Inspection on 12/12/07 for Woodlands Nursing Home

This inspection was carried out on 12th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Woodlands Nursing Home 19/11/08

Woodlands Nursing Home 14/08/07

Woodlands Nursing Home 01/03/07

Woodlands Nursing Home 21/08/06

Woodlands Nursing Home 09/12/05

Woodlands Nursing Home 26/08/05

Woodlands Nursing Home 10/02/05

Woodlands Nursing Home 20/05/04

Woodlands Nursing Home 08/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Woodlands Nursing Home Wardgate Way Holme Hall Chesterfield Derbyshire S40 4SL Lead Inspector Rose Veale Unannounced Inspection 12th December 2007 09:20 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 DS0000002099.V355225.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 DS0000002099.V355225.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodlands Nursing Home Address Wardgate Way Holme Hall Chesterfield Derbyshire S40 4SL 01246 231191 01246 231193 jane.tinsley@tesco.net 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) Midland Healthcare Ltd Mrs B Tinsley Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Woodlands Nursing Home DS0000002099.V355225.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. To allow one service user under category PD to be accommodated for the period of their stay in Woodlands Nursing Home on a named person basis No one falling within category OP to be admitted into Woodlands Nursing Home when there are already 50 persons already accommodated within the home No one falling within category DE(E) to be admitted into Woodlands Nursing Home when there are already 3 persons under category DE(E) accommodated in the home The maximum number of persons to be accommodated at Woodlands Nursing Home is 50 14th August 2007 Date of last inspection Brief Description of the Service: The Woodlands is a purpose built two-storey home, which provides residential and nursing care for up to 50 older people. The service is also registered to accept three people who have dementia related needs. The home is situated on a housing estate and shops and community facilities are close by. The home provides forty-four single and three shared rooms. Three rooms have en-suite facilities. Bedrooms are located on two floors and a lift is available to provide access to those with mobility difficulties. A range of communal areas are available including a small smoking area for service users to use. The home has a garden accessible to people who live there and a car park. The fees charged at the home range from £333.85 - £512.00. There are additional costs for hairdressing, chiropody, none urgent escorts to hospital and personal newspapers. This information was provided at the inspection visit in August 2007. Information about the home, including CSCI inspection reports, is available in the main entrance area of the home, and from the manager. Woodlands Nursing Home DS0000002099.V355225.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and took place over 7 hours. The inspection visit focused on assessing compliance to requirements made at the previous inspection and on assessing all the key standards. There were 44 people accommodated in the home on the day of the inspection visit, including 22 people assessed as needing nursing care and 2 people assessed as needing dementia care. People who live in the home, visitors and staff were spoken with during the visit. The manager was available for most of the inspection visit. Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Records were examined, including care records, staff records, and health and safety records. Most areas of the building were seen. The inspector was accompanied by an ‘expert by experience’, Iris Wagstaffe, for part of the inspection visit. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The expert by experience spoke to residents at the home about the lifestyle in the home and their views of the service. Information from the findings of the expert by experience has been included in the body of this report. At the key inspection in March 2007 the overall rating for the home was poor and so the home was included in the CSCI improvement strategy. A management review was held with the inspector and regulation manager, and then a meeting with the providers of the service. Following another key inspection in August 2007, the providers were required to produce an improvement plan detailing how they were going to make the necessary changes to comply with the regulations and improve outcomes for residents at the home. The improvement plan was produced in the required timescale and covered all of the requirements made. What the service does well: People who could express themselves were happy with the care provided. It was observed that there was a good rapport between staff and people living in and visiting the home. The expert by experience noted, “Residents spoke warmly of the manager, her deputy and the entire staff. As so many older people do in such settings residents were very appreciative of the help they receive.” Also, “The staff were obviously aware of privacy and dignity issues Woodlands Nursing Home DS0000002099.V355225.R01.S.doc Version 5.2 Page 6 as I saw them carefully replacing and re-positioning clothing disturbed by agitated residents”. The home was clean and generally well maintained so that people lived in a pleasant and comfortable environment