call the emergency services straightaway. Evidence of attention from healthcare services such as district nurse, chiropodist, speech therapist and optician were seen however there was nothing to show that they Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: had been informed or consulted about the use of alternative therapies. A pharmacy inspector who visited on the first day of the inspection made the following observations: The homes medication procedures, the medication training records of four staff, fifteen current medication administration records (MAR) charts and eighteen supplementary remedy charts were examined. Also the storage and handling arrangements for medicines (including controlled drugs), dietary supplements and complementary remedies. There are procedures in place for ordering, receiving, administering and disposing of medicines but many of the documents are out of date. The Royal Pharmaceutical Society of Great Britain and advice documents on handling medicines in social care are not available in the home so staff are unable to refer to current best practice guidance. Very little of the medication training provided to staff (including the use of specialist administration techniques) has been delivered independently. This means staff in the home may not fully understand what is expected of them when handling and giving medication. We found supporting evidence of this by examining medication records and storage arrangements in the home. There are very few administration gaps on the MAR charts meaning that people living in the home can expect to receive their prescribed medicines correctly. Three care files contained clear records of recent drug and dose changes. Handwritten entries of seventeen medicines on nine MAR charts are not sufficiently clear and detailed enough to be sure that other staff can follow the changes correctly. The quantity of medication from one monthly cycle to another is not always recorded on the new MAR chart. This means it is difficult to produce a complete record of medication within the home and to check if medication is being given correctly. The homes procedure for non-prescribed home remedies contains a list of thirty eight items including a large variety of dietary supplements and plant products. Many of these products are given routinely to eighteen people living in the home in accordance with written directions from management staff. Homeopathic remedies are administered in accordance with directions from a visiting homeopath and we found records of such administration in a staff communications book, not on a MAR or supplementary chart. Staff told us that this had been the homes practice for many years. There was no evidence that peoples personal preferences about non-prescribed Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: supplements or complementary remedies are sought or upheld. There was no evidence that the continuous use of such supplements and remedies are regularly reviewed by each persons healthcare professional e.g. GP. Care homes may only make arrangements by agreement with the responsible healthcare professional for the use of homely remedies, and only for the limited treatment of minor ailments e.g. for up to fourty eight hours. Most medicines, including controlled drugs, are stored in cupboards in a locked store room. Injections for two people are kept inappropriately in a fridge containing alcohol and non-prescribed dietary supplements. The temperatures of this fridge and the store room are not known. The dates of opening medicines with a limited use once opened are not recorded, so staff do not know that these medicines are fit to use. All medicines must be stored securely at temperatures and conditions recommended by the manufacturer so that staff know they are safe to use when needed. Care Homes for Adults (18-65 years) Page 20 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not protected from abuse. Evidence: The home has a complaints procedure and maintains information about complaints made within a loose leaf folder. The complaints log held documentation relating to concerns or complaints made to the home. This documentation showed that the manager takes action to manage and resolve complaints made. During the visits inspectors found that some of the people at the home may be suffering from varying degrees of abuse. This includes lack of consent to treatments, restricted and poor quality diets, lack of choice, restricted access to healthcare professionals and institutional practices. Allegations of physical abuse are currently under police investigation. All of this information has been referred under multi agency safeguarding procedures and are being handled by Wakefield Metropolitan Council. Training records at the home indicated that none of the staff other than the manager had received any external training in adult protection and whistleblowing. Records showed that some but not all staff had recieved training from the manager in this area Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: using a training package. However the manager confirmed that she had not completed the train the trainers course and was therefore not eligible to deliver this training. Care Homes for Adults (18-65 years) Page 22 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all parts of the home are homely and safe for all of the people who live there. Evidence: The environment is generally clean and well maintained. There are two communal lounges and a large dining room which the majority of people who live at the home use during the day and in the evening. An additional room referred to as a lounge by care staff is situated toward the back of the house. This is a small room with fixed vinyl covered seating along one wall, a small table and two dining chairs. There is also a fridge and a television on the wall. This room does not offer any comfort to people but carers said that all but two of the men who live at the home have to use this room for eating and for relaxing. No reason was given for this. Some radiators in the home are unguarded. When inspectors asked for the heating to be turned on in the home, these radiators became hot enough to cause skin damage. It has been reported which has been reported that one person who lives at the home may have sustained burns from a hot radiator. Bedrooms were nicely furnished although the presence of bidets without any privacy Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: screening is unusual and detracts from the otherwise pleasant appearance. Care Homes for Adults (18-65 years) Page 24 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not appropriately supported by all staff at the home. Evidence: Concerns received about the home prior to the inspection included allegations that some staff do not respect and act in accordance with the rights and choices of people living at the home. Information gained during the visit confirmed that this the case. The majority of staff training is delivered in house by the manager primarily using training videos and supporting training packs in topics including medications, infection control, health and safety, managing challenging behaviour, pressure ulcer prevention, effective communication and abuse. Staff competency is then assessed through the use of written tests and certificates are then signed and issued by the manager. Inspectors were concerned, particularly in relation to abuse and adult protection training that the manager was the only person to have attended the training provided