Inspection on 23/11/09 for Woodlands Manor

This inspection was carried out on 23rd November 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Woodlands Manor 17/07/07

Woodlands Manor 01/06/06

Woodlands Manor 25/10/05

Woodlands Manor 18/11/04

Woodlands Manor 28/07/04

Woodlands Manor 07/04/04

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Poldhu

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Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/06/2011.

Key inspection report Care homes for older people Name: Address: Woodlands Manor Ruffet Road Kendleshire South Glos BS36 1AN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sian Jordan-Jones     Date: 3 0 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 37 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Woodlands Manor Ruffet Road Kendleshire South Glos BS36 1AN 01454250593 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Woodlands Manor Care Home Ltd Name of registered manager (if applicable) Mrs Cheryl Lynn Lawrence Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 40 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admissison to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Woodlands Manor is a part converted and part purpose built home registered in November 2004 by Woodlands Manor Care Limited and operated by the directors Mr and Mrs Jenkins. Mrs Jenkins is the Responsible Individual (RI) for the Home. The home is situated in a rural location, but is on a local bus route to Bristol and Yate, and is accessible to local shops and amenities by bus or car. Communal areas are provided by way of a dining room, lounges and large conservatory areas. There is level Care Homes for Older People Page 4 of 37 Over 65 40 0 2 4 0 6 2 0 1 0 Brief description of the care home access throughout the home and all areas of the home are accessible via a lift. There are a number of bathrooms and toilets with adaptations to meet most of the care needs of people living in the home. Some bedrooms have ensuite toilet facilites. Appropriate equipment can be provided for individual use based on assessed or identified needs. All rooms have a call bell system. The home is set in its own grounds, which are beautifully maintained and accessible to people. Car parking is available for several cars. Visitors are welcome to the home at any time. In house activities and entertainments are provided. The fees charged at the home are available upon request, additional charges are made for Chiropody, hairdressing, newspapers and private telephones. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection was on 17 July 2007. We, The Care Quality Commission (CQC) completed this inspection over three days as we had additional time to look into how the Responsible Individual, representing the Company, investigated a complaint. We had direct contact with the registered manager, the Responsible Individual, one of the proprietors, five registered nurses, three care staff, one of the activity organisers, the fulltime chef and a part-time chef, the person in charge of the laundry, the maintenance man, four relatives visiting the home and seven people living in the home. We also spoke briefly to everyone living in the home when we looked at the environment to help ensure that people knew we were completing an inspection. We had sixteen completed surveys returned to us from people living in the home, some surveys did not answer all the questions, and one by a relative. We also spoke to two relatives on the telephone and five during the inspection. Care Homes for Older People Page 6 of 37 We looked at care records to include medication, and some policies and procedures. The manager had completed an Annual Quality Assessment Audit (AQAA) providing us with information about the home and what has changed in the previous twelve months. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? Activities have improved, and there is an additional part-time activity person to help the fulltime activity organiser provide a variety of activities to include; games, quizzes, puzzles, exercises, ball games, making cookies, beetle drive and entertainment. One to one activities include nail and hand care, looking at the newspaper, word search and walking in the garden. The activity person also spends quite a lot of time talking to people individually. We spoke to the chef and he told us that the quality of the fresh meat provided has improved due to the change in supplier. The menus are changed every month to help ensure that people enjoy a variety of food. People told us; the food is lovely, plenty of choice , I think i have put on weight, and the food is fine, I can choose, sometimes I dont like it and I can have something else. The Environmental Health Officer gave the kitchen and food preparation a four star (very good) rating in July 2009. A recent complaint concerning staff availability during the afternoon and evening has changed the way staff take their breaks, which ensures that there are now more staff Care Homes for Older People Page 8 of 37 available to meet peoples needs at this time. A part-time administration person has been employed to help the manager with office tasks One of the nurses is now the homes part-time clinical manager and is seen by some staff as the deputy manager. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 37 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a detailed assessment recorded by the home before they move in to help ensure that their needs can be met. Information provided to people before they move in could be improved with regard to the fee structure. Evidence: We looked at pre admission assessments completed by the manager before a person decides to move into the home. All the relevant areas were completed with sufficient information for peoples needs to be planned for before admission. The staff complete a plan of care from the pre-admission information soon after someone moves into the home. We looked at the Service User Guide and Statement of Purpose, which are a combined record usually provided once a person has moved into the home. We also looked at Care Homes for Older People Page 11 of 37 Evidence: the homes colour brochure provided when people initially make an enquiry or look around the home. We recommend that the information about the fees for the home are provided before a person decides to move in as this is a legal requirement to help ensure transparency, and to help people understand about the amount of Registered Nursing Care Contribution they may be entitled to. The surveys returned to us told us that nine people received enough information about the home to help them decide the home was the right place, three did not receive enough and two did not know. Care Homes for Older People Page 12 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had care plans that were detailed and regularly reviewed, improvements could be made to include specific protocols with regard to seizures and other clinical tasks. Medication storage, management and administration needs to improve to help ensure that people are protected from poor practice. Evidence: Thirtyone people were accommodated in the home and we looked at three of their care plans in detail and spoke to them and many other people living in the home. The care plans were well recorded and had some good action plans that were person centred and included peoples individual needs. The monthly reviews were generally good and identified any changes. One plan had monthly reviews that frequently recorded no change. Reviews should always be meaningful and record what has happened during the previous month. One plan did not have a procedure for looking after a tracheotomy tube or a protocol Care Homes for Older People Page 13 of 37 Evidence: for when an as required nebuliser should be given. One person was having weekly blood glucose tests, however, there was no record of a three monthly test (HbA1C), that records the levels over a longer period. We were subsequently informed by the manager that the doctor did not require this test as the persons diabetes was not unstable. There were some good records about continence care and mobility, and risk assessments for the prevention of pressure ulcers. Each person had a nutritional risk assessment score to help identify the risk of malnutrition and some evidence was recorded in the daily records of what people ate and drank and their monthly weight. Daily records were well recorded and the keyworkers monthly report was meaningful and looked at issues important to people, for example; keeping their room tidy and finding laundry for them. The doctor visits weekly and records the visits in the care plans. There is also a separate health review record of other health professionals that support people to include for example; chiropodist, dentist and opticians. We recommend that all healthcare professional visits are recorded separately, other than in the daily records, to enable a clear picture of support and outcomes to be readily available for review. Wound care plans seen could be more detailed and the description or a photograph should record progress. We looked at a record of accidents for one person, and one had not been recorded in the daily records. Two other accidents had been recorded. The manager needs to ensure that all accidents are audited monthly to help identify where prevention is possible. During the inspection the manager devised a format to audit future accidents. We observed a hand over between staff at shift change and valuable information about peoples welfare was shared to help ensure continuity of care. Some people with ensuite facilities had their privacy and dignity compromised when using the toilet as they wanted a door on the ensuite toilet, this is also referred to in the environment section of this report. Some people on the ground floor may also want privacy (net) curtains at the window. We looked at the medication storage and the administration records and spoke to the nurse that helps to manage the medication with regard to ordering and checking Care Homes for Older People Page 14 of 37 Evidence: supplies are correct. The administration records were generally well completed and staff had signed that medication had been given. We observed staff administering medication and on one occasion the trolley was left unattended, this is poor practice, which we brought to the member of staffs attention at the time. The home uses a monitored dosage system supplied by the local pharmacy, and do not see the prescriptions written by the doctor. We recommend they see the prescriptions if possible to help ensure that the correct medication is being provided by the pharmacy. We looked at the storage in the cupboards and some external and internal medication were stored together this should be avoided to prevent contamination and medication errors. Two locked trolleys are used for administering