appropriate to their needs. The expert by experience said, “There was bird table which was well stocked with feeding stations and which was easily visible from the lounge windows. Residents told me how much they enjoyed watching the wildlife outside including “squirrels and rabbits”!” What has improved since the last inspection? What they could do better: There was no evidence in the care records that people living in the home, or their representatives, were involved in care planning and risk assessment. People should be consulted so that they understand and agree with the care and support provided. The programme of activities appeared to offer little to people at the home with dementia or communication difficulties, or to those who were very dependent. There should be a programme of activities that provides for the wide range of needs of people living in the home. Although the manager and qualified nurses had received training about the care of people with dementia, most of the care staff had not. As the home is registered to provide for 3 people who’s primary care needs are due to dementia, and many people there had some degree of dementia, this training would improve the service offered. It would be useful for an assessment to be carried out of the dependency of people living in the home so that this could be matched to appropriate staffing levels. Woodlands Nursing Home DS0000002099.V355225.R01.S.doc Version 5.2 Page 7 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 DS0000002099.V355225.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodlands Nursing Home DS0000002099.V355225.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was a satisfactory assessment process in place so that people were confident the home was able to meet their needs. EVIDENCE: The records of 3 people were seen. Each had an assessment of their needs carried out by the home, plus assessments by social services and nursing staff. The assessments covered all areas of the person’s life. Each person had a care plan produced from the assessment information. The expert by experience said, “residents who could express themselves were happy with the care they receive” Standard 6 did not apply to this home. Woodlands Nursing Home DS0000002099.V355225.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was a consistent approach to care planning and improvements in staffing levels so that people’s basic needs were usually met. EVIDENCE: The care plans seen included all the assessed needs of the person. The care plans had sufficient details of the care and support required, including information about the person’s preferences. There were references to ensuring choice, privacy and dignity. The care plans were signed by a member of staff, but not by the person or their representative to indicate their involvement and agreement. The care plans had been reviewed regularly. There were daily records for each person. These were generally detailed and informative. Some daily records had gaps left between entries and at the end of entries. Each of the care records had a range of risk assessments in place, including manual handling, tissue viability, nutrition, and risk of falls. As appropriate, Woodlands Nursing Home DS0000002099.V355225.R01.S.doc Version 5.2 Page 11 there were risk assessments for the use of bed rails. Most risk assessments were signed by a member of staff. None were signed by the person or their representative to indicate their understanding and agreement. There were records of the input of other healthcare professionals, such as GP, District Nurse and chiropodist. People were referred as required to specialist services, such as Speech and Language Therapy, and the memory clinic. The expert by experience commented, “From observations and discussions with residents it was clear that all were cleanly and neatly dressed with clothes well pressed. I was told by one resident that the laundry lady was “lovely” and “washed and pressed things beautifully” so much so that she would not just press any item unless it had been laundered first. The visiting hairdresser was in attendance that day and various ladies went or were taken to have their hair done. All the gentlemen were clean shaven and residents’ hands and nails appeared well cared for, one resident told me that the hairdresser did manicures. Those spoken with had their feet seen by the visiting chiropodist and one lady reported that she was awaiting new spectacles via the visiting optician.” Also, “The staff were obviously aware of privacy and dignity issues as I saw them carefully replacing and re-positioning clothing disturbed by agitated residents.” Staff spoken with were knowledgeable about the needs and preferences of people living in the home. Staff were aware of promoting dignity and choice. Although improvements had been made to staffing levels, there were times when people had to wait for help, and there was a lack of stimulation and activities for some of the very dependent people living in the home. (See Daily Life and Social Activities and Staffing sections of this report). The home’s registration allowed for up to 3 people to live in the home whose primary care needs were due to dementia. In addition, it was seen that there were many people living in the home who had some degree of dementia. The qualified nurses at the home and the manager had received training about