CARE HOMES FOR OLDER PEOPLE
Woodlands HFE Warwick Avenue Clayton-Le-Moors, Accrington Lancashire BB5 5RW Lead Inspector
Christine Mulcahy Unannounced 18 July 2005 10:00 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 HFE v231813 f57 f07 s36436 woodlands v231813 180705 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Woodlands HFE Address Warwick Avenue Clayton-Le-Moors Accrington Lancashire BB5 5RW 01254 232099 01254 396400 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) Lancashire County Care Services Ms Marion Szejner Care Home Only Personal Care (PC) 29 Category(ies) of Old age, not falling within any other category registration, with number (OP) 29 of places Woodlands HFE v231813 f57 f07 s36436 woodlands v231813 180705 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1 The service should at all times, employ a suitably qualified manager who is registered with the NCSC. Date of last inspection 16 and 18 November 2004 Brief Description of the Service: Woodlands HFE is registered with the Commission for Social Care Inspection to provide personal care and accommodation to 29 people over the age of 65 years. The building is single storey detatched in its own grounds and is located just off the main Whalley Road of Clayton-Le-Moors in Accrington. Whalley Road is situated on a main bus route that offers transport to towns in the Hyndburn area. The home is currently under refurbishment and accommodates 15 older people in newly built surroundings. All bedrooms are located on the ground floor of the building some bedrooms are en-suite. The refurbishment has created a new lounge dining area with new furniture, equipment, soft furnishings and lighting throughout. This new refurbishment is phase 1 of 3, phase 2 and 3 are in progress. On completion of the refurbishment it is intended that the home will provide personal care and accommodation for up to 44 older people in 3 separate units. It is also intended for the home to have a number of assissted bathrooms, shower rooms and communal toilets for the service users. Additional services like day care and respite care will also be provided at Woodlands. Woodlands HFE v231813 f57 f07 s36436 woodlands v231813 180705 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the first unannounced inspection in 2005. The inspection took place over one day. At the time of the inspection 14 service users were accommodated at the home. The inspector arrived at 10.00 am and continued until 3.30pm. The service was inspected against the National Minimum Standards for Older People and involved examination of records and discussion with a number of service users. There are various references to the case tracking process. This is a method where the inspector focuses on a small representative group of service users. All records pertaining to these people are inspected along with the rooms they occupy in the home. Observations are made of the care provided and the service users are invited to have a discussion with the inspector to discuss their experiences of life in the home. This is not to the exclusion of the other service users, with a number of other service users being involved in the inspection process in various other ways. Breaches in regulations and standards that pose an immediate risk to service users have been highlighted for urgent action. The inspection was carried out with the co-operation of the duty residential care officers. Over the course of the inspection 4 service users, 5 staff members, and the responsible individual. A tour of the premises took place including all bedrooms. Documents were read and care observed. What the service does well:
The staff and management of Woodlands try to make sure that all service users receive a high standard of care within a comfortable environment. All aspects of medication were well managed and service users were protected from mis administration. Service user care plans addressed areas of care such as routines, likes and dislikes, allergies, health needs, personal hygiene and general health. Past interests, hobbies, present needs and wishes were also included in care plans. A number of service users commented on the cleanliness of the home and the newly refurbished unit including their bedrooms. A number of service users had positive comments about the staff and the manager. Saying, “The staff help us with anything we want and update our care plans once a month.” Staff confirmed that training was ongoing and had undertaken training in first aid, moving and handling, basic food hygiene and health and safety.
