CARE HOMES FOR OLDER PEOPLE
Woodlands Woodlands Grimston Road Kings Lynn Norfolk PE30 3HH Lead Inspector
Mrs Jacky Vugler Unannounced Inspection 24th January 2006 09:50 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 DS0000034240.V279603.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 DS0000034240.V279603.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Woodlands Address Woodlands Grimston Road Kings Lynn Norfolk PE30 3HH 01553 672076 01553 670744 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) Norfolk County Council-Community Care Carole Ann Heley Care Home 40 Category(ies) of Dementia (13), Old age, not falling within any registration, with number other category (27) of places Woodlands DS0000034240.V279603.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The home can accommodate up to 27 Service Users who are Older People not falling in any other category. The home can accommodate up to 13 Service Users who are elderly and have dementia. The home is to accommodate up to 40 Older People. Date of last inspection 7th July 2005 Brief Description of the Service: The home is a two-storey care home that is owned and managed by Norfolk County Council and is situated in South Wootton on the outskirts of Kings Lynn. It is set beside Crossroads, a large day centre for older people, which is also owned by Norfolk County Council. The home is within easy reach of Kings Lynn and is on a bus route that serves the South Wootton area from the town centre. Nearby are local shops and other facilities, for example, a post office and public house. The home was first built in 1963 as a residential home for older people. In 1998 an extensive refurbishment programme was completed. As part of this programme a 13-bedded unit for the elderly mentally frail was developed within the home, known as the Heather Unit. There were lounges and reception rooms for service users in the main building offering facility for quiet space or company and activity. There was a large dining room, which served the twenty-seven service users in the main unit. Heather unit had its own dining room and lounge. The home offered both permanent and shortterm care as well as two places for day-care. The home has thirty-nine single bedrooms and one double room on the ground and first floors, although these are all used as single rooms. There is a passenger lift. The home has a ramp to the front entrance, which provides good access for wheelchair users. There are large grounds to the front and the rear and there is a secure garden area for service users from Heather Unit Woodlands DS0000034240.V279603.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection taking place over 7 hours on a weekday. Mrs Carole Heley, the Manager, was present most of the inspection and Ms Diane Benefer, Care Co-ordinator, was present for part of the day. There were thirty-eight residents accommodated on the day, twenty-six in the main unit and twelve in Heather unit. A tour of the building was undertaken and records were seen. It is understood that Norfolk County Council have undertaken a review of the windows and therefore this condition of registration has been removed. However, the CSCI need a copy of that review and a timetable for their replacement. Nine residents, four visitors and three members of staff were spoken to privately. One resident in the main unit was not happy with the staff or the care provided, but everybody else spoken to was highly satisfied, including the staff who were a strong team. What the service does well: What has improved since the last inspection?
Three previous conditions of registration have been removed. Firstly, the Manager is only responsible for the management of personal care offered to residents accommodated at Woodlands. Secondly, there is always a member of staff working who has training in the care of people with dementia. Thirdly, Norfolk County Council have reviewed the metal windows, although they must
Woodlands DS0000034240.V279603.R01.S.doc Version 5.1 Page 6 be risk assessed and a plan for the replacement of those causing most discomfort must be submitted to the CSCI. Risk assessments have been written for the brakes on beds, and the brakes on old beds have been changed. 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 DS0000034240.V279603.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 DS0000034240.V279603.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): EVIDENCE: These standards were not assessed on this occasion. Woodlands DS0000034240.V279603.R01.S.doc Version 5.1 Page 9 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): 8, 9 & 10 The residents’ health care needs are fully met. The residents are protected by the home’s policies and procedures with regard to medication; however, a requirement and recommendation have been made regarding the records. Residents feel they are treated with respect and their privacy is upheld. EVIDENCE: There was evidence in the residents care plans that other health care professionals were involved where necessary. For example, the GP, continence advisor, optician, chiropodist, audiologist; diabetic and warfarin clinics, and the District Nurses who also gave advice on tissue viability and provided pressure relieving equipment when necessary The home used the NOMAD monitored dosage system. Medications were appropriately stored in both units in medicine trolleys chained to the wall. The medications records were appropriately signed, dated and codes were used when not given. The medications for a resident who returned from hospital the previous day were appropriately recorded and correct.