the care of people with dementia, but most of the care staff had not. Medication at the home was stored in 2 rooms. The ground floor storage room was used for the medication of people requiring personal care only, and the first floor room was for the medication of people assessed as needing nursing care. The senior care assistants administered medication for people needing personal care only, and the qualified nurses administered medication for people with nursing needs. The senior care assistants had received training about medication. Woodlands Nursing Home DS0000002099.V355225.R01.S.doc Version 5.2 Page 12 Since the last inspection, there was a new system in place for disposal of unwanted medication. Discussion with staff and records seen indicated that the system was working well. The medication administration records seen were correctly completed and included records of medication received into the home. Woodlands Nursing Home DS0000002099.V355225.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although improvements had been made, there was a lack of activities for some of the people living in the home. It was not clear that people’s social and recreational needs and preferences were fully met. EVIDENCE: There was an activities coordinator employed at the home, working for 20 hours per week. Since the last inspection, another person had been employed to help with activities, working for approximately 12 hours per week. Regarding activities, the expert by experience reported, “I spoke with and observed the activities organiser with a small group of 4/5 residents making paper lanterns at a dining table. I understand that there are activities each afternoon which were advertised on various wall notices. There seemed very little on offer for the frailer/confused residents who mainly sat and mostly slept in their chairs. The activities organiser told me that the care staff rarely joined in the activities as they “were too busy with other duties”. Whilst she was clearly doing her best she said that she had no formal training in activities for Woodlands Nursing Home DS0000002099.V355225.R01.S.doc Version 5.2 Page 14 frail older people nor had any training to lead chair based exercises or to cater for residents with dementia. A professional theatre group had performed the pantomime Dick Whittington on the previous afternoon which residents had much enjoyed. I was told that there was a church service in the home each month and that was the only time that the home’s electronic organ was played. Several residents said that they would like to have live music played on the organ. Notices in the hall advised of three carol singing events by a local nursery, primary school and church. A few residents spoke of going out occasionally in the home’s mini bus but there did not appear to be any use of the larger local community transport bus to take out greater numbers than could be conveyed in the small mini bus. Many residents said they would just “like staff to have more time to sit and talk to them”. The activities organiser and manager spoke of the “friends of the home association” but residents seemed unaware of this group.” The manager said that a chair-based exercise session was planned for the following day and also for after Christmas, and that staff were to be trained so they could continue with the sessions. It was observed that the people who were more dependent had little interaction with staff, other than to provide basic care. Most of these people were assisted to bed in the early afternoon and remained there until the next morning. This was said to be necessary for pressure area care. They were given their teatime meal in bed. Although relief of pressure areas was clearly an important priority, there was a risk that spending so much time in rooms on their own would isolate people. The expert by experience said, “Most residents appeared to retire to bed early from 7 p.m. onwards and one gentleman told me that having gone to bed at 7 p.m. he was always awake by 4 a.m. when he got up. When I asked him how he spent his time from then until breakfast at 7/8 a.m. he said he was able to wash and dress himself and that he “pottered about”.” There were 2 dining areas in the home. The menu for the day was displayed in the main dining area. People spoken with said they enjoyed the meals. The expert by experience reported, “That day’s lunch was braised beef with button mushroom in gravy, mashed potato, brussel sprouts, peas mixed with sweet corn followed by lemon Bakewell tart with custard. Water and/or juice was served with the meal. Tables were neatly set with paper napkins for those not fitted with appropriate protective pinnies/bibs. There were no cruets on the tables but staff did provide them from the serving counter when I requested condiments. Those I sat with were able to use normal cutlery and did not need assistance to feed. I did note that some frailer residents were placed at the dining tables some time before the actual meal was served around 12.45 p.m. Some residents were left in their armchairs where staff assisted them. The lunches all appeared approximately to have the same sized portions……. Tea, as given on the notice board, consisted of sandwiches with some choice of Woodlands Nursing Home DS0000002099.V355225.R01.S.doc Version 5.2 Page 15 filling, or soup and a roll plus cakes and tea. Hot drinks such