Inspection on 01/05/07 for Woodlands Nursing Home

This inspection was carried out on 1st May 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Woodlands Nursing Home 31/03/08

Woodlands Nursing Home 18/09/07

Woodlands Nursing Home 02/11/06

Woodlands Nursing Home 31/05/06

Woodlands Nursing Home 19/10/05

Woodlands Nursing Home 29/04/05

Woodlands Nursing Home 10/02/05

Woodlands Nursing Home 17/09/04

Woodlands Nursing Home 08/04/04

Similar services:

Whiteley House

Tyndale Avenue

2-10 Norfolk Road

Bennfield House Nursing Home

Eastfield Residential Home

Sign Health

Springwood

Fairburn Mews

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

CARE HOMES FOR OLDER PEOPLE Woodlands Nursing Home Sands Lane Mirfield West Yorkshire WF14 8HJ Lead Inspector Sally McSharry Key Unannounced Inspection 09:50 1 , 15 and 17th May 2007 st th 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 Nursing Home DS0000001100.V333445.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 Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodlands Nursing Home Address Sands Lane Mirfield West Yorkshire WF14 8HJ 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) 01924 491570 01924 497377 Woodlands.Mirfield@Craegmoor.co.uk Speciality Care (REIT Homes) Limited vacant post Care Home 87 Category(ies) of Dementia - over 65 years of age (87), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (87) Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Can provide accommodation and care for 5 named service users under 65 years of age. 2nd November 2006 Date of last inspection Brief Description of the Service: Woodlands Nursing Home provides nursing, personal care and accommodation for up to 87 older people who suffer from dementia type illnesses and mental disorders. Woodlands is a large, brick built home set within 47 acres of woodland. The home is divided into 4 units over two floors. Access to the first floor is gained via a passenger lift. The home provides single and double room accommodation. Some rooms have en-suite facilities; some rooms have a small cubicle which is fitted with louvre doors; the cubicle contains a toilet. The home is in a secluded position, one mile from public transport. The home has a mini bus which is sometimes used to help visitors travel to Woodlands. Woodlands has its own gardens that includes patio areas, seating, an orchard and a pond. Some outside areas are securely fenced to allow freedom to walk or sit in a protected setting. The provider informed the Commission for Social Care Inspection on 23rd March 2007 that fees range from £344.71 to £596.29 per week. Additional charges include hairdressing, private chiropody, newspapers, special toiletries, tobacco and some clothing. Information about the home and the services provided are available from the home in the Statement of Purpose and Service User Guide. Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included three unannounced visits carried out at the home by two inspectors. The first visit took place at 9:50 pm on 01/05/07 and lasted for two hours and forty minutes; the second commenced at 9:15am on the 15/05/07 and lasted seven hours forty five minutes and the third started at 10:45 am on the 17/05/07, on this occasion the inspectors were at the home for eleven hours and fifteen minutes. During these visits, the inspectors spoke to some of the people living in the home, visiting relatives, some of the staff and the home’s management. On 17/05/07 the inspectors also sat in on a relatives’ meeting at Woodlands attended by some of the relatives of people living in the home, representatives of the home’s management team and senior managers with in Craegmoor Health Care Ltd. On the first visit of this key inspection, carried out on the evening of the 01/05/07, the inspectors found that the home was one member of staff short on the night shift. There were eight members of staff on duty, rather than nine. The inspectors also found that the staff on duty did not have access to sufficient bed linen, wipes and continence aids. Inappropriate repairs had also been made to some bedrails in use in the home. At that visit, the inspectors left an immediate action form asking the registered provider and acting manager to take immediate action to address these issues. The Commission for Social Care Inspection received written confirmation that staffing levels would be maintained at nine night staff at night, new bed linen had been ordered, sufficient wipes and continence aids had been provided. New bedrails had been ordered to replace those with inappropriate repairs. During the visits, the inspectors read care records, audited a sample of medications, reviewed staff recruitment and training records, carried out a brief tour of the building and observed members of staff working with the people who live in the home at mealtimes and at different times of the day and night. Prior to the inspection, twenty questionnaires were sent to Woodlands to obtain the views of people living in the home about the service provided. One completed questionnaire was returned. Many people living in the home are physically and mentally frail and may have difficulty completing a questionnaire, therefore surveys were sent to seventy two relatives/ representatives of the people living in the home to obtain their views. Twenty five completed surveys were returned. Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 6 Three surveys were sent to visiting health care professionals that visit the home including a person’s doctor. All three completed and returned surveys. Other information used in the inspection process included notifications from the provider to the Commission for Social Care Inspection about any deaths, illnesses, accidents and incidents at the home, copies of the monthly management visit reports produced by the provider, minutes of residents’ meetings and a pre inspection questionnaire completed by the provider and manager. The inspectors would like to take this opportunity to thank everyone who participated in the inspection process. What the service does well: What has improved since the last inspection? The management and control of people’s finances has improved. Records are clear and show that people in the home receive their personal allowances and have access to their money. Any money held by Craegmoor on behalf of people is now in an account that earns interest for the individual. The standard and quality of meals available has improved. One relative commented “The food is good.” Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 7 Two bathrooms in the home have been refurbished. What they could do better: Woodlands Nursing Home has had a history of fluctuating standards of care. The CSCI have taken enforcement action against the home in the past. Standards improve for a short period, however Craegmoor Health Care Ltd struggle to sustain improvements for any length of time. Care standards in the home vary from unit to unit, and from day to day. During the three visits carried out, the inspectors saw some good care delivered to people by skilled, caring and competent members of staff. However, this does vary and poor practice and care was also witnessed. This included people looking unkempt and unclean, people who had been heavily incontinent waiting to be helped with hygiene and changing of clothes or bedding, a poor standard of support and supervision for some people at mealtime and a lack of regular meaningful activities for the people living at Woodlands. Although staff from the home assess people’s needs before they are admitted to Woodlands, there is evidence that not all the needs of people living at the home are being met and some relatives are dissatisfied with the care and environment provided. One relative stated, “I find visiting very depressing. People urinate as they sit but, though staff change them, I have never seen a chair disinfected or even wiped dry before allowing another resident to sit in it”. Another said, “The care is adequate. However, there appears to be a lack of suitable staff, who appear to have other duties, for example, the management undertaking decorating”. Although people in the home have care plans and some are of a good standard, the standard is inconsistent. Some care plans lack the detailed information needed for care staff to care for the individual appropriately. People’s privacy and dignity is not being maintained in the home. Examples were seen during this visit and relatives also advised of poor practice such as people not being dressed in their own clothes. Some activities are provided and relatives were complimentary about individual members of staff and the efforts they make. However, there is a lack of stimulation and activities for people living in the home. Some relatives commented, “There appears to be little social interaction, as unfortunately language and different cultures are becoming more of a problem;” “ Residents do not appear to be encouraged to participate in any form of activity which would stimulate them. Outings are very rare;” and “I do feel there is a lack of Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 8 stimulation or simple conversation and reminiscence.” Suitable activities must be available to all people living in the home. Staff at the home are not supporting individual people maintain their spiritual and cultural backgrounds. Action must be taken to support people to maintain their spiritual and cultural needs. This includes the observation of dietary laws. The home has a complaints procedure and people said they were aware of it and able to use it. However, some verbal complaints made at the home have not been responded to formally. All complaints should be dealt with formally using the company’s complaints procedure. Some redecoration, repairs, maintenance and refurbishment have taken place at the home. Issues about the environment, the standards of furnishings and fitting have been raised both by the inspectors and relatives and representatives. Comments made include “The building itself could be improved with decoration and the unit I visit new windows. The garden is a disgrace and, as it stands now, residents who can walk out would not enjoy it much”, “over the years the condition of the care home has deteriorated and we have been unable to ascertain Craegmoor’s future plans to address this problem,” “They have recently changed the carpet but there is still a heavy smell of urine which will not disappear with air freshener” and “The home could do better. Needs better staff. The home needs to get repairs done to windows”. The entire building must be audited inside and out and a detailed action plan developed to address the issues. Some staff shortages have been noted and concerns raised about the high number of overseas staff employed which, in some cases, has led to communication difficulties. Although a good level of training is evident in the home, evidence seen during the visits shows that training and good practice is not always being implemented in the home. Comments about staffing from relatives include, “The staff appear to work to the best of their ability with obvious limited resources and staff;” and “They seem to have a regular turnover of staff. Some staff not experienced in care and some don’t speak good English. They should ensure care workers have the appropriate level of experience/training and language skills.” The home must ensure that, at all times, they have sufficient numbers of skilled, experienced and competent staff to meet the needs of the people living in the home. Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 9 The recruitment process and practice operating at the home is not fully protecting people. References are inappropriate and the training needs of staff that have been employed from overseas need to be reviewed to ensure people are able to communicate well. Training records show a good amount of training has been delivered at Woodlands, however care must be taken to ensure staff, once trained, are competent and deliver care to a good standard. Woodlands has been without a registered manager for more than two years. A new acting manager has been in post since January 2007. Records in the home show that the company has carried out quality audits about the services provided in the home. However, evidence seen during these visits showed that the reports made about the quality of the service and the state of the building are inaccurate. Feedback from relatives indicates their views are not taken into account. The service is not being run in the best interests of the people living there and the company has failed to make improvements and address issues, which have been repeatedly raised by the CSCI or by relatives. Some of the comments made by relatives about Woodlands and how the home could improve include, “We regularly attend relatives’ meetings with the manager and the activities co-ordinator at Woodlands. Despite repeated requests for Craegmoor management to attend these meetings, to date they have either been unwilling or unable to attend;” and suggested improvements “Permanent management for continuity of care, more staff, higher percentage of English speaking staff, more interaction for residents, residents taken out even if they can only go as far as the garden. Maintenance of the inside and outside, especially draughty windows and dreary rooms”. The company must have an effective quality monitoring system. They must listen to what people say about the service and make improvements. Current health and safety precautions in the home are inadequate. The company is working with West Yorkshire fire safety officers to improve the fire protection systems in the home. During the visit the inspectors witnessed some unsafe practices, for example use of broken bed rails and wheelchairs, poor infection control practices. The acting manager and registered provider must carry out a detailed health and Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 10 safety audit. The person carrying out this audit must be trained and competent to complete such an audit. Issues identified must be addressed. 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. The summary of this inspection report can be made available in other formats on request. Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 11 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 Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who use the service are assessed before they move into the home. EVIDENCE: Before people are admitted to Woodlands, the acting manager and her deputy visit prospective residents and complete an assessment. This assessment helps the acting manager make a judgement as to whether Woodlands can meet the health and welfare needs of the person. Evidence gathered during this inspection showed people’s needs are not always being fully met at Woodlands. Care must be taken to ensure the home and the staff team can meet people’s needs before any new person is admitted to the home. Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 13 Records show that a copy of the pre-admission assessment is held at the home and that a copy of the Community Care Assessment (CCA) is also obtained. The CCA is an assessment produced by the social worker and other health care professionals and outlines the person’s health and welfare needs. Relatives and representatives confirmed that they were able to visit the home and look round before making the decision to place their relative at the home. Information about the home is available and a copy of the last Commission for Social Care Inspection report is usually available in the home’s reception. The home has admitted service users with a diverse range of needs and from a variety of cultural backgrounds, mainly from the local area. Woodlands Nursing Home does not currently provide any intermediate care. Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Care plans do not always include all people’s health and welfare needs. The staff at the home are not maintaining people’s privacy and dignity. EVIDENCE: People living in the home have a care plan. This should provide written information about the individual, their health and welfare needs and give members of staff clear and specific advice as to how that individual person’s needs are to be met whilst in Woodlands. Some of the care plans do this, however others failed to give the necessary detail or information to ensure good quality care is provided. For example, one care plan did not say where a person’s wound was on their body, what the wound was to be dressed with and how often it was to be dressed. Care plans failed to provide specific information about individual people’s continence care and management. Relatives and members of staff spoke to the Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 15 inspectors in person, and in surveys, about people in the home being incontinent and the failure of members of staff to wash and change people promptly. Evidence of this was seen during each of the three visits to the home. Care records fail to show what continence aids are to be used for individuals. When the inspectors talked to members of staff, there was confusion about how the continence pads and aids are supplied and which people wear which pads and aids. This results in poor continence management for some people in the home. Some people are often wet and soiled and, in some areas of the home, there are unpleasant odours. Care plans fail to provide detailed information about people’s social, cultural and spiritual needs and people’s needs in these areas are not being met. This included failing to help people observe dietary laws. Care plans must be individualised, detailed and specific. They must clearly identify all the health care and welfare needs of the individual and tell staff specifically and in detail how those needs are to be