medication to the two floors in the home and both were well organised and clean. The temperatures were recorded for the medication storage room and the refrigerator. The room temperature record was well over 25 degrees Centigrade on occasions and the highest recorded was 29 degrees centigrade. This may be too hot for most medication and a cooling system is recommended to ensure the potency of the medication. The storage was secure, however, the controlled drugs cupboard should be bolted to the wall to comply with Misuse of Drugs (Safe Custody) Regulations 1973. We did a spot check of the controlled medication, which was correct. There was no one self-medicating in the home. The administration records were complete and any allergies were recorded . There was a picture of each person with the record. We looked at the medication procedure in the office and recommended that a copy should be kept with the medication to include a list of homely remedies agreed by the doctor for each person. Staff can only administer a homely remedy agreed by the doctor for a given time, the doctor is contacted if the need continues. We recommend that the home has a copy of the Royal Pharmaceutical Societys medication guidance for care homes. The home had a medication reference dated March 2008. There was no protocol in a persons care plan for seizure management or a protocol for as required medication intervention. There should be a protocol in the medication administration records for all as required medication. Care Homes for Older People Page 15 of 37 Evidence: Some medication in boxes and bottles had not been dated when started which means that a correct audit of the medication cannot be completed to help ensure safe practice. We found three boxes of Warfarin tablets out of date in 2007, and there was an excess of this medication stored. Six people are prescribed Warfarin and staff must only administer from named boxes, which are dated when opened to ensure safe and legal practice. Information regarding Warfarin administration practice can be found in the National Patient Safety Agency Guidance about anticoagulants. The web site address is www.nspa.nhs.uk/patientsafety/alerts-and-directive/alerts/anticoagulants. The administration records must carry forward any medication still in the home when a new chart is started. The practice of discarding any medication not on the monitored dosage system at the end of each month should be reviewed as they can be added to the next total and prevent wastage. We recommend that a regular audit of each persons medication is completed to help identify any errors or poor practice to help safeguard people. We also recommend that qualified staff have medication training updates to ensure their safe practice. Oxygen was stored, most from a previous prescription ready to be collected soon, the room had an oxygen identification on the door. Care Homes for Older People Page 16 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities have improved and additional staff have been employed to provide different activities and one to one sessions. People have a variety of food to choose from, which includes fresh fruit and vegetables, and the quality of fresh meat has improved. Nutritional assessments are recorded and special diets are provided. Evidence: We spoke to the new part-time activities organiser who had recently been employed to support the fulltime organiser. There was an activity plan for the week in the hall that included games, quizzes, puzzles, exercises, ball games, making cookies, beetle drive and entertainment. We saw some activities taking place and an entertainer. One to one activities include nail and hand care, looking at the newspaper, word search and walking in the garden. The activity person also spent quite a lot of time talking to people individually,which they appeared to enjoy. We looked at the records kept by the activity organisers about the activities people had completed. We recommend that an individual record is completed that can can be transferred to peoples care plan more easily, to see what people have enjoyed doing. The record also contained some personal histories, which Care Homes for Older People Page 17 of 37 Evidence: help to identify past interests, we discussed updating some histories with more information about what interests people have had in the past. In the sixteen surveys returned to us nine people told us there were always activities arranged they could take part, three told us usually and four indicated sometimes. Comments in the surveys included the following: I would like to go out more, the home does activities well, I would like a bit more activities and they keep the gardens lovely and I like to sit and look at them, the flowers are lovely too. One relative commented that there were ample activities, and that there were generally good quality grounds and facilities. We spoke to the fulltime chef in charge of catering and a nurse that works part-time in the kitchen. There are four catering staff preparing all meals from 7:30 until 19:00 hrs and there is also a daily kitchen assistant. Most meals are prepared from fresh ingredients, and homemade soup and cakes are prepared daily. We looked at the menus that are changed every month and take into consideration seasonal variations. A lot of thought has gone into preparing menus with a variety of food that people can choose from, and peoples preferences are known. There are two choices for each