by the local authority but had not undertaken the train the trainers course and is therefore not eligible to take the lead in such training. Several staff files did not contain any reference to them having undertaken any Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: training in adult protection and abuse. Detailed induction training records signed by the manager were seen although none had been signed by the inductee to say they had received and understood the training. Staff files showed that effective recruitment procedures are in place and that all necessary checks and clearences are taken prior to a person starting work at the home. It was identified that this home does not provide waking night staff and that carers work from five pm until nine pm and then one sleeps on the lounge floor with sixteen service users in their care and another in the bungalow where three service users sleep. People with physical and mental dependancies and significant health and care needs often require attention during the night. However care records showed that some people require input from two staff to safely meet their needs. Care Homes for Adults (18-65 years) Page 26 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health safety and welfare are not always promoted and protected. Evidence: The registered manager is also registered as the responsible individual for the home and is a director of Woodlands Residential Homes Ltd. She has managed the home for many years but other directors of the company appear to have a large say in the general running of the home and in the delivery of care to the people who live at the home. The manager is a registered social worker and has undertaken appropriate training relevant to her job. There was no evidence of staff or the people who live at the home being included in making decisions about the running of the home. Staff meetings are held but minutes of these suggest that they are mainly for discussing care and being given instruction from management. Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: Inspectors did not see any public results of quality monitoring taking place at the home but did not ask to see any records which may be kept privately. Concerns relating to the health, safety and welfare of the people living at the home are documented throughout this report and relate in particular to use of alternative remedies, some aspects of healthcare, nutrition and food storage and people being restricted in their right to make decisions about their care and their lifestyles. Care Homes for Adults (18-65 years) Page 28 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 People living at the home must be supported and enabled to make decisions about their lives, their health and welfare and their lifestyles. To make sure that people have choice and self determination. 17/04/2009 2 16 12 People must be able to make decisions about their daily routines within the home and have unrestricted access to all communal areas of the home. So that peoples right to an independent lifestyle is not restricted. 17/04/2009 3 17 16 People must receive nutritious diets suited to their personal tastes at times they choose. 17/04/2009 Care Homes for Adults (18-65 years) Page 30 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action So that people can enjoy a nutritious diet suited to their personal tastes. 4 18 12 People must receive the care 17/04/2009 they need in the manner they choose which protects their individuality and dignity. So that peoples health and wellbeing is met with dignity and individuality. 5 19 13 People must have access to healthcare professionals whenever needed. To keep people safe and to protect their health and wellbeing 6 20 13 Procedures must be put in place to ensure that each persons needs and choices concerning medication (including complementary remedies and dietary supplements) are ascertained and taken into account through formal assessment and regular review by a healthcare professional. To make sure people are only given products they need to improve or maintain their health & well-being. 17/04/2009 17/04/2009 Care Homes for Adults (18-65 years) Page 31 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 7 20 13 Arrangements must be made to ensure that all medication is stored securely at the correct temperature & conditions recommended by the manufacturer. This makes sure staff know that medicines are fit to use when needed. 17/04/2009 8 20 13 Arrangements must be made to ensure that accurate records are kept of all medicines received, administered and leaving the home or disposed of. to confirm that medication is being given as prescribed and facilitates accurate checking of stock levels. 17/04/2009 9 23 13 Arrangements must made to 17/04/2009 make sure that people living at the home are protected from abuse. To protect people 10 24 12 People living at the home must be allowed access to and to decide which communal areas they would like to use. 17/04/2009 Care Homes for Adults (18-65 years) Page 32 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action So that people are not restricted in their access to all communal parts of the home 11 32 12 All staff must respect the wishes and feelings of people living at the home. To make sure that staff respect the people in their care. 12 33 18 The registered person must 17/04/2009 make sure that at all times there are suitably trained staff avaiable in sufficient numbers to meet the needs of people living at the home. To make sure that people get the care they need. 13 35 18 The registered person must make sure that all staff receive training appropriate to their work. This must include safeguarding and abuse training. To protect people living at the home. 14 37 9 The registered manager 17/04/2009 must have the integrity to make sure that people living at the home are protected. 17/04/2009 17/04/2009 Care Homes for Adults (18-65 years) Page 33 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To make sure people are safe. 15 38 24 The registered person must make sure that the views of people living and working at the home are considered in the development of the service. To ensure an inclusive atmosphere. 16 42 12 The registered person must make arrangements to ensure the health and welfare of the people who live there. To keep people safe. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 17/04/2009 17/04/2009 1 2 3 5 6 6 Contracts should include clear information of routine extra charges and a breakdown of these charges. Short term or emergency care plans should be in place to give staff immediate direction on how to give care. Wherever possible, people should be involved in the development of their care plans to make sure that they have a say in their care and treatment. Care plans should include evidence that the person has been enabled and supported to make decisions about their lives. Handwritten entries on MAR charts should should be accurately recorded and detailed. This makes sure that the Page 34 of 36 4 7 5 20 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations correct information is recorded so that all staff understand and follow the changes correctly. 6 20 Professional guidance documents on handling medicines in social care should be available for staff to use in support of the existing medication policy & procedures. Complaints should be recorded in a bound book so that pages cannot be removed. 7 22 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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