Inspection on 23/05/06 for Woodlands

This inspection was carried out on 23rd May 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Woodlands 09/01/08

Woodlands 06/12/05

Woodlands 16/06/05

Woodlands 14/10/04

Woodlands 26/04/04

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CARE HOMES FOR OLDER PEOPLE Woodlands Toll Bar Distington Workington Cumbria CA14 4PJ Lead Inspector Liz Kelley Unannounced Inspection 23rd 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 DS0000036573.V291197.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 DS0000036573.V291197.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Woodlands Address Toll Bar Distington Workington Cumbria CA14 4PJ 01946 830065 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) www.cumbriacare.org.uk Cumbria Care Lynne Maria Newbury Care Home 40 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (38), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (1) Woodlands DS0000036573.V291197.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 40 service users to include: up to 38 service users in the category of DE(E) (Dementia over 65 years of age) 1 service user in the category of DE (dementia under 65 years of age) 1 named service user in the category MD(E) (Mental disorder, excluding learning disability or dementia - over 65 years of age). An application to vary the registration must be made to the Commission for Social Care Inspection when care is no longer offered to this person in category MD(E). When single rooms of less than 12 sqm usable floor space becomes available they must not be used to accommodate wheelchair users and where existing wheelchair users are in bedrooms of less than 12 sqm they must be given the opportunity to move to a larger room when one becomes available. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 6th December 2005 2. 3. Date of last inspection Brief Description of the Service: Woodlands is a residential care home registered with the Commission for Social Care Inspection to provide personal care and accommodation for up to forty older people with dementia. Short-term respite care is also offered. The home is owned and run by Cumbria Care which is part of Cumbria County Council. Mrs Lynne Newbury is employed as the registered manager the home. Woodlands is located on the outskirts of Distington and consists of a purpose built single storey building set in its own grounds. Accommodation is provided in forty single bedrooms all with wash hand basins. The home is arranged into three living units, each with its own kitchen, sitting and dining areas. Outdoor space is provided in the form of a pleasant secure courtyard with flowerbeds and seating for residents and a garden area which is accessible to the people living in the home. All referrals are arranged through Social Services. The current scale for charging is £422. A Handbook is available for prospective residents, which Woodlands DS0000036573.V291197.R01.S.doc Version 5.1 Page 5 includes a summary of the latest Commission for Social Care Inspection report. Woodlands DS0000036573.V291197.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over a full day. In the month previous to the visit feedback cards had been sent out to service users, relatives and professionals to gain their views on their experience of the Home. The manager and staff were interviewed as part of the inspection. Time was spent with residents in each of the units. And a tour of the building was undertaken. What the service does well: What has improved since the last inspection? What they could do better: The manager has a good understanding of the areas in which the home could further improve. Planning was in place and set out how these improvements are to be resourced and managed. These areas included refurbishment of further bedrooms and communal areas, and accessing the latest training and good practice in the care of people with dementia. The home should provide physical intervention training and ensure that this is in accordance with the latest DH guidance for those rare occasions when they need to help a person who is agitated. Woodlands DS0000036573.V291197.R01.S.doc Version 5.1 Page 7 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 DS0000036573.V291197.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodlands DS0000036573.V291197.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2,3 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home has robust and well-established procedures in place to introduce new residents and this results in a high number of successful placements. The Home is careful to only take people whose needs they can meet, and equally the individual is given the opportunity to vet the home and make an informed choice of where to live. EVIDENCE: Admissions are not made to the home until full needs assessment has been undertaken. Files contain relevant paperwork, including social work assessments and reports from health care professionals prior to a person choosing to stay at the home. The manager also carries out an assessment which includes visits to see the person in their own home or while in hospital. One relative described the introduction to the home which included a series of visits, and another had used the respite facility prior to making a decision. Each resident is provided with a statement of terms and conditions prior to moving to the home. This sets out in detail what is included in the fee, the role Woodlands DS0000036573.V291197.R01.S.doc Version 5.1 Page 10 and responsibility of the provider, and the rights and obligations of the resident. These measures ensure that admissions to the home only take place if the service is confident staff have the skills and ability and qualifications to meet the assessed needs of the prospective resident. This results in successful placements. This procedure is in line with the Homes Statement of Purpose. The home is currently producing a new Statement of Purpose and Service Users Guide. A copy of these new documents should be submitted to the Commission for Social Care Inspection. Woodlands DS0000036573.V291197.