CARE HOMES FOR OLDER PEOPLE
Woodlands Care Home Great North Road Wideopen Newcastle Upon Tyne NE13 6PL Lead Inspector
Janine Smith Unannounced 18 May 2005 09:30 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 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 Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Woodlands Care Home Address Great North Road Wideopen Newcastle Upon Tyne NE13 6PL 0191 217 0090 0191 217 0090 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) North East Care Homes Ltd Application received CRH 40 Category(ies) of DE(E) Dementia - over 65 (20) registration, with number MD(E) Mental Disorder - over 65 (1) of places OP Old age (19) Woodlands Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: A condition of registration is in place which remains appropriate. Date of last inspection 24/11/04 Brief Description of the Service: Woodlands was purpose built to provide personal care (but not nursing care) for up to forty elderly people of both sexes. Service users living in the home include people who require care due to old age and physical frailty and people with memory loss including dementia type illnesses. The home is located in a residential area of Wideopen, which has shops and pubs in the locality. There is a bus route passing the home. The building consists of two storeys, which provide level access throughout the building. There is a passenger lift to the first floor. There are 32 single bedrooms and four double rooms. Eight of the single bedrooms are equipped with en-suite facilities. Woodlands Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 9 ¾ hours and was an unannounced visit. A partial tour of the premises took place and a sample of care records were inspected as well as other records. Fourteen of the service users, the manager and four of the staff were spoken to. Since the last inspection of Woodlands, the ownership of the home has changed. Since mid February the home has been run by North East Care Homes Ltd., and a new manager, Mrs Gallon, was appointed at the same time. What the service does well:
The new Manager is keen to develop a high quality service for the residents in the home. She has drawn up a clear plan of action to develop the home and has agreed this with the owner and she is providing good leadership for the staff team. She has involved the staff team in reviewing the ways things are done in the home and is ensuring that the staff receive 1-1 support and training for their roles as necessary. The home has a core group of staff, who have worked at the home a long time. The staff team are caring and work hard. Residents spoken to felt that the staff treated them with kindness and were helpful to them. One resident who has lived at the home for just over three months, said that they would recommend Woodlands to anyone. Meals are varied and nutritious and fresh ingredients are used. Residents are offered choices at each mealtime. Residents are valued and encouraged to become involved in the running of the home. One has taken on responsibility for the Social Activities budget and was also helping out with plans for a D-Day celebration day. Woodlands Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
Assessment and care planning needs to be more thorough to ensure that the staff are able to know what to do for each resident. The Manager and the staff team were already working together to identify how they could make improvements. Some residents may need more support in their personal care. One gentleman was unshaven and one lady had dirty finger nails. Routine checks should be carried out to make sure that residents see dentists at appropriate intervals. The medication is handled appropriately but care needs to be taken to ensure that stock records are not updated until returned medication has actually left the home. There was evidence that the home take complaints seriously and try to put things right. However, their record of the action taken was not as detailed as it could be to show what had been done. There are 5 care staff on duty through the day and evening up until 8 p.m. when the night shift take over. Two residents felt that staff were very busy in the early mornings and evenings and that this meant they had to wait for help in getting up and going to bed. One had changed her bed-time routine because of this. A review of staffing levels should therefore be carried out to ensure that there are enough care staff on duty at busy times of the early morning and later evening.
Woodlands Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 Page 7 Fire drills and equipment checks need to be carried out more frequently to ensure the safety of all who live and work in the home. 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 Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Woodlands Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 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 standard(s) 3, 4 and 5. The process followed in the home ensures that potential residents are provided with details of the services the home provides, which helps them to make an informed decision about admission to the home. EVIDENCE: Inspection of the records for two recent admissions showed that a full assessment had been obtained prior to their admission, however, there was not a care plan in place for one. These two residents confirmed that they had made visits to the home to decide whether they would like it. One also remembered receiving written information, which told her about the Home and the services/facilities provided. Both residents said that they were happy living in the home, and one added that she ‘would recommend Woodlands to anyone’. One also confirmed that all of her health care needs were being met. One of the staff members on duty was spoken to and she was fully informed about the care needs of these two residents. Woodlands Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 Page 10 During the inspection a gentleman came to the home to have lunch and spend some time there prior to making a decision as to whether he would like to have a trial stay. Woodlands Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 and 10. Improvements are needed in the arrangements to ensure that all of the health and welfare needs of residents are identified and met. Shortfalls have a potential to place residents at risk. The systems for the storage and administration of medication good but some improvement in needed in the stock control system to ensure that all medication can be accounted for correctly. EVIDENCE: Three care records were looked at. There was no care plan in place for one person. The other two were generally reasonable and being updated at appropriate intervals but important information about both residents was not included within their care plans. Two members of staff were not fully aware of this important information but were aware of their general care needs. Without detailed care plans in place, residents are at risk of not having their health and welfare needs met as reliance would need to be placed on good verbal communication. There was a lack of evidence to demonstrate that residents were consulted about their plan of care.