met in the home. This will help ensure each individual person’s needs are fully met, taking into account any preferences, likes and dislikes, cultural and spiritual needs. There is evidence that assessments in relation to health care needs are being carried out and action taken to minimise risks identified, such as nutritional assessments, fall risk assessments, assessments to predict the risk of developing pressure ulcers and movement and handling assessments. Care plans and risk assessments are reviewed and evaluated monthly. Surveys returned by health care professionals indicate that members of staff are pleasant but communication with some staff can be difficult due to their language skills. During the visits, a sample of medications were checked on different units. These checks showed that medications are being stored, recorded, administered and destroyed appropriately. Medications entering the home can be accounted for. Information and evidence about people’s right to privacy and dignity within Woodlands varies. Some people in the home were confident that their relative or friend in the home is being treated correctly. However, other information provided by relatives or friends in surveys, during conversation with the inspectors, information provided at the relatives meeting and observations during the visits evidence, indicated this is not always the case. For example, some privacy curtains in shared rooms do not extend to the length of the room, therefore if someone was having a strip wash by the sink, they would be in full view of the other occupant in the room. Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 16 Some toilet and bathroom doors do not close properly in the home and do not afford privacy. Relatives in surveys and during conversation with the inspectors spoke of people often being “soaking wet” when they visit. During the visits the inspectors brought to the attention of staff two people who were being nursed in bed who were very wet and needed changing. In one of those cases the smell of urine was very strong and unpleasant. Some people were seen in an unkempt state, clothes dirty and dishevelled and gentlemen unshaven. Relatives spoke of people being dressed in other people’s clothing on a regular basis; the inspectors noted one gentleman wearing another gentleman’s slippers. The inspectors realise these examples of lack of a privacy and dignity do not occur all the time, however they occur in such frequency to indicate generally standards are poor in the home and must be improved. Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People living in the home are not having their lifestyle needs and expectations met. There is limited access to social activities and people’s cultural and religious needs are not maintained. People are able to maintain contact with their families. Some people are not supported as they should be in eating their meals. EVIDENCE: At the last inspection in November 2006, it was identified that people in the home did not have access to adequate activities. It was made a requirement of the last report that further social activities be provided. The registered provider responded on 07/01/07 stating that two activity co-ordinators had been provided, a new board had been provided in the entrance showing what daily activities were taking place, a new activities room had been provided, TV aerials had been replaced by digital boxes to improve the TV reception and quality of picture. A new TV was to be purchased and the activities coordinator was to document activities in care plans. The work done to improve the TV reception in the home has made a positive difference to viewing. Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 18 At this visit, staff and relatives informed the inspectors that the second activities person had left the home and the activities room provided in January had been taken from the activities co-ordinator. They also reported that the one remaining activities co-ordinator, who works 37.5 hours per week, now has the added responsibility for some driving of the mini bus to collect visitors to the home and has been assisting in the redecoration of the home. Documented activities are minimal. Staff and relatives spoke of some activities, however these are insufficient to meet the needs of all the people living in the home. Some care staff on some units provide some activities, however this is insufficient to meet all the needs of the people in the home. It remains a requirement of this report that activities be increased to meet the needs of all the people living in the home. Although there is some evidence of increased spiritual support for people in the home, this is not consistent. Following a conversation with a relative regarding a person from a religious minority living in the home ,the inspectors asked staff how they were meeting this person’s spiritual and cultural needs. Evidence was that these needs were not being maintained at all. This was discussed with two members of staff, who later that day reported having made dietary arrangements and said they were trying to contact the local religious leader. Later that day, the inspectors checked what this person was having for their evening meal, to find that staff had provided a meal that directly contravened their dietary laws. This was brought to the attention of the manager, regional manager and responsible individual for the company. People’s spiritual and cultural needs must be respected and maintained. Some relatives and representatives reported difficulties visiting the home on a regular basis due to its location. However, those that do visit said they were welcomed by staff and offered hospitality. The home has made some efforts to assist visitors who have difficulty getting to the home by offering them transport in the home’s minibus. The standard of choice offered to people living at Woodlands seems to vary depending on which unit people live and what staff are on