Woodlands HFE v231813 f57 f07 s36436 woodlands v231813 180705 stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? 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 HFE v231813 f57 f07 s36436 woodlands v231813 180705 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Woodlands HFE v231813 f57 f07 s36436 woodlands v231813 180705 stage 4.doc Version 1.30 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 standard(s) OP 1, 2, 3 Written information about the home and the facilities was comprehensive, up to date and set out the aims, terms and conditions of the home. Service users had a plan of care for daily living and longer-term outcomes based on the care management assessment. Service users were always assessed prior to admission to the home. EVIDENCE: Case tracking of service user case files confirmed that service users had been provided with a service user guide and statement of purpose. When asked service users said they had been issued with the documentation on admission to the home and had signed a contract of conditions. Both documents contained information that was needed for a prospective service user to understand how the home was run. Service users confirmed they had been issued with an up dated copy of the homes statement of purpose. This should be updated to include information about the amount and type of furniture service users can bring with them on admission to the home. The home does not provide intermediate care. Woodlands HFE v231813 f57 f07 s36436 woodlands v231813 180705 stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 The health care needs of service users were identified and met through care plans. The control of medication was well managed promoting good health. EVIDENCE: Case tracking of three service user case files showed that care plans were drawn up from the initial service user assessment. Each care plan addressed areas of care and detailed the care to be given. Choices in day-to-day living, assistance, dietary needs, intellectual cultural needs, interests hobbies, background, life history, and lifestyle choices enabled staff to meet service users needs better. Care plans also contained a service user personal profile and reason for admission to the home that included a medical history, known allergies and last wishes. Care plans were reviewed regularly and monthly care plan review sheets had been completed and signed by staff. Two service users when asked knew who their key workers were. “They help us with anything we want and once a month they help us with our care plans.” Woodlands HFE v231813 f57 f07 s36436 woodlands v231813 180705 stage 4.doc Version 1.30 Page 10 A care plan for a service user admitted on the 26.6.05 did not include a photograph of the service user. A pre admission assessment form had been completed but the service user care plan needed completing to enable staff to deliver the care to the service user. Records on diary sheets examined had not been written daily. Access to professionals had been arranged as needed and one service user told the inspector that she regularly saw her G.P and the District Nurse at the home. Documents to record minor service user accidents at the home were accurate and up to date. There was a medication policy and procedure at the home. Written guidance was available for staff to follow when administering medication. Policies and procedures examined ensured service user safety. All medicines were stored in a locked trolley within a locked room ensuring service users were kept safe from harm. The inspector observed an RCO administering medication to service users at lunchtime and it was apparent that she was competent in this area of service user care. The care plan of one service user who self medicated did not include a risk assessment for this activity. Woodlands HFE v231813 f57 f07 s36436 woodlands v231813 180705 stage 4.doc Version 1.30 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 standard(s) OP 12, 13, 15 There was not enough opportunity for service users to maintain their social interests. The meal served looked appetising. Service users were given sufficient time to eat and independent eating was encouraged. EVIDENCE: Case tracking and discussions with service users confirmed that routines and daily living were based on service user wishes. This information was highlighted in care plans. Past interests, hobbies, present needs and wishes were also included in care plans.” We can get up more or less when we want.” said one service user. “We used to have bingo and music to movement classes but we’ve nothing at the moment because of all the building work. We’re hoping there will be something when everything is finished by September.” “Those in wheelchairs who need help get up by the night staff, 7-ish, she said. Another service user said, “Since August 2004 we’ve had about 3 entertainers, they haven’t enough staff for activities. The vicar comes weekly with Communion and Father comes monthly.” When asked service users told the inspector they had used postal votes in the last General Election and felt their rights were respected and upheld. Three full meals were served daily two of these were hot. The meal served for lunch on the day of the inspection was fried egg, chips and beans. Pudding was chocolate sponge and custard. Meals were served in the new dining room. One service user said, “Foods alright, no complaints”.
Woodlands HFE v231813 f57 f07 s36436 woodlands v231813 180705 stage 4.doc Version 1.30 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 standard(s) Standards in this section were not assessed at this inspection. EVIDENCE: Woodlands HFE v231813 f57 f07 s36436 woodlands v231813 180705 stage 4.doc Version 1.30 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 standard(s) OP 19, 21, 24, 26 There were sufficient toilet and washing facilities in the home. Most areas in the home were safe and well maintained. The home was clean, pleasant, and hygienic. EVIDENCE: The location of the home was suitable for it’s stated purpose. A tour of the home showed a good standard of cleanliness and hygiene. The new lounge diner now provided staff and service users with a kitchen area comprising of a domestic dishwasher, microwave, toaster and kettle to enable service user independence and create a more homely environment. When asked about the new living unit service users commented by saying, “It’s lovely but very small, it was better when we were in there.” She said pointing to the old part of the building. “There’s no space to see visitors in private, It’s done now.”