Woodlands Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 Page 12 There was a lack of evidence to show that one resident had been offered access to a dentist for over fourteen months. The new Manager was fully aware of shortcomings in the care planning system and is beginning to address this. A new care plan model has been drawn up in consultation with the staff team and training sessions have started to ensure that they have the necessary skills to undertake care planning, risk assessment and review. This was confirmed by a member of the care staff team. It was noted that attention had been paid to residents’ personal care and dignity, other than it was observed that one resident was unshaven and another had dirty finger nails. The records indicated that one of these residents was not offered shaves at regular enough intervals. A random sample of medication records and the system for storage and handling medication was looked at and found to be appropriate, other than:The actual amount of medication given was not recorded, when the prescribed amount was variable, e.g. when one or two tablets can be taken. This was also highlighted at the last inspection. The amount of a controlled medication in stock was incorrectly recorded, as the record indicated the medication had been returned to the pharmacist, when in fact it remained in the home. This was also highlighted at the last inspection. A thermometer was not available to enable the temperature of the storage area to be monitored. Woodlands Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 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 standard(s) 12, 13, 14 and 15. Social activities and meals are being well managed, providing daily variation and interest for people living in the home. The systems for consultation with residents are good and there was a variety of evidence that indicates that their views are both sought and acted upon. EVIDENCE: An Activities Co-ordinator has recently been appointed who has begun to organise regular social activities for the residents of the home including skittles, bingo, dominoes, armchair exercise, and reminiscence. A budget has been set aside for activities and a resident has been given responsibility for the accounts. This is good practice. The staff were seen in 1-1 social activities with some of the residents during the inspection. A party to celebrate D-Day was being arranged and a resident said they were looking forward to this and was helping with the arrangements. There had also been an outing recently to a local garden centre and a resident said she had enjoyed this very much. Bedding plants had been planted up in containers ready to put out in the garden.
Woodlands Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 Page 14 The Manager said she has also made arrangements with the Discovery Museum in Newcastle to participate in a Reminiscence Project and some of the residents will be visiting the Museum shortly. Church services are held in the home and arrangements have been made for ministers to visit individual residents in the home. The Manager is providing support to one resident to enable them to go out to church each week. This is good practice. A resident confirmed that she could receive visitors at any time. The new Manager has held a meeting for residents and their relatives to obtain their views and opinions about the services provided. A resident confirmed that suggestions she had made had been taken up. For example, some residents are now provided with tureens of vegetables on their table and pots of tea, so that they can serve themselves at mealtimes. Residents are provided with substantial choices at all mealtimes and fresh ingredients are used in the preparation of meals. For lunch on the day of inspection, residents could choose between roast chicken, stuffing, roast potatoes or lamb with a minted sauce, mashed potatoes and vegetables. This was followed by peach pudding with custard or ice cream. The roast lamb and pudding were sampled and were tasty and attractively presented. At tea time residents could have soup, sandwiches or a mixed grill. Residents said that they liked the food and confirmed that there were always choices available including at breakfast and supper times and ample quantities were provided. Drinks are provided mid morning and afternoon. One resident said that the ‘mashing’ of the tea could be better. Staff were observed to provide discrete assistance at mealtimes to those who needed this and there was a pleasant atmosphere in the dining room. One resident was observed to have difficulty eating beans provided for tea and it was suggested different cutlery be provided where this was more appropriate. Two residents separately stated that they felt there should be more care staff available in the mornings and in the evenings to provide more timely assistance to residents who need help getting up and going to bed. One resident was getting ready for bed earlier than they would have preferred as care staffing levels reduce to 3 after 8 p.m. This was discussed with the Manager and it was agreed a review of staffing levels should take place. The home are to be commended for the positive steps being taken to consult and involve residents in the way the home is run and acting upon the suggestions made.
Woodlands Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 Page 15 Woodlands Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 Page 16 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 standard(s) 16 and 18. There is a complaints procedure which works well. Staff have been given training in adult protection which helps to protect residents from abuse. EVIDENCE: The home has a complaints procedure and there was evidence that any complaints are listened to and investigated. A written record is kept but this could be more detailed to reflect the action taken and the outcome. A resident said that they would readily tell the Manager if they had any concerns, as did a member of the staff team. A procedure for responding to allegations of abuse has been drawn up previously. Staff have received training in adult protection issues. Woodlands Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 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 standard(s) 19, 20, 21, 25 and 26. The standard of the environment in this home is being improved, which will provide residents with a more attractive and homely place to live. EVIDENCE: A tour of the premises was undertaken and a small number of bedrooms viewed. Since the last inspection a programme of redecoration and refurbishment has begun. During the inspection corridors were being redecorated and new carpets are to be laid in these areas shortly. Lighting has been improved in the office and treatment room and new teapots and crockery obtained. A gazebo has been put in a sheltered garden area to provide an outdoor sitting area, which residents will be able to use safely when warmer weather arrives. A gardener and a handyman have been employed to assist in the maintenance of the premises.