duty. During the three visits made to the home, the inspectors saw some staff offering choices to people around what time they would like to get up in a morning, go to bed at night and meals and refreshments offered. Some care plans include people’s specific likes and preferences, however care plans with this level of detail are in the minority. People who live at the home, and relatives, were complimentary about the standard of catering at the home. Three main meals are offered and two Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 19 suppers are provided. The meals being provided whilst the inspectors were at the home looked and smelt appetising and attractive. Some staff were aware of people’s specific likes and dislikes in relation to their diet and contacted the kitchen for alternative meals for individuals. Meals on some units were calm and organised and staff assisted people who were unable to feed themselves appropriately. However, this was not always the case, the inspectors witnessed some poor practice. One member of staff was standing over a person who was sitting in an armchair. The member of staff was not talking to the person and was spooning food into the person’s mouth. One person was seated in an armchair, their meal had been placed on another chair in front of the person. The person was not able to reach their meal or eat in any comfort or dignity. One person was expected to eat a meal in a room where another person had vomited. Some attempt had been made to clean the vomit up, however the smell was evident and there were still signs of the vomit on the floor. During a visit, one person’s relative had raised concern with members of staff in the home that the person wasn’t eating enough. The acting manager asked staff to make a record of this person’s dietary intake. This record had been maintained for one day only, which was insufficient to make a reasonable judgement about the person’s dietary intake. These are a few of the examples of poor practice seen during the visits. Action must be taken to ensure people are supported and assisted properly to have their meals. Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Complaints made at the home are not always dealt with appropriately. Service users are being protected from abuse. EVIDENCE: The acting manager maintains a record of complaints made at the home. Three complaints have been recorded since the last inspection. One had been upheld and two were still being investigated. During discussion with some relatives and staff, it appears that not all verbal expressions of concern or dissatisfaction are being dealt with as a complaint. The acting manager says she has, in some cases, responded verbally but no written record of the event made has been made. During the visits, the inspectors heard one relative complaining to a member of staff. This was not logged or recorded as a complaint. Another member of staff told the inspectors that members of a family had raised concern with her about the state of their relative’s room. The member of staff had advised the visitors to speak to the acting manager. The acting manager had not seen the visitors and therefore knew nothing of their concerns. The acting manager and members of staff must make a formal Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 21 written record of any concerns raised verbally with them. These should be acknowledged, investigated and responded to, in writing. The majority of staff have had adult protection training and this is also covered in induction training. Records show that appropriate adult protection referrals have been made and investigated by the Local Authority. Staff at the home have assisted during any such investigations. The company, where appropriate, have taken action to protect people living in the home. Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25, and 26. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People do not live in a well maintained home. The majority of indoor and outdoor facilities are poorly maintained. Some areas of the home are not clean or pleasant. EVIDENCE: After the last inspection in November 2006, the report held seven requirements relating to the maintenance and standard of accommodation at Woodlands. It would be unfair to say nothing has been done to improve the standard, however the overall standard remains very poor. The building is showing increasing signs of wear and tear and the maintenance programme in operation in the home is insufficient to keep pace with the level of work required, both inside and outside the building. Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 23 People who live in the home, relatives and members of staff raised concerns, in conversation, in surveys and at the relatives’ meeting about many areas in the home. There has been some redecoration in some communal areas and some bedrooms, however generally the standard of décor is poor. There is damage to plaster work in bedrooms and dining rooms, some of which has been badly repaired or filled with foam. The furniture is old, there are vinyl chairs which are badly cracked and staff have to cover these chairs with quilts and sheets to prevent the cracked areas catching people’s skin. Wardrobes, chests of drawers and under sink cupboards are shabby. Many doors do not hang properly and are loose; cupboard drawers do not have knobs or handles. Carpeting in some areas is worn, smells offensively and, when walking on the carpet, your feet stick to it. In some bedrooms there is vinyl flooring which is cracked and has holes in. Some metals strips between carpeting and vinyl flooring is lifting and could be a danger, possibly causing trips or injury. Externally, there are two garden areas, one of which is maintained by two dedicated relatives. To the front of the home, there is a lawned area and small orchard. People living in the home used to be able to walk out in this area, however it has been poorly cared for over the last few