course, however, for breakfast there are a variety of cereals and cooked food. The chef told us a variety of light meals are always available for example; omelette, jacket potatoes and salads. We recommended that these alternatives are always displayed on the menu board and that care staff offer them when recording peoples choice from the main menus. There was little dessert choice for people with diabetes, however, we were informed that sometimes desserts are made with artificial sweeteners so that everyone can enjoy them and there is usually a sugar free jelly dessert prepared. There was plenty of food in the kitchen, including a lot of fresh fruit and vegetables. The chef told us there are three food deliveries each week to include fresh meat and vegetables, and that because people complained about the quality of the meat the supplier was changed and the quality has improved in the last few months. The food provided looked appetising and was well presented, which included soft diets. We observed staff helping people with their meals in a relaxed and appropriate manner. The chef told us that the kitchen is deep cleaned on a Saturday and that one area will soon have a stainless steel wall to help improve the kitchen cleanliness. There was also a daily cleaning schedule for kitchen staff to follow. We looked at some appliances and they were clean, however, the microwave seal needs replacing. The freezer seals Care Homes for Older People Page 18 of 37 Evidence: need replacing to lessen the risk of foods defrosting each week when they are removed. The broken freezer shelves also need replacing. The oven thermostat is not working correctly and needs to be repaired, as there may be occasions when food is overcooked, however, the chef told us people are not at risk from undercooked food as all food is probed to ensure safe temperatures are reached. The Environmental Health Officer gave the kitchen and food preparation a four star ( very good) rating in July 2009. We spoke to people and received the following comments;the food is ok, some meat needs lower and longer cooking as I cant eat it, I didnt realise I could have alternative snacks like an omelette or jacket potatoes, the food is very good and there is choice and variety, the food is lovely, plenty of choice , I think I have put on weight, and the food is fine, I can choose, sometimes I dont like it and I can have something else, The surveys returned to us in July 2009 may be out of date now as the quality of fresh meat supplied to the home has improved, people told us in the surveys that; food is sometimes cold and the quality is poor, the cooking could be better, the food is good but not cooked well, the desserts are excellent, I like breakfast and supper, but the cooked meat is always hard. Six people told us they always like the food, seven indicated usually, one sometimes and one never liked the lunch. Care Homes for Older People Page 19 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaint investigation could be improved and all records should be kept for inspection. People are protected from abuse by the homes safeguarding procedure. Evidence: The manager was unable to locate the complaints record, the AQAA told us there had been two in the last twelve months. We looked at the complaints procedure and recommended that it mentions a reply should be received within 28 days, in line with the regulations. We were aware of one complaint by a relative and had seen the letters, the complaint was investigated by the Responsible Individual (RI). We discussed this complaint with the RI for the Company and found that the investigation was inadequate as the complainant had not been spoken to as we had advised, and subsequent interviews of staff were inappropriate. This may be due to inexperience of investigating this type of complaint, however, the RI did eventually interview the complainant. The interruption of the interview by one of the providers was perceived by the complainant as unprofessional and inappropriate, which gave us cause for concern. The surveys returned to us told us that nine people knew how to make a complaint and seven people did not know. We recommended to the manager that she ensures that all people have a copy of the complaints procedure, and that her regular Care Homes for Older People Page 20 of 37 Evidence: individual contact with people may help to highlight any concerns. People should also be made aware that the complaints procedure is in their own copy of the servcie users guide. We looked at the safeguarding procedure for the staff, which was comprehensive and included the different types of abuse for staff to recognise. We recommend that the local South Gloucestershire safeguarding team contact details are included to help ensure that they can be easily contacted. The home also had a copy of the Department of Health guidance about whistle blowing called No secrets. The manager was able to give us an example where she had followed the safeguarding procedure and a member of staff was reported to the Independent Safeguarding Agency (ISA) for possible inclusion on the barring list. The manager told us that most of the staff have had safeguarding training, we looked at a copy of the training matrix provided by the home and several staff were about to complete Protection Of Vulnerable Adults training in October 2009. Care Homes for Older People Page 21 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally the home is well