Inspection on 30/05/06 for Woodlands Care Home

This inspection was carried out on 30th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Care Home 05/07/07

Woodlands Care Home 19/10/05

Woodlands Care Home 18/05/05

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Woodlands Care Home Woodlands Care Home Great North Road Wideopen Newcastle Upon Tyne NE13 6PL Lead Inspector Janine Smith Key Unannounced Inspection 30th May 2006 09:30 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 Care Home DS0000062615.V291220.R01.S.doc Version 5.2 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 Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodlands Care Home Address Woodlands Care Home Great North Road Wideopen Newcastle Upon Tyne NE13 6PL 0191 217 0090 0191 217 0090 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) North East Care Homes Ltd Mrs Linda Elizabeth Gallon Care Home 40 Category(ies) of Dementia - over 65 years of age (29), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (10) Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Once the resident in the MD(E) category leaves the home, the CSCI must be notified immediately. This place will then revert to category DE(E). 19th October 2005 Date of last inspection 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. Fees range from £356 to £375 weekly. The fees do not include charges for hairdressing, private chiropody, toiletries, transport and costs for outings. 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. Information about the service, including inspection reports, are readily available. Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took 21 hours and was carried out over 2 1/2 days, starting on the 30th May 2006. The home had not been given advance warning. There were 34 residents at the time of this visit. A tour of the premises was made and some of the bedrooms were seen. The systems for the storage, handling and administration of medication were looked at, as well as the system for handling residents’ money. A sample of records about residents and staff were also looked at. 8 of the people living in the home were spoken to. 4 relatives of residents living in the home also gave their views. The Manager and 5 of the staff were also spoken to. Before the inspection took place, a number of questionnaires for the use of residents and relatives, were sent to the home. The questionnaires provide an opportunity for residents and relatives to pass on their opinions about the home directly to the Commission. At the time of writing this report, 10 replies had been received from residents, who were offered assistance by staff. No replies had been received from relatives. Questionnaires were also sent to local doctors’ practices, who have contact with the home, and 2 replies were received. The results of these surveys have been included in this report where relevant. What the service does well: Residents’ care needs are regularly assessed, which helps staff to know what support residents need. After talking with residents, the manager, staff and some relatives, as well as looking at records, evidence was available to show that residents’ health is closely monitored. Two replies were received from local GP practices, which have patients living in the home. Both agreed that the home communicated clearly and worked in partnership with them. One was satisfied with the overall care provided by the home. The other said that the overall care could be improved. A Care Manager, who has visited the home a number of times, said that she had seen many improvements in the care provided by the home since the current Manager took up her post. Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 6 Two residents said that they were well looked after by the staff team. One said, “this home is wonderful” and also added that the staff work hard and were very good to him and that the Manager works very hard. Two relatives said they were very happy with the care being given to their relative and said that they had seen a major improvement since the current Manager took over the home. Staff are kind and caring and attentive to residents. They showed sensitivity and understanding towards those residents who have dementia type conditions. This home provides an excellent range of social activities both inside and outside the home. Activities are tailored to residents’ individual needs. There are stimulating activities for people who have dementia and for those who don’t. Links have also been forged with the local community and organisations. The Discovery Museum has visited several times and provided interesting social events for the residents. Residents have attended tea dances run by the Alzheimers Disease Society. An Operatic Society and a Brass Band have visited amongst others. Some residents have joined the Gala Bingo Club and regular outings there are arranged. Two relatives were very pleased that their relative was now able to enjoy going out to the church luncheon club and local coffee mornings. There are good choices of well-cooked food available, which provides nutrition and interest for the residents living in the home. One resident wrote on a comment card, ‘I like them because I always get what I ask for’. What has improved since the last inspection? As outlined above and in the body of this report, comments were received from relatives and a Care Manager who all said that they had seen improvements in the care provided to residents since the current Manager took up her post. Improvements in the quality of care planning have continued to be made. Fifty per cent of the care staff team have now achieved a National Vocational Qualification (NVQ) in care. A number of the staff team have completed or are doing training courses about caring for people with dementia. The Manager is carrying out regular audits and surveys so that she knows what people think about the quality of care provided in the home and where improvements need to be made. Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 7 What they could do better: Service users (or their representative) must be involved in drawing up and reviewing their plan of care. This helps to ensure that their views are obtained and that they are fully involved in planning how their care will be provided. They (or their representative) should be asked to sign their agreement to the plan. The previous timescale for complying with this requirement has not yet been met. Staff sign the care plans, to show that they have read them, although not all had done this. One carer did not seem to be aware of the past mental health history of a resident, which they need to know about, so they can monitor that person’s wellbeing more effectively. The Manager needs to ensure that all of the care staff read and fully understand the care plans and other relevant information, for example, past physical and mental health history. During the inspection, a resident was seen by their GP in the lounge area, which meant that other people could overhear and see what happened. Health consultations must take place in privacy. Residents are asked whether they would prefer a male or female carer to provide personal care. However, the home need to do more so that residents’ are assured that their choices in this matter can be respected at all times. Staff were seen to knock residents’ bedroom doors except on one occasion. Staff must knock bedroom doors and request permission to enter, unless there is good reason why this cannot be done. The privacy lock to a bathroom needs to be repaired and other locks checked for ease of use and repaired/replaced as necessary. A random sample of medication records and the system for storage and handling and administration of medication was looked at. Several issues were identified which give cause for concern that medication is not being dealt with as safely as it should. Medication is not being stored and handled as safely as it should and safe procedures are not being followed. This could lead to residents being harmed. Specific senior care staff have responsibility for the handling and administration of medication but not all of them have received accredited medication training, although training was provided in-house. Staff must be made aware of the procedure to follow if mistakes are made with medication, for example, giving the medication at the wrong time or missing a medication. Medication errors must be notified to the Commission. This was also highlighted as a necessary improvement at the last inspection. Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 8 References need to be checked more thoroughly before staff are employed. There were details of induction training on the staff records, although there insufficient information to show that the induction fully met with the Foundation standards set by TOPSS. 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 DS0000062615.V291220.R01.S.doc Version 5.2 Page 9 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 Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this home. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Detailed assessments are obtained and carried out before agreeing to admit people to the home, which ensures that their needs can be met. EVIDENCE: Nine of the ten residents completing a questionnaire said that they had received a contract. One said they did not. Eight said they had received enough information about the home and 1 said they ‘came to have a look round before moving in’. One resident spoken to, could not remember what sort of information they were given before they moved in, but said they were helped by a social worker and made a visit to the home and had a trial stay. Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 11 A concern was received from a friend of a resident before this inspection expressing concern that their friend may not have been appropriately placed in this home. This was looked into and there was evidence that a Local Authority Care Manager had assessed the resident’s needs and that this home could meet those needs. A plan of care, based on the assessment, had been put into place. Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. There are good arrangements in place to ensure that residents’ care needs are regularly assessed, which helps staff to know what support residents need. Improvements in care planning have continued to be made but residents (or their representatives) need to be more involved in this process, which will ensure that their views are taken into account. There are good arrangements in place to ensure that residents’ health care needs are monitored and met. Personal support is offered in such a way as to promote and protect residents’ dignity, but further steps are needed to ensure that their rights to privacy are always respected. Medication is not being stored and handled as safely as it should and safe procedures are not being followed. This could lead to residents being harmed. Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 13 EVIDENCE: Three care records were looked at. Care staff assess and review residents’ care needs at regular intervals and update and review their plan of care. Risk assessments are carried out to find out if there is a risk of residents having falls, getting pressure sores or infection. A risk assessment needed to be carried out in respect of a resident at risk due to smoking. Most care plans drawn up following this process were relevant and generally up to date. There was, however, a lack of evidence that residents, or their representatives, had been involved in drawing up their plan of care. Staff sign the care plans, to show that they have read them, although not all had done this. One carer did not seem to be aware of the past mental health history of a resident, which they need to know about, so they can monitor that person’s wellbeing more