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10, and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Woodlands provides a high standard of care which meets the needs of the residents living there. Health care needs, including medication, are carefully monitored and residents and relatives are confident that the home can meet their needs. Positive and supportive relationships are formed between staff and residents leading to a caring, friendly atmosphere. Care plans are of a good standard and ensure that each person receives the care they need to be healthy and safe whilst promoting privacy and dignity. EVIDENCE: The care plan is used as a working tool and is understood by all staff. It is written in clear language and can be used in an emergency. Each care plan includes a comprehensive risk assessment. Management of risk takes into account the needs of residents and demonstrates a balanced view in maintaining safety while also offering choice. The rights of others living in the home are also considered when drawing up an assessment of risk. Appointing key workers helps to build-up supportive relationships with residents and encourages work on a one-to-one basis. Woodlands DS0000036573.V291197.R01.S.doc Version 5.1 Page 12 Staff were observed delivering care in a sensitive and respectful manner: addressing service-users by their preferred name; knocking on doors and enabling service-users to maintain as much independence as possible. The home tries to gain as much information about a persons past as possible, and staff were seen to use this information to engage with individuals and initiate stimulating conversation. Conversations were observed on past occupations and interests and this led to conversations between staff and between residents. This was identified as a positive feature of the home. The manager has identified this style of working with people with dementia, known as a person centred approach, as one that the home is seeking to develop further. This has been incorporated into the homes Development Plan, and is to include visits to “beacon centres” and working with individuals to make up detailed life history story books and albums. A relative card commented, “ They have taken every care of my mother, she has been escorted to the dentist, she has a special electric bed and her medical needs are taken care of scrupulously.” The home works to an efficient Medication Policy supported by procedures and practice guidelines. Staff follow robust systems to make sure that medication records are fully completed, contain required entries and are signed by appropriate staff. Regular management checks are recorded to monitor compliance and the home has a system of a dispenser and a second person as a checker to reduce the chances of errors. A medication round was observed and staff reported that they had recently picked up an error from a pharmacists in good time for it to be rectified. The home makes every effort to support residents at the end of their life to remain in the home if this is their wish. They are aware of the support services and can access additional staffing when required to offer support to allow a person to die in the place of their choice. Staff have received training in palliative care and are also given support to help them through the process of caring for a person who is dying. Woodlands DS0000036573.V291197.R01.S.doc Version 5.1 Page 13 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, and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Dietary needs of residents are well catered for with a balanced and varied selection of good quality food and home cooked meals. Resident’s choice and control over their lives has a high profile in the home and staff are skilled at encouraging residents to make decisions. EVIDENCE: Food and mealtimes are treated as an occasion and something to look forward to. An experienced cook is responsible for providing nutritional meals that meet the cultural and dietary needs of residents. The cook has regular contact with residents to listen to their choices and suggestions for the menu. When interviewed, the cook had good knowledge of the needs she is catering for, and is skilled in providing meals that need to be specially prepared. Care staff are sensitive to the needs of residents, for example the need for encouragement and careful monitoring of amounts consumed. Tables are set attractively with table clothes and napkins and appropriate cutlery and aids to help individuals during their meal. Birthdays and celebrations are made special for individual residents. Meal times were observed to be relaxed and unhurried. Maintaining independence and enabling residents to make their own decisions, wherever possible, is an important objective for the home. Woodlands DS0000036573.V291197.R01.S.doc Version 5.1 Page 14 The routines of the home are planned around the residents needs and wishes. There are a number of organised group activities across a normal week, including dominos, arm chair exercises and sing-a-longs. The home has also had good success in working one-to-one with residents carrying out everyday activities which help to retain skills, such as helping with setting the table, dressing or dusting. Also individual staff are often involved in one-to-one or group discussions with residents and sufficient staffing levels are provided to allow time for this type of stimulation. Family and friends reported that they always feel welcome and know they can visit the home at any time. One relative cards sums up the views “I visit my wife regularly and feel she is very well cared for in every way. Each person is attended to with tender loving care. I receive similar kindness”. And another said “I can go anytime I wish, they never know when I am visiting and I always find him clean and well cared for.” Religious and spiritual needs are recorded and arrangements are made to allow each person to practice their religion. One resident feedback form stated “My spiritual needs are being seen to and any visitors from my church are warmly welcomed.” Woodlands DS0000036573.V291197.R01.S.doc Version 5.1 Page 15 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 using available evidence including a visit to this service. The home has a clear complaints procedure and residents and their families know action will be taken to resolve their concerns. Staff have a good knowledge and understanding of Adult Protection issues which safeguards residents from abuse. EVIDENCE: Woodlands has a clear complaints procedure which is given to new residents when they move in to the home. A copy of the complaints procure is displayed in the home and is given to residents’ families. The manager carries out a preadmission talk with relatives stressing the importance of having an open dialogue and speaking up to sort things out before they become larger issues. A relative said that she had been told that she must feel free to speak about even the smallest of issues and not to let them build-up. This has led to an open and friendly atmosphere in the home . Residents and relatives are confident they can raise any complaints and appropriate action will be taken to resolve their concerns. One relative card stated that “ Once or twice we have raised concerns only to find the staff have already noticed a problem and acted accordingly.” A recent issue about withdrawing medical attention for one resident by a medical professional had been treated with due seriousness by the manager and after meetings with all concerned and the family the issue was Woodlands DS0000036573.V291197.R01.S.doc Version 5.1 Page 16 satisfactorily resolved. The manager had acted to protect the rights of the resident. The policies and procedures regarding protection of residents are satisfactory and are regularly reviewed and updated in line with regulations and other external guidance. The home had the latest guidance on the local multidisciplinary procedures for reporting abuse. Staff have received Adult protection training and demonstrate an awareness of the content of the policy and know the immediate action to take, and who to refer to. Feedback from relatives and others associated with the home state that they are very satisfied with the service provision, feel very safe and well supported by the home which has the protection and safety of residents as a priority. Some care plans had instructions on how to handle people when they became agitated and aggressive, which included using low level physical restraint. The home should provide physical intervention training and ensure that this is in accordance with the latest DH guidance. Woodlands DS0000036573.V291197.