Woodlands HFE v231813 f57 f07 s36436 woodlands v231813 180705 stage 4.doc Version 1.30 Page 14 The inspector examined all bedrooms during the inspection. Bedrooms had been personalised with service user photographs and ornaments and tastefully furnished with new furniture and soft furnishings. Each bedroom comprised of a single bed with bedding, single wardrobe, one 3-drawer chest, one dressing table, one bedside cabinet with lockable drawer and wall-to-wall carpet. One service user said, “I have a nice bedroom, I’m satisfied.” Discussion with 2 service users highlighted that bedroom facilities were not satisfactory and some service users had to reduce their clothing stock because the furniture provided was not sufficient to accommodate their existing collection of clothing. One service user said, “The wardrobes aren’t big enough to keep your clothes in, I’ve had to get rid of 3 bags of clothing to the charity shop.” She said that she was unable to keep her own furniture once a new room had been allocated to her. “I have a wardrobe, set of drawers and a bedside table. They’re in the old lounge now, my grandson can have it, there’s nowhere to keep it.” She said. A requirement was made for the registered person to consult with service users and ensure that adequate furniture suitable to the needs of the service user is provided in service user bedrooms. A requirement was also made for the registered person to ensure that the service user guide and statement of purpose clearly informs the service user about the amount and type of their own furniture they are able to bring into the home. Following a requirement made at the previous inspection daily records of hot water temperatures were examined and hot water temperatures in the new building were consistent with the temperatures recommended by the Environmental Health Department. High water temperatures in staff toilets and kitchen areas in the existing building remained the same but staff had been made aware of these temperatures and warning signs were in place to alert the staff of the high temperatures. There were sufficient toilet and washing facilities throughout the new building. These were clearly marked and located near to service user accommodation to enable service users independence. Discussion with staff highlighted that the new sluice room did not provide adequate ventilation and made tasks in this area unpleasant and difficult. Service users had commented that the new lounge diner was too small for service users who used walking frames and wheelchairs. “Now they’ve built this it looks nice but there isn’t enough space for us and our wheelchairs to move about.” Said one service user. When asked the RCO on duty explained that this matter was to be looked at and discussed between the buildings manager and the Lancashire County Care Services responsible individual. Woodlands HFE v231813 f57 f07 s36436 woodlands v231813 180705 stage 4.doc Version 1.30 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 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) OP 27, 29, 30 Staff numbers were not adequate to meet the service user need. Staff training had taken place and was ongoing. Staff files held information required to ensure service users are safe from harm or abuse. EVIDENCE: Service users told the inspector there were not enough staff for activities. Throughout the inspection one member of staff was seen competently carrying out different tasks during the course of her duty and could be identified in a specific role due to the type and colour of her uniform. On the day of the inspection the staff rota examined complied with the minimum levels required by the previous registering authority. However it was apparent that a number of service users had high dependency needs and the ratios of care staff to service users made it difficult for the staff to attend to the service user needs some of the time. Staff were clearly committed to their work and getting jobs done. One said, “We are short staffed but we all just get on with it.” A requirement was made for the registered person to review the staff rotas and ensure appropriate numbers of staff are available in the home at all times. Discussions with 2 staff highlighted that the skill mix was appropriate to service user assessed needs. The inspector spoke to a 2 staff who when asked were aware of the homes policies and procedures and knew where they could be located. One member of staff who had been employed within the home for 3 years described her employment route that followed the homes recruitment policy.