as Horlicks were offered in the evening around 7 p.m. Some resident’s visitors told me that they felt that there was too long a gap between what was served in the early evening and breakfast next morning. I found no evidence of cups of tea being offered in residents bedroom in the early morning. One resident told me she could have “a glass of water or juice to take to bed” with her. I did get a sense that that residents were reluctant to ask for hot drinks during the night however all reported that if they summoned staff for help during the night there was an immediate response. I was told it was normal practice for each resident to have a birthday cake on their birthday but did not see any photographs on display illustrating this practice.” Also, “Residents told me that they were not offered fresh fruit at all and only enjoy that which their visitors brought in. Residents told me that staff were aware of their likes and dislikes and that the food offered was acceptable to them.” It was observed that appropriate meals were served to people who had specific nutritional or cultural needs and preferences. Woodlands Nursing Home DS0000002099.V355225.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were satisfactory policies in place and good staff awareness so that people were protected and their concerns effectively dealt with. EVIDENCE: The complaints procedure was displayed in the home. Records of complaints were seen and showed that complaints were responded to within appropriate timescales. People spoken with were aware of the complaints procedure and said they would be happy to raise any concerns with staff or the manager. No complaints had been received about the home by CSCI since the last inspection. Since the last inspection, the safeguarding vulnerable adults policy and procedure had been reviewed and updated. The policy was clear and included all the required information. Staff spoken with were aware of safeguarding adults issues and the correct procedures to follow if abuse was suspected. It was seen that in house safeguarding adults training was included as part of the induction programme for new staff. Training records showed that most staff had received training about safeguarding vulnerable adults. Woodlands Nursing Home DS0000002099.V355225.R01.S.doc Version 5.2 Page 17 There had not been any investigations relating to safeguarding vulnerable adults since the last inspection. Woodlands Nursing Home DS0000002099.V355225.R01.S.doc Version 5.2 Page 18 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean and generally well maintained so that people lived in a pleasant and comfortable environment appropriate to their needs. EVIDENCE: Most parts of the building were seen, including all of the communal areas, the bathrooms and toilets, and some of the bedrooms. Since the last inspection work had been carried out to meet requirements made and to improve the home environment. This work included: • a new door with a clear glass panel fitted to the smoking room so that people could be observed to ensure safety without staff having to enter the room • extraction units in toilets, bathrooms and the smoke room cleaned and in working order. Many had been replaced with new units. Woodlands Nursing Home DS0000002099.V355225.R01.S.doc Version 5.2 Page 19 • • • the floor in the laundry repaired to ensure that it was not a trip hazard to staff several bathrooms and bedrooms redecorated, or in the process of being redecorated new bedroom furniture provided in 2 bedrooms seen, and the manager said there was an ongoing programme to eventually replace all of the bedroom furniture. Most of the communal areas and corridors remained in need of redecorating, as noted at the last inspection. In places, the décor appeared tired with peeling paper, and scuffed and marked paintwork. The flooring in the first floor medication room required repair or replacement as it was lifting and was a potential trip hazard for staff. The expert by experience commented on the “large lawned area with tables and garden seats which residents told me they used during the summer. I could see no evidence of raised flower beds or tubs which might possibly be enjoyed by a couple of residents I spoke with who had been keen gardeners – one gentleman told me he had “grown everything in his time”. There was bird table which was well stocked with feeding stations and which was easily visible from the lounge windows. Residents told me how much they enjoyed watching the wildlife outside including “squirrels and rabbits”!” The bedrooms seen were pleasant and comfortable. People were encouraged to bring in their own possessions to individualise their rooms. The home appeared clean in all areas seen and there were no offensive odours. People spoken with were satisfied with cleanliness at the home. Staff spoken with described using disposable gloves and aprons appropriately and were aware of measures to prevent cross-infection. Some staff had received training about the control of infection. Woodlands Nursing Home DS0000002099.V355225.