effectively. After talking with residents, the manager, staff and some relatives, as well as looking at records, it was confirmed that residents’ health is closely monitored. They see GPs and Consultants when they needed to and saw dentists, opticians and chiropodists at regular intervals. The outcome of these consultations was clearly recorded in the care records seen. Two replies were received from local GP practices, which have patients living in the home. Both agreed that the home communicated clearly and worked in partnership with them and that there was always a senior member of staff to confer with. One was satisfied with the overall care provided by the home and indicated that the staff had a clear understanding of the care needs of the residents. The other said that this was only the case sometimes and that the overall care could be improved. A Care Manager who has visited the home a number of times, was also spoken to, and said that she had seen many improvements in the care provided by the home since the current Manager took up her post. Some residents can present difficult behaviours due to their nature of their illnesses. During the inspection, carers were seen to intervene quietly and sensitively to distract residents, for instance, when one was shouting at another. There was evidence that any incidents are reviewed and that the staff seek professional help and advice about how to deal with this. Records are kept of any incidents and examples were seen of good recording, which showed what happened and what was done. This helps the staff and health professionals to review what happened and how best to deal with future incidents. The advice obtained could be more clearly shown in the plan of care however. Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 14 Two relatives of one resident were spoken to. They said they were very happy with the care being given to their relative and said that they had seen a major improvement since the current Manager took over the home. They said they were kept well informed about the welfare of their relative. They also commented that the staff were much more professional and that the number of staff had improved. Two other relatives also said they were very happy with the care their relative received and that they were kept well informed. Two residents said that they were well looked after by the staff team. One said, “this home is wonderful” and also added that the staff work hard and were very good to him and that the Manager works very hard. 8 of the residents completing a questionnaire said they ‘always’ received the care and support they needed, 1 said they ‘usually’ did, and 1 said they ‘sometimes’ did. One added, ‘the company is nice, the place is nice.’ Residents were well groomed and attention was paid to their dress. Spectacles and teeth were clean. Two visitors said that they could see that attention was paid to their relative who was now always shaved and kept much cleaner than had been the case in the past. Staff are caring and gave sensitive support to residents when needed. Residents are asked whether they prefer to receive care from female or male carers. One resident said that she always had a female carer to assist her with baths, which was her wish, but that she accepted a male carer when she needed the commode as otherwise she was worried she may have to wait too long for help. Two staff were seen to knock residents’ bedroom doors before entering but one did not. The privacy lock on a bathroom door was broken and the lock on a toilet door was difficult to use. Both GP practices completing a questionnaire said that they could see their patients in private. However, it was observed during the inspection that a senior carer brought a GP into the lounge to see a resident and that the consultation took place there in the presence of other residents. A random sample of medication records and the system for storage and handling and administration of medication was looked at. Several issues were identified which give cause for concern that medication is not being dealt with as safely as it should. Specific senior care staff have responsibility for the handling and administration of medication but not all of them have received accredited Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 15 medication training, although a senior carer confirmed that training was provided in-house. One resident had been prescribed an anti-biotic medication 3 times a day. The medication administration record indicated that on two days, the medication had been given 4 times. This would suggest that staff are not following safe administration procedures. It was not clear whether this error was noted at the time. Where mistakes are made, the ‘drug error’ procedure should be followed, but this was not done. The importance of this was also highlighted at the last inspection. It was also seen that one resident had refused to accept prescribed eye drops on 9 occasions in a 2 week period, and the senior carer said this often happened. The GP had not been informed of this but had been informed of failure to take another medication. One medication was being given to a resident in food on the advice of a doctor. However, the medication was being crushed, and it was not clear whether this had been advised by the doctor. Crushing could alter the effect of the medication. A new resident had been recently admitted and it had been agreed with her that she would look after her own medication. However, due to a breakdown in communication, an assumption was later made that the home would be administering her medication and she was not given the support she needed to look after it herself. Residents also need to be provided with suitable, lockable storage in their bedrooms, where they could keep medication safely. The following matters were also highlighted:o New medication stock was locked in the treatment room (to which many people have access) but not within a locked medication cabinet. The refrigerator for storing medication also did not have a lock fitted. o The duplicate set of keys was not being stored securely. o A handwritten change to the dosage instructions for one medication was not signed. Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 16 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 excellent. This judgement has been made from evidence gathered both during and before the visit to this service. This home provides an excellent range of social activities both inside and outside the home. There was ample evidence to show that there is a good understanding of residents’ social needs and wishes and activities were tailored to their individual needs. Residents are encouraged to keep in contact with their relatives and friends and are supported and encouraged to join in community activities, which provides interest and variety for them. Residents are helped to exercise choice and control over their lives, which means their wishes and rights are respected. There are good choices of well-cooked food available, which provides nutrition and interest for the residents living in the home. Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 17 EVIDENCE: A wide range of social activities are provided both inside and outside the home for small groups of residents or on a 1-1 basis. The Activities Organiser was observed setting up group social activities and carers were seen playing games or doing jigsaws with residents. A group of entertainers also arrived to provide a film show about local towns and the Tall Ships event. Links have also been forged with the local community and organisations. The Discovery Museum has visited several times and provided interesting social events for the residents. Residents have attended tea dances run by the Alzheimers Disease Society. An Operatic Society and a Brass Band have visited amongst others. One of the residents said that the Activities Organiser was very good at organising social events. She said she enjoyed bingo sessions, musical dominoes, film events in the small lounge. She had also enjoyed an outing to the Discovery Museum and the events provided by the Museum at the home. She also said there were outings to the theatre. A resident is treasurer of the Residents’ Activities Fund. The Activities Organiser and care staff take into account those residents who are reluctant to join activities. Time was spent 1-1 with them as much as possible and records kept of this. Before the inspection, a friend of a resident expressed concern that there were insufficient social activities. There was evidence that this resident had participated in a number of activities although declined others. A Care Manager stated that she had observed the care staff offering and providing a range of social activities to residents during her regular visits. Four relatives confirmed that they could visit at any time and were welcomed into the home. Two said that they were able to let themselves into the home. A friend of a resident stated that they had been discouraged from visiting but no evidence could be found to say why this should be the case. A group of residents now regularly attend a church luncheon club and local coffee mornings. Some residents have joined the Gala Bingo Club and regular outings there are arranged. Two relatives were very pleased that their relative was now able to enjoy going out to the church luncheon club and local coffee mornings. Residents were seen going about the home and using their bedrooms as they wished. Residents can furnish and decorate their bedrooms as they wish. Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 18 Many of the residents have dementia type illnesses and need help with their finances and medication. Residents, who are able, are encouraged to look after their own finances and medication. It had been agreed with one resident that she would look after her own medication, but due to a breakdown in communication, this had not happened. The Manager helps residents to find advocacy services where appropriate and said one resident has an advocate. Eight of ten residents completing a questionnaire stated they ‘always’ liked the meals; one said they ‘usually’ did, and one said they ‘sometimes’ did. One added that they like them because ‘I always get what I ask for’. One commented that the ‘supper is very late’. A senior carer confirmed that supper is provided at about 8 pm but it is provided earlier for those residents who request it. A resident said that they got plenty of choice at mealtimes and lots to eat. Drinks and snacks are provided through the day and evening. The lunch-time meal provided on the first day of the inspection was a choice between mince and dumplings or roast beef with potatoes, green beans, turnip, carrots and gravy. This was followed by meringue with fresh cream and berry sauce. The meal was sampled and found to be hot, tasty and very appetising. Residents who needed help were given sensitive support. There was evidence that residents were monitored closely to ensure that they receive adequate nutrition. Some residents ate in the lounge area using low level coffee tables that were not ideal. The chef said that it was difficult to defrost the freezer regularly as there was insufficient alternative freezer space to keep foodstuffs. One of the fridges needs cleaning. Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made from evidence gathered both during and before the visit to this service. There is an effective complaints procedure, which means that residents and their representatives are listened to and their concerns acted upon. The Manager and staff have good knowledge of adult protection issues, which helps protect residents from abuse. EVIDENCE: Nine residents indicated via a questionnaire that they ‘always’ knew who to complain to and how to do this; one replied ‘sometimes’. Six said the staff ‘always’ listen and act on what they say; three said ‘usually’ and one said ‘sometimes’. A resident said that they would tell the Manager if they had any concerns and added, “she’s jolly and makes you feel at home. She gets things done”. She had raised a concern in the past and said it was dealt with. One resident had not been happy about services provided in the home and the Manager and staff had tried to address this, for instance, obtaining different sausages. This was recorded in the care file, although not in the complaints record. Where appropriate, the Manager also involves other professionals, for Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 20 instance, social workers, which ensures residents have someone independent to support them. Four relatives were seen who said that they found the Manager approachable and would readily raise any concerns with her if they had them. A friend of a resident said that they found the Manager unapproachable and dogmatic. The Manager felt that she could have dealt with them in a better way and should have kept a better record of the issues discussed. The Manager has properly dealt with any concerns about the safety of any resident including informing the Commission and Local Authority and ensuring that residents are safeguarded. Staff training records showed that Protection of Vulnerable Adults training is provided and staff knew what they should do if they had any concerns about residents. Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before this inspection. The building provides suitable accommodation for older people who require care due to frailty. A programme of refurbishment is being carried out which will improve the environment for residents. Staff work hard to keep the home clean and reduce unpleasant smells. EVIDENCE: A tour of the home was made and ten bedrooms were seen. Refurbishment is taking place gradually. The Manager stated that 17 bedrooms have been redecorated and more are to be done. The carpet in one bedroom was very stained despite constant cleaning and needs replacement. Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 22 Residents are provided with keys to their bedrooms, where they can manage these. However, there is a lack of suitable lockable storage space in their bedrooms so that they can lock away valuables or medication. The temperature of hot water delivered to a bath was tested and found to be safe. The call system was tested and was working. The call system is used a lot and produces a very loud and high pitched noise, which is unpleasant and distracting. A comment was received in a resident’s questionnaire, stating the ‘the laundry is wrong’. It was not clear what this meant, however, there is a system to sort clothes in the laundry. The laundry assistant is solely responsible for washing and return of clothing to help avoid misplacement of items. Before the inspection, a concern was received that the home smelled of urine. There was a smell of urine in parts of the corridors and in 2 of the bedrooms seen. The cleaner was busy cleaning. Carpet cleaners are used. A relative said that the staff work hard to keep the home clean and that the ‘smell had improved’. All 10 of the residents completing a questionnaire said the home is kept fresh and clean. The corridor carpets were stained with unsightly black marks. The carpets are professionally cleaned every 6 weeks but the stains return quickly. The staff use the protective gloves and aprons provided. Some of the staff team have received infection control training. The arm of a dining chair was loose. Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 23 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 adequate. This judgement has been made from evidence gathered both during and before this inspection. The number and type of staff on duty throughout the day and night is sufficient to meet the needs of residents. Staff are enthusiastic and morale is good. They are kind and work hard to meet residents’ needs. Vetting procedures need to be improved for the protection of residents. Induction training is provided to new staff, although it was not clear whether this fully met TOPSS standards. Following induction, staff are given further relevant training, which helps them to provide the care that residents need. EVIDENCE: Examination of the rotas and discussion with the staff and Manager showed that the numbers of care staff are as follows:8 am to 4 pm 5 Woodlands Care Home 4 pm to 8 pm 6 8 pm to 10 pm 3 or 4 10 pm to 8 am 3 Version 5.2 Page 24 DS0000062615.V291220.R01.S.doc The above includes a senior member of staff and is enough to meet the needs of residents. The Manager’s hours are not included in the above nor staff employed for other tasks such as food preparation, cleaning and laundry. An Activity Organiser works in the home from 10.30 am to 3.30 Monday to Friday. Eight residents completing a questionnaire said staff are ‘always’ available when needed; 3 said they ‘usually’ are and 1 said ‘sometimes’. One resident they sometimes had to wait longer at weekends. A concern was received before the inspection that staff spent time in the office drinking tea and the residents were unsupervised. Checks were made about this. Staff breaks are staggered with a maximum of 2 staff on a break at any time. The carers are given specific responsibility for particular residents and their bedrooms during the shift to make sure that their needs are attended to. A ‘handover’ meeting is held at 8 am and 8 pm to allow exchange of vital information between staff at the end of a shift and the staff starting the next shift. The Manager, senior staff and as many other carers as possible attend these meetings, which helps keep them informed, providing there are some available to provide care to residents. There had been about 40 staff turnover since the last inspection due to a number of reasons. The records of 5 recently employed staff were examined. Vetting of staff needs some improvement. One carer had started work before their second reference was received. A carer had started work on the strength of 2 references, although one said a reference could not be provided, as they did not know the candidate personally due to the passage of time. Another reference had not been sought. Colleagues, rather than the Manager of the care home one had worked in previously, had provided the references for another. Checks of the Protection of Vulnerable Adults (POVA) List and Criminal Records Bureau (CRB) Disclosures had been obtained for these new staff. An old CRB had been accepted for another member of staff, where a new check should have been carried out. There were details of induction training on the staff records, although there insufficient information to show that the induction fully met with the Foundation standards set by TOPSS. Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 25 The Manager stated that 50 of the care staff team have now achieved a National Vocational Qualification (NVQ) in care. NVQ certificates were seen in some of the staff files looked at. A range of other care related training has been provided to individual members of the staff team. For instance, some have received training in diabetes awareness, supporting continence, handling aggression and challenging behaviour. Five have completed a course called ‘Positive Dementia Care’ and another 3 have done a basic course. The Manager said that some staff had been unable to obtain local training courses, because they are from abroad. To overcome this, the Manager was providing structured training about how to care for people with dementia, which she considered an important priority. Time had been set-aside for this. It was being documented and a carer confirmed this training was very helpful to her. Staff are kind and caring and attentive to residents. They showed sensitivity and understanding towards those residents who have dementia type conditions. Residents said they were treated well. One resident said it would be better if staff with long hair tied it back. The inspector was told that a resident’s toiletries had been used with their permission for another resident whose supplies had run out, but that this had happened several times. Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 26 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 and 38. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home is managed well. The Manager demonstrates high ethical standards and puts the needs of residents first which means that their needs and wishes are more likely to be met. She provides clear leadership, which means that the staff team know what to do and what is expected of them. The Manager regularly reviews aspects of the home’s performance through a good quality assurance system, which includes seeking the views of residents, relatives and other interested parties. The system for handling residents’ money is thorough, which helps protect residents and staff. Some further training and maintenance checks need to be carried out to help protect service users and staff. Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 27 EVIDENCE: The Registered Manager, Mrs Linda Gallon, is managing the home well. She has achieved the Registered Manager’s qualification. A concern was received before this inspection that the Manager was unapproachable and dogmatic and staff seemed to be afraid of her. Two members of staff stated that they found the Manager very fair and helpful and someone they could discuss issues with. Two relatives of a resident said that they had seen a major improvement since the current Manager took over the home. They commented that the staff were much more professional and that the number of staff had improved and that the building had improved. The Manager has had to deal with some difficult issues and reviews the actions she takes. She felt that one situation could have been dealt with better and had not been recorded as well as it could have been. The homes uses various methods to monitor the quality of care provided. The Manager had sent questionnaires to residents, relatives and other people who visit the home. The results had been analysed and put on the notice-board for all to see. Regular meetings are held with staff with the aim of the developing the workforce and driving forward improvements. Audits are carried out in a number of areas, such as, record keeping and environmental standards. The Manager monitors residents’ nutrition. She reviews any accidents that have occurred to help prevent recurrences. The owner of the home is not providing a report of regular unannounced visits to the home, which is a regulatory requirement. The system for handling and storing money held on behalf of residents was looked at. This was found to be appropriate. The staff are given training in moving and handling skills and other health and safety training. Only seven of the staff have had formal training in infection control. More staff need to be given formal training. This was a requirement at the last inspection. Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 28 Fire safety checks are carried out regularly in the home. Records showing that essential equipment has been serviced were in place apart from:- a Periodic Inspection Report on the Electrical Wiring; - a report of testing of portable electrical appliances; - a report of servicing/maintenance of gas appliances. No health and safety hazards were seen during this inspection other than a looped pull cord resting on a resident’s pillow, which could have been hazardous. This was addressed immediately. Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 2 Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15 & 12(2) Requirement Service users (or their representative) must be involved in drawing up and reviewing their plan of care. They should be asked to sign their agreement to the plan. Previous timescale of 31/8/05 not met. Ensure that all care staff read and fully understand the care plans and other relevant information, for example, past physical and mental health history. Where residents smoke and clothing and/or furnishings are being burned, an individualised risk assessment must be carried out to reduce the risks to the safety of the individual and all who live/work in the home. 2. OP10 12(4)(a) GP and other health consultations must take place in privacy. Ensure that resident’s choice of gender of staff providing personal care can be respected Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 31 Timescale for action 30/09/06 31/07/06 at all times and that residents are made aware of this. Staff must knock bedroom doors and request permission to enter, unless there is good reason why this cannot be done. The privacy lock to the bathroom must be repaired and other locks checked for ease of use and repaired/replaced as necessary. 2. OP9 13(2) Staff involved in handling or administering medication must be given accredited medication training as set out in Standard 9.7. Staff must also be trained in the Home’s specific medication procedures. Staff must be made aware of the procedure to follow if mistakes are made with medication, for example, giving the medication at the wrong time or missing a medication. The Medication Administration Records must be checked carefully to ensure that medication is administered correctly. Any medication errors must be notified to the Commission. This was a requirement at the previous inspection on 19/10/06. Where residents persistently refuse prescribed medications, their doctors must be informed so that their treatment can be reviewed. 30/11/06 3 OP9 13(2) 30/09/06 Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 32 One medication was being crushed, and it was not clear whether this had been advised by the doctor. Crushing could alter the effect of the medication and this must be checked out with the doctor or pharmacist to ensure crushing is recommended. Medication must only be looked after and administered to residents, if they (or their representative, if they lack capacity) have given their permission. Permission must be obtained from them. Residents must be given the support they need to look after their own medication and a safe place to keep it, if they have been assessed as able to do this safely. All medication stock, including new stock and refrigerated stock, must be stored securely. The duplicate set of keys must be stored securely. Dose changes should be signed and dated. This was a requirement at the previous inspection on 19/10/05. Keep a record of any limitations agreed with the service user (or their representative) as to the service user’s freedom of choice, liberty of movement and power to make decisions. Keep a record of all complaints made by service users or representatives or relatives of service users about the operation of the care home, and the action taken by the registered person in respect of Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 33 4 OP16 17 30/09/06 5. 6. 7. OP15 OP19 OP29 16(2)(g) 23(2)(c) 19 any such complaint. Clean refrigerator in storeroom. Repair or replace dining chair with loose arm. Two satisfactory written references must be obtained before staff are employed. This was a requirement at the previous inspection on 19/10/05. An enhanced CRB disclosure, including a check of the POVA list, must have been obtained for any staff employed after 26/7/04. 30/07/06 30/07/06 30/09/06 5. OP30 18 Provide evidence that new inexperienced staff receive induction training, which meets Topss Induction and Foundation standards. Staff must be given training in infection control as necessary. Provide a training plan as to how this is to be achieved. This requirement is outstanding from the previous inspection on 19/10/05. The Registered Provider must make regular unannounced visits to the home to interview service users, their representatives and persons working at the home in order to form an opinion of the standard of care provided in the care home. He must then make a written report of his findings to the Registered Manager and the CSCI. Provide up to date documentary evidence to show that the following are inspected and maintained at adequate intervals by suitably competent people: DS0000062615.V291220.R01.S.doc 30/09/06 8. OP38 18 31/12/06 9. OP38 26 31/08/06 10. OP38 13(4) & 23 30/09/06 Woodlands Care Home Version 5.2 Page 34 1. The gas boiler and system must be inspected annually by a Corgi registered gas engineer. 2. The electricial wiring system must be inspected periodically by an Approved Electrical Contractor and a (NICEIC) Periodic Inspection Report provided. 3. All portable electrical appliances must be inspected for safety at least annually. These requirements are outstanding from the previous inspection on 19/10/05. 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. 3. 4. 5. Refer to Standard OP15 OP19 OP22 OP24 OP27 Good Practice Recommendations Provide tables of a suitable height for residents who eat meals whilst sitting in lounge armchairs. Consider replacing stained carpets in corridor. Provide a call system, which does not produce loud, intrusive noises. This will improve the environment for all residents, but particularly with dementia. Provide each service user with a lockable storage space for medication and valuables in their bedroom. Consider request by resident that staff with long hair should tie it back when assisting residents with personal care. Ensure residents have sufficient toiletries. Woodlands Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Cramlington Area Office 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 © 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 Care Home DS0000062615.V291220.R01.S.doc Version 5.2 Page 36 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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