Woodlands HFE v231813 f57 f07 s36436 woodlands v231813 180705 stage 4.doc Version 1.30 Page 16 Examination of the staff file confirmed that appropriate Criminal Record Bureau and POVA checks were carried out prior to her starting work at Woodlands. Staff confirmed that more training opportunities had been introduced at the home. All staff had undertaken training in first aid, moving and handling, basic food hygiene, sign language, working with the visually impaired fire evacuation, aggression, bereavement and dementia. Staff files examined confirmed that information required was held on file. Service users had commented on the staff team and one said, “We’ve no complaints about the staff, they’ve had to put up with a lot of changes, they do very well.” Woodlands HFE v231813 f57 f07 s36436 woodlands v231813 180705 stage 4.doc Version 1.30 Page 17 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) OP 31, 35, 38 The attitude of the staff and management is to ensure the home is friendly and flexible for the service users. Written procedures ensure the health and safety of staff and service users are safe guarded. EVIDENCE: The Assistant manager has been involved in residential management 4 years. She has achieved National Vocational Qualification Level 4 and the registered managers award. From information documented in the homes statement of purpose she has periodically updated her knowledge through various courses. Records examined confirmed that she had 22 years with Lancashire County Council within older persons care and a good knowledge of the conditions and diseases of old age. Following a requirement made from the previous inspection case tracking confirmed that systems were in place to ensure service users control their own finances. The duty RCO said that only small amounts of service user monies were held on the premises. Service user relatives, representatives or solicitors
Woodlands HFE v231813 f57 f07 s36436 woodlands v231813 180705 stage 4.doc Version 1.30 Page 18 were now responsible for their relative’s finances. Service user pensions are now paid directly into the service user bank account and fees are deducted accordingly. There was a secure facility for service users money kept on the premises, and appropriate recording arrangements. A number of equipment maintenance certificates were examined and noted to be up to date. An emergency evacuation procedure was in place and staff had signed to confirm their awareness and knowledge. The homes fire log-book was examined and fire test equipment had been completed regularly by the contracted company. A requirement was made for the registered manager to contact the local fire officer to confirm that the homes current fire evacuation procedure meets with the homes staffing levels and new building layout. Woodlands HFE v231813 f57 f07 s36436 woodlands v231813 180705 stage 4.doc Version 1.30 Page 19 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 2 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 x 3 x x 2 x 3 STAFFING Standard No Score 27 2 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 x x x 3 x x 2 Woodlands HFE v231813 f57 f07 s36436 woodlands v231813 180705 stage 4.doc Version 1.30 Page 20 NO 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 OP1 Regulation 4(1a) Sch1 Requirement The registered manager must ensure that the up dated copy of the homes statement of purpose includes information about the amount and type of furniture service users can bring with them on admission to the home. Timescale for action 18.07.05 2. OP7 15(1) 13(4c) 3. OP12 16(2n) 4. OP24 16(2d) 18.07.05 The registered person shall consult with the service user or a representative prepare a written plan as to how the service users needs in respect of his health and welfare are to be met. The registered person shall also ensure that unnecessary risk to the health and safety of service users are identified and as far as possible eliminated through the use of service user risk assessments.This includes risk assessments for those service users who self medicate. The registered person shall 18.07.05 consult with the service users about the programme of activities and provide facilities for recreation including activities in relation to recreation, fitness, and training. The registered person must 18.07.05
Version 1.30 Page 21 Woodlands HFE v231813 f57 f07 s36436 woodlands v231813 180705 stage 4.doc 4(1a) 5. OP27 18(1a) 6. OP38 23(4) permit service users so far as it is practicable to do so, to bring their own furniture and furnishings into the rooms they occupy. The registered person having regard to number and needs of service users ensure that at all times suitably qualified competent and experienced persons are working at the care home in such numbers as are approprite for the health and welfare of service users The registered person shall consult with the fire authority to confirm that the homes current fire evacuation procedure meets with the homes staffing levels and new building layout. 18th July 2005 18th July 2005 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. Refer to Standard OP26 Good Practice Recommendations The registered person should make arrangements to discuss the lack of ventilation in the sluice area with the environmental health authority. Woodlands HFE v231813 f57 f07 s36436 woodlands v231813 180705 stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 1st Floor, Unit 4 Petre Road, Clayton-Le-Moors Accrington Lancashire. BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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