years. The grass has become overgrown and, although it has been cut, it is too long for elderly people to safely walk on. Over the past few years, there has also been a problem with rubbish being thrown out of the home’s windows onto the grounds. Again, at this visit, there were used safety razors, disposable gloves and empty tablet plaster packs thrown out of the windows on the grass area around the home. Since the last inspection, two bathrooms have been refurbished and those two bathrooms are a great improvement. However, the remaining bathrooms and toilets are of a very poor standard. There is rust visible on some of the “Parker” baths in the home. On one unit, the staff on duty had not been trained to use the new bath, of the other three older bathrooms on that unit there was not visible evidence that the baths had been used recently. This would indicate that people are not receiving baths. The toilets of the same unit are poor. One toilet off the dining room area had an area of faeces the size of a large hand on the doorframe; the toilet on the corridor could not be accessed as the door had “dropped” on its hinges, it was caught on the carpet and was very difficult to open. If someone living in the home had been able to get into the toilet, the door could not be closed, as it did not fit in the frame. The toilet off the lounge area on this unit was dirty, the door handle to the outside was broken, the privacy lock Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 24 didn’t work and, when inside the toilet, there was no handle at all. These two toilets were in the same condition throughout all three visits to the home. Not all bathrooms and toilets in the home had liquid soap, paper towels or a waste bin available. Therefore, basic hand washing facilities are not available to people living in the home or to staff. Hand washing forms the basis of good infection control and this is not well facilitated in Woodlands. Specialist equipment is available in the home. However, there is evidence that staff lack the skill, knowledge and competence to safely use some of the equipment. Bedrails which had broken had had inappropriate home made repairs. These repairs are not recognised by the manufacturer and the bedrails are classed as faulty. The inspectors asked for them to be removed and alternative arrangements made. Poorly fitting metal bedrails were seen in use and metal bedrails were used on a bed with two mattresses. Both these instances are potentially dangerous and staff were asked to take action immediately. Several relatives, visitors and members of staff raised with the inspectors in conversation, and in returned surveys, concern about some of the window frames in the home. A group of relatives have written directly to Craegmoor Health Care Ltd with their concerns. Some of the window frames are rotten on the outside. Members of staff and the person occupying one room told the inspectors that, when it rains in a certain direction, the rain comes into their room round the top of the window frame and leaks in. The person staying in this room finds this distressing. Relatives told of draughty windows in winter. On one unit relatives advised once, when they visited during the day, the windows were closed, curtains drawn and the people sitting in the lounge were wrapped in extra blankets to keep them warm; members of staff were said to be wearing their coats to keep warm. There has been an ongoing shortage of decent bed linen. One relative advised that they had purchased their relative their own bed linen to ensure they had sufficient of a good quality. Some new bed linen, pink and blue sheets, have been purchased however there is still some linen in the home which is faded to a dirty grey colour, some of it is very thin and worn. During the visits, some cups and plastic feeder beakers were seen to be heavily stained and required sanitising. Curtains in dining areas were dirty and greasy. Some privacy screens in shared rooms did not fully screen off the room or provide full privacy. Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 25 Some areas of the home are not clean or homely. Bathrooms, toilets and some carpets and bedroom areas were seen to be dirty. There was some evidence of faeces on corridors and toilet walls. Some carpets have an offensive odour and are sticky and dirty. Some radiators have debris down the back and in the radiator, when the radiator comes on and heats up it causes unpleasant smells. All the issues in this part of the report were identified during only a partial tour of the building. All the issues identified impact on the quality of life for the people living in Woodlands and some on their safety. These must be addressed. Some relatives have had a long association with the home and are aware that, although there have been recent changes in the management team, Craegmoor Health Care Ltd have owned and been responsible for the home for many years. The decline in the standard of accommodation has been ongoing for years and has been highlighted to the company both through inspection reports and via relatives’ meetings repeatedly. Some work has been done and members of staff at the home are just as keen to see improvements for the people they care for. A detailed and thorough audit of the standard of accommodation, furnishings and equipment is required. It is difficult to see how the issues can be properly addressed without a major investment by the registered provider. Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The staff recruitment process does not protect people living in the home. The numbers, skill mix and competencies of staff do not meet people’s needs fully or safely. EVIDENCE: The duty rotas show that, on occasions, there are staff shortages; this was also raised by members of staff in the home and relatives, both in returned surveys and in conversation with the inspectors. The visit carried out on 01/05/07 also identified a shortage of night staff. The acting manager and registered provider must ensure that, at all times, there are sufficient numbers of staff on duty, with the necessary skill, experience and competence to meet the needs of the people living in the home. Relatives, some members of staff and two health care professionals raised concern about problems with communicating with some members of staff. Many members of staff in the home are from overseas and, although they have to achieve a level of English language before employment, communication difficulties occur. The acting manger and registered provider should ensure Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 27 support is provided to overseas staff to help them improve their English and future recruitment plans should take into account the current high proportion of overseas staff already employed at the home. During these visits, the inspectors were concerned about some of the competency levels of some of the staff. Maintenance staff are carrying out audit checks and maintenance work and are not competent to do so. Therefore, safety issues relating to bedrails, wheelchairs and the fire safety system are not being addressed correctly or safely and potentially put people in the home and members of staff at risk. Some care staff are not providing care in an appropriate manner, people are not always being assisted with their meals properly. Staff are not using wheelchairs and aids and equipment properly. The inspectors saw members of staff transferring people in wheelchairs with one or no footplates. One bed that had an airflow mattress on was not working properly. Someone had placed a second soft foam mattress on top of the airflow mattress. This was brought to the attention of staff as inappropriate. Later, the inspectors checked this bed again; the person had been placed in bed on the airflow mattress, which had a fault, and the panel was indicating it was at low pressure, which means that the mattress will not be effective. Furthermore the alarm, which indicates to staff that the mattress is faulty, had been silenced. The staff showed a lack of competence to use or understand the safe use of this equipment. The matter was brought to the attention of the responsible individual of the company who ensured that the mattress was changed. The recruitment files of four members of staff were audited. The files of three new members of staff that have started at the home earlier in May 2007 had “to whom it may concern” references. Some were on headed paper and could be identified where they had been obtained from, however one member of staff had two “to whom in may concern” references both dated 02/05/07, one was on a blank piece of paper, there was no address or proof of where this letter was sent from or the referee’s relationship to the applicant. One member of staff was working unsupervised despite still awaiting a full clearance from the Criminal Records Bureau. Although this member of staff was working through their induction programme, they had not had fire or movement and handling training. This is not good practice and does not safeguard people properly. The acting manager advised that there has been a high level of training in the home. Members of staff and records supported this, however the evidence seen during these visits indicates that staff are not always working to an acceptable standard. Training is either of poor quality in terms of content or delivery and is not being understood by staff, or staff are not fully competent. Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 28 The acting manager and registered provider must ensure that all training is satisfactory, appropriate and that staff become and remain competent. Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 29 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People live in a home that is neither run in their best interests nor is appropriately or effectively managed. The health, safety and welfare of people is not always protected or promoted. EVIDENCE: Since the last inspection on November 2006, another acting manager has been appointed to the home. Ms Briggs has been in post since January 2007 and advised the inspectors that she is currently making application to the Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection to become the registered manager of Woodlands. Visits to assess the quality of services provided at the home have been delegated to people who are not competent to do the job. This means that faulty and unsafe equipment has remained in situ and that improvements that should have been made as a matter of urgency have been ignored. Since the last inspection, the company has audited people’s finances and this is one area in which standards have improved. The Company acts as appointee for some people who live in the home that require this help with managing their finances. Computerised records show funding being paid into named individual accounts and clearly identify people’s personal allowances. People living in the home can have access to cash amounts and any items purchased on their behalf is clear on the balance sheet. A copy of the supporting receipt is made and held at the home, the original receipt is sent to the company’s financial headquarters. It is also clear on the computerised records that the money held in these accounts earns interest and interest is added to the total balance. Some people living at the home have small amounts of cash held in the safe. This system also runs with a hand written balance sheet. A sample of these monies was checked and found to be correct, again receipts are available for items purchased on people’s behalf. At the last visit to the home in November 2006, officers from the West Yorkshire Fire Safety team were visiting the home and identified areas of serious concern. Craegmoor has not fully addressed fire safety issues in the home and, on 17/05/07, officers from the West Yorkshire Fire Safety team were again at the home. Timescales agreed with the fire safety officers for work to be completed had not been met. At the meeting on 17/05/07, an extension to the timescale was agreed and plans were discussed for a new system to be fitted throughout the building to replace the existing outdated system. The West Yorkshire Fire Safety team will monitor this work. As previously mentioned in this report, health and safety issues were identified by the inspectors relating to inappropriate repairs made to bedrails. Audits carried out on wheelchairs showed little wrong, however, in reality wheelchairs in use in the home were not safe. Some had no footplates and other had only one footplate. Weekly fire safety checks carried out in the home failed to identify a door that did not close properly and would be ineffective as a barrier in the event of a fire. Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 31 Razors and other items have been inappropriately disposed of; they have been thrown out of the windows and were seen to litter the exterior of the home. A competent person must carry out a full and detailed health and safety audit of the building to identify health and safety issues. Issues identified must be acted upon and the home made safe. Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 32 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 2 1 2 2 2 1 1 STAFFING Standard No Score 27 2 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 1 X 1 Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement All people using the service must have an up to date, detailed care plan. This will ensure that they receive person centred support that meets their needs. Staff must be trained, supervised and monitored to ensure people living in the home have their privacy maintained and their dignity upheld. All service users must have access to daily activities which meet their individual needs. Timescale of 13/11/06 not met. The staff must make suitable arrangements to help people maintain their religious beliefs and cultural needs. Action must be taken to ensure staff support and assist people properly with their meals and dietary intake. A record of all complaints made by people living in the home, their representatives and staff must be maintained and action taken by the registered person. A competent person must carry DS0000001100.V333445.R01.S.doc Timescale for action 30/06/07 2. OP10 12(4) 30/06/07 3. OP12 16(n)(m) 30/06/07 4. OP12 12 (4) 30/06/07 5. OP15 12(1) 30/06/07 6. OP16 17(2), schedule 4. 13(4) 30/06/07 7. OP19 31/07/07 Page 34 Woodlands Nursing Home Version 5.2 8. OP19 23 (2) 9. OP19 23 (2)(o) 10. OP19 23 11. OP21 23(2)(n) 12. 13. OP24 OP27 OP28 OP30 16 (2) (c) 18 (1) out a detailed and thorough audit of the standard of accommodation, decoration, furnishings and equipment. An action plan with realistic timescales produced to address all the issues and ensuring the home is a pleasant and safe place to live for the people at the home. The registered provider must ensure that all areas of the home are maintained to exclude draughts and leaks and maintain a comfortable and safe temperature. The exterior of the home must be maintained, kept tidy and safe for people to use. Timescale of 31/12/06 not met. All areas in the home must be audited and a redecoration programme implemented to keeping pace with the wear in communal rooms and bedrooms. Timescale of 31/11/06 not met. Toilet and bathing facilities and practice in the home must be reviewed to ensure areas are clean, well maintained and adequately equipped, to ensure service users can be adequately bathed in pleasant and hygienic facilities with the risk of cross infection eliminated as far as possible. Timescale of 31/07/06 and 28/02/07 not met. New suitable bed linen must be provided. Timescale of 30/11/06 not met. The acting manager and registered provider must, at all times, ensure that there are sufficient numbers of skilled, experienced and competent staff DS0000001100.V333445.R01.S.doc 30/09/07 31/07/07 30/07/07 28/07/07 31/07/07 31/07/07 Woodlands Nursing Home Version 5.2 Page 35 14. OP29 15. OP31 16. OP33 OP38 17. to meet the needs of the people living in the home. They must ensure that training is satisfactory and staff become and remain competent to do their job. Schedule The acting manager and 2. registered provider must not Regulation allow a person to work in a care 7,9, & 19. home unless the employer is satisfied that the references supplied are authentic and appropriate. Staff employed at the home with a POVA First check must work under supervision unit a CRB check has been obtained. 9 The registered provider must put forward a suitably qualified and skilled person of good character to manage the care home. Timescale of 31/12/06 not met. 10, 12, 15 Effective quality audit systems and 24. must be implemented to maintain and monitor standards in the care home. Timescale of 30/11/06 not met. 12(1) A competent person must carry 13 (2-5) out a full and detailed health and 16 (2) safety audit of the building to 23(4-5) identify health and safety issues. Issues identified must be acted upon and made safe. 30/06/07 31/07/07 31/07/07 31/07/07 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 OP10 Good Practice Recommendations It is recommended that further training and supervision be provided to staff to ensure that, at all times, service users’ DS0000001100.V333445.R01.S.doc Version 5.2 Page 36 Woodlands Nursing Home 2. 3. 4. OP19 OP26 OP28 privacy and dignity is maintained. The redecoration programme should be continued and address all bedrooms and bathrooms. All parts of the home should be free from unpleasant odours. Training should continue with the aim being for the home to have 50 of its staff trained to NVQ level 2 or above. Woodlands Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Nursing Home DS0000001100.V333445.R01.S.doc Version 5.2 Page 38 - 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. 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