Woodlands Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 Page 18 Two of the bedrooms viewed had smells of urine and control of odour needs to be improved. However, the bedrooms seen were generally comfortable and pleasant. Residents can bring in items of their own furniture, providing space allows. The Manager is planning to create another laundry room, which will provide more space and enable the handling of soiled and clean laundry to be carried out in different rooms. Measures are in place for the control of infection and staff confirmed that they were provided with protective clothing. Protective covers have been fitted to all radiators throughout the home to safeguard service users. Thermostatic devices are said to be in place on baths and showers and a sample testing of hot water to one bath was appropriate and safe. Window opening restrictors were in place to safeguard residents. Consideration should be given to improving the level of lighting in bathrooms, which have no natural light, as the lighting in use has low luminescence. Woodlands Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27. EVIDENCE: Discussion with the Manager and with members of the staff team provided evidence that the numbers of care staff on duty, excluding the Manager, are as follows:8 am to 8 pm 8 pm to 8 am 5 care staff 3 waking night care staff This is enough to meet the needs of the residents through the day and the early part of the evening. One member of staff said that they had more time to spend with residents through the day, particularly doing social activities and that this had been beneficial to residents and rewarding for the staff team. However, two residents spoken said that the staff had a lot to do and were very busy in the early mornings and in the evenings when they needed help to get up or get ready for bed. One resident had changed their preferred bedtime routine as a result. One member of staff said that these times of day could be hectic and very busy. This was discussed with the Manager and it was agreed that the staffing levels should be reviewed. The night shift starts early in the evening at 8 p.m. and it may well be necessary to increase the number of staff on duty between 8 p.m. to 10 p.m. to 4, given the needs of residents during this period.
Woodlands Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 Page 20 The Manager has employed a gardener and a handyman to assist in the upkeep of the home. Several residents commented that the staff at the home treated them with kindness and helped them. The staff were observed to work hard and be attentive and respectful to residents throughout the inspection. Woodlands Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 32 The manager has a clear development plan and vision for the home, which she has effectively communicated to the staff team. Improvements in the fire safety checks need to be made for the wellbeing of all who live and work in the home. EVIDENCE: Mrs Gallon had taken up post as the Manager in mid-February this year and has made application for registration. She has drawn up a development plan for the home with clear objectives and timescales for improving all aspects of the running of the home. Mrs Gallon was clear about the steps she wishes to take and the importance of consulting and involving her staff team and the residents in this process. Members of staff spoken to during the inspection gave positive comments about the way in which the home was being managed and one said that
Woodlands Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 Page 22 morale was improving. They confirmed that the new manager had implemented arrangements for 1-1 supervision, to ensure that each member of staff receives and can give feedback on their work and to identify any training or other issues that need attention. Records indicated that fire safety checks, including weekly testing of the fire alarm and monthly checks on the emergency lights, are not being carried out as required. Fire drills also need to be carried out more frequently. Woodlands Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 x x x 2 2 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 3 x x x 3 x 2 Woodlands Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 Page 24 Yes Are there any outstanding requirements from the last inspection? 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 7 Regulation 15 Requirement Service user plans must be in sufficient detail to provide clear guidance to staff on the actions to be taken to meet their health and welfare needs. Service users must be involved in drawing up their plan of care and they, or their representative, should be asked to sign their agreement to the plan. Service users must be provided with access to dentists and other health care rights at appropriate intervals. Where a variable dose of medication is prescribed, the actual amount administered should be recorded. The quantity of controlled drugs held in the home must be correctly recorded at all times. (Previous timescale of 31/12/04 not met). Provide thermometer to enable the temperature to be monitored where medication is kept. Ensure daily shaves offered to residents who need assistance with this. Provide assistance with nail care to residents who need this. Ensure all details relating to the Timescale for action 31/8/05 2. 8 12(1) 30/6/05 3. 9 13 30/6/05 4. 10 12 30/6/05 5. 16 17(2) 30/6/05
Page 25 Woodlands Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 6. 7. 8. 25 26 27 23(2)(p) 16(2)(k) 18(1)(a) 9. 38 23(4)(c) investigation and outcome of complaints are recorded. Improve the level of luminscence in bathrooms with no natural lighting. Improve odour control in bedrooms as necessary. Review care staffing levels in the early morning and late evening to ensure sufficient staff on duty to meet the care needs of residents who need help getting up and going to bed. The fire alarm must be tested weekly. The emergency lights must be checked monthly for faults. Fire drills must be carried out at the frequency advised by the Fire Brigade. The details of such fire safety procedures must be entered in the Fire Log Book. 31/8/05 31/8/05 30/6/05 30/6/05 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 15 Good Practice Recommendations Provided appropriate cutlery and plate guards where appropriate. Woodlands Care Home B53-B03 S62615 Woodlands Care Home V222657 180505 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection Northumbria House Manor Walks, Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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