maintained, however some areas require attention. Some peoples privacy and dignity were not respected with regard to ensuite toilet facilities. The temperature of the home for vulnerable people was inconsistant. The home was clean throughout with the exception of some carpets that may need replacing. Evidence: We looked at all the areas in the home with a registered nurse. People can enter the home easily, however, there is a keypad to leave the home. The gardens are not secure, however, the manager told us that there is a minimal risk for anyone with dementia healthcare needs wandering away from the home. A relative told us that they were concerned that the home was not secure and that anyone could enter. The dining room was being used by staff as an office area for completing and storing records, and for staff handovers between shifts. This practice is an unacceptable use of the peoples home, and is inappropriate for the storage of confidential records. The communal areas were generally satisfactorily maintained, however, we noticed some minor issues in the dining room, which the manager agreed to address. We spoke to one of the five domestics who told us that her hours had increased to complete a more thorough clean in some rooms, for example vacuuming curtains. Care Homes for Older People Page 22 of 37 Evidence: Apart from several carpets the home looked clean throughout, and there were no offensive odours. The majority of surveys returned to us told us the home was always clean. The following carpets require cleaning or replacement; the dining room, the conservatory, bedroom 3, 12, 20, 21, 24, 36 and the staff room. We saw the maintenance man cleaning a carpet in an empty bedroom and he told us that the home has suitable equipment to clean the carpets. Should people refuse to have their bedroom carpet cleaned this must be recorded. We noticed one bath had hazardous, badly damaged bath panels, which were replaced during the inspection. We also noticed that bedroom 21 needs decorating, however, the provider is planning to refurbish several rooms in the older part of the home soon. The furniture for the bedroom refurbishments was being stored in one of the communal areas, which is unacceptable and the manager must ensure they are stored elsewhere. There are several bathrooms, however, none have a fully adjustable bath for people unable to use the bath hoists, and there are no showering facilities in the home. The Responsible Individual for the company told us that there are plans to include a showering facility in the home, which may provide several frail people with the opportunity to be showered instead of having a bed bath. We asked that more of the existing toilet facilities near the communal rooms be identified for use by people living in the home, as there were two staff toilets and a visitors toilet. We discussed this with the manager who agreed that two of the toilets could be made available for people to use. One person told us that when people are having a bath they are unable to easily access the toilets. Two people told us that their bedrooms were too cold and we noticed there were no individual thermostats to control bedroom temperatures in the older part of the home. The radiators were cold and the rooms felt cold. We asked the same people on a different day if there was any improvement and one person was still cold. We were told that problems with the older heating system had been resolved. People must be warm enough and a regular check of bedroom temperatures must be made to ensure people are comfortable. The manager showed us the temperature reading from a thermostat located in the office, this recorded 22 degrees centigrade, however,this did not tell us what the bedroom temperatures were. Staff told us that several people in the older part of the home complained of being Care Homes for Older People Page 23 of 37 Evidence: cold particularly at night. We saw a portable heater not in use in the lounge, should any portable appliances need to be used they must be safely fixed to the wall. We discussed with the manager the use of a portable humidifier in one lounge, which if required should be fixed to the wall to avoid accidents. We were told the humidifier was used to reduce any mal odours. All the ensuite toilet facilities provided are accessed by a wide arch and have no door for privacy and dignity. Some people were sitting very close to the toilets and may be affected by any mal odour, even though there was an extractor fan. We informed the manager that one person wanted a larger towel rail in the toilet. People on the ground floor with ensuite toilets may need net curtains at the window for privacy as the ensuite toilets do not have a door. We recommended that the manager completes an audit asking people, on the ground floor in particular, if they would like a privacy curtain at the window. During the inspection a privacy curtain was provided at a ground floor window for one person on respite care who felt that her dignity was compromised when using the ensuite toilet. We spoke to five people in their bedrooms about the ensuite facilities and all of them wanted a door to provide them with privacy and dignity. One person had provided her own screen once, however, it was deemed unsuitable. Whilst we can appreciate that the provider may not be able to complete this important task immediately a safe solution to the problem must be found, and the manager should ask everyone with an ensuite