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Woodlands provides a safe, clean and comfortable environment for residents to live in. EVIDENCE: Woodlands was purpose built as a care home for older people with dementia. The home is clean and well maintained and provides safe and comfortable accommodation for residents. The home is suitable to meet the needs of residents. Specialist equipment is provided including grab rails, a call bell system and assisted bathing and toilet facilities. The home is well laid out and accommodation is clearly signed so that residents can identify their own rooms. Recently nine bedrooms have been re-decorated. The manager has developed a maintenance programme for the home, which identifies areas for priority. The next improvement will be the hallways and replacement of curtains in this area. There are some bedrooms which are in need of decoration, and these are included in the plan of improvements. Woodlands DS0000036573.V291197.R01.S.doc Version 5.1 Page 18 The home usually has two domestics on duty, who have clear cleaning rotas, which include regular steam cleaning of carpets. This leads to a clean and hygienic home where odours are kept to a minimum. The bedrooms in the home are on the small side and below the National Minimum Standards, and none have en-suites. These shortfalls are clearly set out in the homes Statement of purpose and in each persons terms and conditions. Woodlands DS0000036573.V291197.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The recruitment practices of the home are good which ensures that service users are safeguarded and that staff have the qualities and aptitudes to work in social care. Woodlands has a competent and well-trained workforce with a good mix of skill, experience and age. This leads to good levels of confidence and satisfaction from residents, relatives and professionals with the care that is delivered. EVIDENCE: Staffing levels within the home are sufficient to meet the needs of residents. A typical shift consists of nine care staff, one supervisor and the manager, who works weekday office hours. The home has three waking night staff, and an on-call back up for emergency’s. The manager can access additional staffing hours through her operations manager, and this has proved particularly important when settling new residents or when caring for a person at the end of their life. The selection procedure includes obtaining two written references, a formal interview and an informal interview involving service users, wherever possible. All staff had enhanced CRB disclosure checks. Upon appointment staff are issued with a handbook, which includes job descriptions and terms and conditions. Appointments are subject to a six-month probationary period. Staff are also issued with the General Social Skills Council’s code of conduct Woodlands DS0000036573.V291197.R01.S.doc Version 5.1 Page 20 handbook. A sample of staff files were examined and these contained all the relevant documentation and were clearly sectioned and well-organised. These are all good practices and ensure that service users are supported by a carefully selected and vetted staff team. The service ensures that all staff within its organisation receives relevant training that is targeted and focused on improving outcomes for residents. The Home has more than 50 of staff qualified in NVQ level 2 in Care, and staff have recently completed a number of short courses on the Safe Handling of Medication and health related issues. The home accesses external providers to provide training as required to provide more specialist support in dementia care. For example nine staff have completed a specialist NVQ 2 in Dementia care, and senior staff attended a training courses aimed at promoting awareness of best practice in mental health issues. Woodlands DS0000036573.V291197.R01.S.doc Version 5.1 Page 21 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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Woodlands is well managed and residents’ interests, safety and welfare are protected. EVIDENCE: The manager has the required qualifications and experience and is competent to run the home. She works to continuously improve services and provide an increased quality of life for residents. There is a strong emphasis of being open and transparent in all areas of running of the home. The manager is supported well by a competent senior staff team, and the home generally has a low staff turnover rate. Care staff reported that they received good support from senior staff and had regular supervision to discuss their role and personal development. This all leads to a stable and consistent service for people living in the home, which in dementia care is particularly important. Woodlands DS0000036573.V291197.R01.S.doc Version 5.1 Page 22 The Home operates to Cumbria Cares Quality Assurance standards that includes physical aspects of running the Home as well as monitoring the delivery of service. The provider, Cumbria Care carries out regulation 26 monitoring visits and sends a copy of these into the Commission for Social Care Inspection. The home has effective systems in place to ensure the safety and up keep of the physical environment, such as cleaning rotas and maintenance records. Fire Records, annual gas and electrical checks, and servicing of hoists were all checked and these were all up-to-date. The administrative systems within the home were found to be up-to-date and in good order, the manager is supported by an administration assistant, ensuring the home is run in an efficient and effective manner. Woodlands DS0000036573.V291197.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 X X X 2 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Woodlands DS0000036573.V291197.R01.S.doc Version 5.1 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP18 OP31 Good Practice Recommendations The home should provide physical intervention training and ensure that this is in accordance with the latest DH guidance. The manager and senior team should ensure that they keep abreast of the latest training and guidance in Dementia care, and would benefit from visits to “beacon centres” Woodlands DS0000036573.V291197.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Woodlands DS0000036573.V291197.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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