Woodlands DS0000034240.V279603.R01.S.doc Version 5.1 Page 10 However, the numbers of some of the medications stored in their boxes did not match the records and it is presumed that this is because a ‘brought forward’ total was not added. A requirement has therefore been made. In Heather unit, several boxes of eye drops, not in use, were out of date and were discarded immediately. The eye drops in the main unit were dated when opened, but this was not so in Heather unit, therefore a recommendation to this effect has been made as they have a ‘shelf life’ once opened. A controlled drug had been received into the home and locked in the appropriate cupboard, but had not been recorded as received. During the inspection Ms Benefer spoke of the problems they were having with a tablet that needed to be broken in half and it was suggested she spoke to the pharmacist. Before the end of the inspection she had discussed this with the pharmacist and a suitable solution had been reached. Ms Benefer is commended for her prompt action. The Manager said that a Care Co-ordinator usually completes a monthly audit of the medications, but she has been on sick leave for some time and this has lapsed. All residents spoken to felt they were treated with respect and their dignity and privacy protected at all times. Woodlands DS0000034240.V279603.R01.S.doc Version 5.1 Page 11 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): EVIDENCE: These standards were not assessed. Woodlands DS0000034240.V279603.R01.S.doc Version 5.1 Page 12 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): EVIDENCE: These standards were not assessed. Woodlands DS0000034240.V279603.R01.S.doc Version 5.1 Page 13 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): 20, 24 & 26 There are a number of sitting areas in the main unit, which provide comfort and variation for residents, but the sitting area in Heather unit is cramped and ad extension to this area would provide choice and more comfort for residents and their visitors. EVIDENCE: In the main unit, as well as the lounges, there are several smaller sitting areas and during the day, residents and their visitors occupied many of these. In the reception area there is a large aquarium, which the residents said they enjoyed. The lounge in Heather unit is however quite cramped for thirteen residents, three staff and any visitors. The staff said that residents and their visitors liked to stay in the lounge with everybody else. They also said that two of the residents needed the use of a hoist and others use a walking frame, which ideally would be kept with the resident to promote their independence. However, this is not always possible and the requirement to extend this communal space has been repeated.
Woodlands DS0000034240.V279603.R01.S.doc Version 5.1 Page 14 Residents and staff spoken to say that some of these windows are very difficult to open and close, thus taking away some independence for the residents. Some windows are also draughty causing further discomfort. The home is pleasant and hygienic. Woodlands DS0000034240.V279603.R01.S.doc Version 5.1 Page 15 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): EVIDENCE: These standards have not been assessed on this occasion. Woodlands DS0000034240.V279603.R01.S.doc Version 5.1 Page 16 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 & 35 This is a well run and managed home. The residents’ financial interests are safeguarded. EVIDENCE: The Manager no longer has any responsibility for the neighbouring day service and is now able to devote her time to Woodlands and this condition of registration has now been removed. She has however, highlighted a concern regarding a reduction of her administrator’s hours. She feels that the new hours will not be enough for a home of this size, and as more management and care co-ordinator time will be taken up with this duty, it may have an impact on management of care. In view of these concerns, a recommendation has been made. The residents’ financial records were in good order. Receipts were kept and there was a record of income and expenditure with two signatures. Fourteen
Woodlands DS0000034240.V279603.R01.S.doc Version 5.1 Page 17 of these monies were randomly checked and all found to be correct. These records are audited monthly. Woodlands DS0000034240.V279603.R01.S.doc Version 5.1 Page 18 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x x 2 x x x 2 x 3 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x 3 x x x Woodlands DS0000034240.V279603.R01.S.doc Version 5.1 Page 19 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 OP20 Regulation 23(2)(h) Requirement Timescale for action 31/03/06 2 OP9 13 (2) 3 OP24 23 (2) The Registered Person should ensure that the communal space provided for service users in the Heather Unit be extended to give choice to service users appropriate to their circumstances. The Registered Person must 20/02/06 make arrangements for the recording of medicines received into the care home. Controlled drugs must be entered in the records as soon as they are received by the home. The Registered Person must risk 31/03/06 assess and submit to the CSCI a plan for replacing the windows causing the most discomfort. 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 DS0000034240.V279603.R01.S.doc Version 5.1 Page 20 1 2 OP9 OP31 It is recommended that it is recorded when eye drops are opened. It is recommended that consideration be given to increasing the planned administrator hours. Woodlands DS0000034240.V279603.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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