facility their wishes for an improvement. The results from a recent quality assurance survey completed by people living in the home indicated that one person wanted a door to the ensuite toilet facility. We looked at the maintenance book and spoke to one of the two maintenance men and it indicated that they were completing tasks around the home to help ensure people were in a safe and well maintained home. Three lifting hoists had tape on them to repair cracks and a faulty switch, all had been serviced this year according to the records. The manager was asked to ensure that one standing hoist had a replacement part as the crack may be hazardous, and to check with the manufacturer that the other two hoists were safe to use. The home has an infection control policy, and we saw staff using disposable aprons and gloves. We looked in the laundry, which was clean and well organised, and spoke to the laundry staff. The home has appropriate washing facilitates to manage all the laundry, however, red bags should be used for soiled laundry to reduce the risk of Care Homes for Older People Page 24 of 37 Evidence: cross infection. We recommend that there is a laundry infection control policy posted in the laundry to help ensure that all staff are kept informed. Most of the staff have had infection control training or it was planned for later this year. We were told that some of the beds were not suitable and did not have brakes, and we looked at one with wheels that did not have working breaks. One person living in the home told us their bed was uncomfortable. The manager should complete an audit of all beds to ensure they are safe and that people are protected and comfortable. Care Homes for Older People Page 25 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were sufficient staff available to met peoples needs. The home has thorough recruitment procedures to help protect people, and the staff complete a comprehensive induction and are well trained. Evidence: The manager told us that currently there were nine empty rooms in the home and that the staffing levels had remained the same. We looked at the staffing rotas and there appeared to be sufficient staff to meet peoples current needs. There was no evidence on the rotas provided to us when the registered manager was on duty and in day to day control of the home, the manager must be on the staff rota to help us and everyone in the home know when she is available. The manager should complete regular recorded staffing level assessments to help ensure that there are always sufficient staff available, according to peoples dependency, to meet all their needs. A recent complaint concerning staff availability during the afternoon and evening has changed the way staff take their breaks, which ensures that there are now more staff available to meet peoples needs at that time. The sixteen surveys completed by people living in the home indicated that; nine people thought there are always staff available, three usually, one sometimes and one never, two did not fill in this section. Care Homes for Older People Page 26 of 37 Evidence: The manager told us about some changes, for example there are now two activities staff and additional admin staff. One trained nurse is now the homes part-time clinical manager and is seen by some staff as the deputy manager. We looked at the minutes of one of the regular quarterly nurse meetings, these were detailed and recorded that Mental Capacity Act training was planned for all the staff. We looked at the homes training matrix, which told us about the recent training completed. Most staff, including the homes bank and ancillary staff, have completed mandatory training, which includes moving and handling, fire safety, first aid and food hygiene. In addition to this most staff had also completed or were about to complete protection of vulnerable adults and infection control training. The manager is keen to ensure the staff are well trained and completes much of the training herself, in house. There are twentyeight care staff and seventeen had completed NVQ level 2 in care or above and four are currently working towards the qualification. We looked at two recent recruitment records and the information was complete. Interviews are recorded in a checklist format, which covered the relevant areas and there was room for additional comments. Training certificates had been photocopied and kept on the staff file. References were sought and applications forms completed to ensure that any gaps in employment can be explored. Criminal Record Bureau checks however, should not be photocopied and the original should be destroyed when appropriate. The Skills for Care Common Induction Standards are completed by all new staff recruited. We interviewed five care/nursing staff, and spoke briefly to three other staff and they all felt that their training needs were being met and that any additional training required would be identified at supervison. The qualified staff were concerned that they may not be able to access agency staff when nurses call in sick and the manager is not available, which may mean them working a very long shift to ensure the home always has qualified staff on duty. Care Homes for Older People Page 27 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality assurance procedures include people living in the home and some good results were seen, Further improvements could be made to include visiting professionals and relatives. The management could be improved as some health and safety issues need to be addressed, and the manager may need to be more accessible. Evidence: The manager is experienced and well qualified, to include completing the Registered Manager Award. However, the management of the home does not appear to be open and inclusive as some staff and five relatives sometimes found the manager unapproachable with regard to highlighting concerns. People living in the home also told us that they rarely spoke to the manager. We discussed this with the manager who was unaware of the perception some people had and stated that she had an open door policy that anyone could contact her. We recommend that the manager spends more time talking with the people living in the home and that her duties regarding training are shared with the clinical manager or a deputy manager. Care Homes for Older People Page 28 of 37 Evidence: We looked at the results of a satisfaction survey completed by people living in the home in March 2008. A coloured bar chart had been completed and the manager told us that the results and any remarks made had been posted on the notice board for everyone to see. We recommend that relatives and visiting professionals are included in quality assurance surveys. Another survey had been completed recently, however, the final results had not been collated. We also looked at a sample of the last surveys, which indicated that many of the results were positive. We looked at the record of two service users personal monies, and the records and monies were correct. The staff are supervised formally and we looked at a sample of the procedure used. The staff also told us they were supervised regularly. All records must be stored securely, not in the communal rooms, and staff must have additional space to complete records and have confidential meetings about peoples care. We were concerned that the manager had not notified us about a recent fire in the home as the regulations require. People had been asked to sign a disclaimer regarding the practice of wedging the fire door open to their bedrooms. This is unsafe practice and we advised the manager to contact the fire safety officer. We saw many rooms with fire doors wedged open and staff told us they were also wedged open at night. The risk assessment should be reviewed and alternatives provided, for example Dorguards that close when the fire alarm is activated. We looked at the homes fire risk assessment that stated the unsafe practice and subsequently contacted the local fire safety office. The fire safety officer agreed to visit the home to ensure safe practice and advise the manager. The manager is responsible for health and safety in the home and had completed a Health and Safety Awareness course, and had recorded risk assessments in the home. We looked at the maintenance book and spoke to the maintenance man, and staff were recording issues and a date was noted when they were complete. As mentioned in the environment section of this report, regarding the lifting hoists, although they had been serviced they had been temporarily repaired in the home with tape, which is unsatisfactory and may not agree with the manufacturers instructions. The manager agreed to ensure that the split knee pad of a standing hoist is replaced as soon as possible. The manager assured us that the equipment was safe, Care Homes for Older People Page 29 of 37 Evidence: however,all repairs must be in accordance with manufacturer instructions and replacement parts provided where required. One staff member told us that the home needs more hoists to help meet peoples needs. We were told that some beds do not have breaks that work and are unsafe, and we saw an example. We recommend that the manager completes an audit of all the commodes, bed tables and beds as some may need to be replaced. The AQAA told us that all the homes policies and procedures had been reviewed this year and that equipment had been serviced or tested as recommended by the manufacturer or other regulatory body in 2009 or 2008. We looked at the Regulation 26 records where the Responsible Individual for the Company completes a monthly check of the home and looks at procedures. The record also included comments from people living in the home. Care Homes for Older People Page 30 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 All medicines in the home 30/01/2011 must be kept safely so as prevent unauthorised access and within the temperature range specified by the manufacturer or pharmacy. This refers to the particular storage issues identified in the report. This is to make sure medicines are always stored securely and at the right temperature as the manufacturer or pharmacist directs and not be a risk to people living in the home. 2 9 13 Warfarin medication must be 30/01/2011 administered from the correct named boxes for each individual. This is to ensure legal and safe practice as the medication remains the property of the people it is prescribed for, and this Care Homes for Older People Page 32 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action allows for clear audit trails to be completed. 3 9 13 Review medicine records 30/01/2011 and care plans for people living in the home to make sure that for all medicines prescribed with a direction when required or with a variable dose there is always clear, up to date and detailed written guidance for staff on how to reach decisions to administer the medicine and at a particular dose, taking into account the provisions of the Mental Capacity Act 2005. This will help to make sure people living in the home receive the correct amounts of medication in a consistent way in line with planned actions. 4 10 23 People must be consulted and their needs met with regard to enclosing ensuite facilities. This is to ensure their privacy and dignity at all times. 5 25 23 All areas of the home must be kept at a comfortable temperature for people, and this should be monitored as 30/01/2011 30/01/2011 Care Homes for Older People Page 33 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action bedroom radiators do not have individual thermostats This is to ensure that vulnerable people are in comfortable temperatures at all times. 6 38 23 The lifting hoists must be repaired in accordance with manufacturer instructions and replacement parts provided where required. This is to ensure safe practice when hoists are used. 7 38 23 The fire risk assessment 30/01/2011 should be reviewed as fire doors were wedged open day and night. Alternatives must be used in consultation with the fire safety officer. This is to ensure that everyone in the home is protected from the effects of a fire. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 30/01/2011 1 1 We recommend that fee information is provided before a person decides to move in. This is a legal requirement to help ensure transparency, and to help people understand about the amount of Registered Nursing Care Contribution they may be entitled to. Page 34 of 37 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 2 3 7 7 We recommend that clear protocols are recorded for seizure management. We recommend that wound care plans could be more detailed, and that the description or a photograph should record progress of the healing. We recommend that the manager ensures that all accidents are recorded and audited monthly to help identify where prevention is possible. We recommend that all healthcare professionals that visit are recorded separately other than in the daily records to enable a clear picture of support and outcomes to be readily available for review. We recommend that qualified staff have medication training updates to ensure their safe practice. We recommend that a copy of the medication policy and procedure should be kept with the medication, to include a list of homely remedies agreed by the doctor for each person. Also that the home has a copy of the Royal Pharmaceutical Societys guidance. We recommend that arrangements are made to write the date on containers of any medicines when they are first opened to use and record the quantity of any stocks of medicines that are carried forward to the next medication cycle. This is to help with good stock rotation in accordance with the manufacturers or good practice directions and to enable audit checks that medicines are being used correctly and the right quantities remain in stock. We recommend that a regular audit of each persons medication is completed to help identify any errors or poor practice. The oven thermostat is not working correctly and needs to be repaired, as there may be occasions when food is overcooked. The freezer seals need replacing to lessen the risk of foods defrosting each week when they are removed. The broken freezer shelves also need replacing. We recommend that the manager ensures that all people have a copy of the complaints procedure, and that the managers regular individual contact with people may help Page 35 of 37 4 7 5 8 6 7 9 9 8 9 9 9 10 15 11 15 12 16 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations to highlight any concerns. 13 16 We recommend that only registered persons are involved in investigating complaints to do with the day to day running of the home. The complaints procedure should include that a complainant should recieve a reply within 28 days in line with the regulations. We recommend that the local South Gloucestershire safeguarding team contact details are included in the safeguarding procedure to help ensure that it is easy for staff to contact them. We recommend that the dirty carpets identified are either cleaned or replaced. Communal toilet facilities could be improved as many bedrooms do not have ensuite facilites. The manager should complete an audit of all beds to ensure they are safe and that people are protected and comfortable. We recommend that there is an infection control policy posted in the laundry to help ensure that all staff are kept informed, and that red bags are used for soiled laundry to promote infection control. When the manager is unavailable qualified staff should be able to contact an agency to ensure that there is a qualified nurse to continue cover. The manager should complete regular recorded staffing level assessments to help ensure that there are always sufficient staff available according to peoples dependency to meet all their needs. We recommend that the manager spends more time talking with the people living in the home and that her duties regarding training are reduced. We recommend that relatives and visiting professionals are included in quality assurance surveys. All records must be stored securely, not in the communal rooms, and staff must have additional space to complete records and have confidential meetings about peoples care. 14 16 15 18 16 17 18 19 21 24 19 26 20 27 21 27 22 32 23 24 33 37 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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