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels had improved and were generally sufficient to meet people’s basic needs, but not enough to ensure a holistic approach to care and support. People were protected by the home’s recruitment procedures, and the training provided generally ensured that people were supported by competent staff. EVIDENCE: At the last inspection it was found that staffing levels were not sufficient to meet the needs of people living in the home. An Immediate Requirement was made for the home to provide staff rotas to CSCI to demonstrate staff were provided in sufficient numbers. The home complied with this requirement and staffing levels were increased. At this inspection, it was found that the increased staffing levels had mostly been maintained. There were 44 people living in the home, (7 more than at the last inspection). 22 people were assessed as requiring nursing care, and 2 people were assessed as needing specialist care due to dementia. In addition to the people living in the home, there were 3 people who came to the home for day care. Woodlands Nursing Home DS0000002099.V355225.R01.S.doc Version 5.2 Page 21 The rotas seen showed that there was always one qualified nurse on duty for each shift. There were usually 6 care assistants for the morning shift, 4 for the afternoon shift and 4 for the night shift. There were 3 days in the previous 3 weeks where there had been 3 care assistants for the afternoon shift. The manager said this was due to sickness at very short notice, and staff spoken with confirmed this. New staff had been recruited since the last inspection. The manager said it was planned in future to have 7 care assistants for the morning shift and 5 for the afternoon shift. The rota seen for the week following the inspection showed this level of staff was planned. One new member of staff had been recruited to give additional help with activities, and also to help with the induction of new staff. The expert by experience commented “Whilst sitting with residents during the day I did have to look for staff on several occasions for residents who needed the toilet - staff did respond promptly. However I was concerned that the main lounges did not have a member of staff in constant attendance and that it could be very stressful for residents who had mobility problems to alert staff to their needs. Staff seemed very busy most of the time with the numbers of highly dependent residents”. Also, at lunchtime,“ Staff were kept very busy both serving the meals and assisting those who needed help with feeding”. The expert by experience concluded “staff were kindly but faced challenges given the high dependency levels of the vast majority of the residents and that the numbers of staff available seemed insufficient to deal significantly with such dependencies.” It was observed that lunchtime was very busy for staff with 8 people requiring help with eating and drinking, and many people needing help to move from the lounges to the dining rooms. As observed by the expert by experience, this resulted in several people being assisted to the dining tables approximately 45 minutes before the meal was served. It was observed that people who were very dependent, with limited mobility and communication were mainly together in one lounge. Staff attended people in this lounge as necessary to provide assistance, but there was little other interaction observed. Although the manager and staff were clearly aware of individual dependencies, this was not formally assessed. If people were assessed in this way, the manager would have a clear picture, properly documented, of the dependency levels at the home and would be able to put forward a case to the providers for appropriate staffing. Staff spoken with confirmed that the increased staffing levels had generally been maintained whenever possible since the last inspection. Staff said that the planned staffing levels of 7 care assistants in the morning and 5 in the Woodlands Nursing Home DS0000002099.V355225.R01.S.doc Version 5.2 Page 22 afternoon “ would really help” and “would make a difference”. The manager said that she had started ensuring extra help around teatime by having kitchen staff on duty. Previously, care assistants had been responsible for some food preparation and for washing dishes as there were no kitchen staff at teatime. Staff files were found to be satisfactory at the previous inspection in August 2007. At this inspection, the files of 3 new members of staff were seen. All the required information and documents were in place. As at the previous inspection, staff induction and training was mostly clearly recorded and up to date. Staff spoken with confirmed that they had received the training recorded. There were 23 care staff at the home, 10 of whom had achieved National Vocational Qualification (NVQ) at Level 2. People spoken with made positive comments about the staff and it was observed that there was a good rapport between staff and people living in and visiting the home. The expert by experience commented “Residents spoke warmly of the manager, her deputy and the entire staff. As so many older people do in such settings residents were very appreciative of the help they receive.” Woodlands Nursing Home DS0000002099.V355225.R01.S.doc Version 5.2 Page 23 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, 32, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements had been made, and the home was generally well organised. However, there remained issues about staffing levels and staff training so the home was not run in the best interests of the people living there. EVIDENCE: The manager had been in post for over 10 years. Since the last inspection, the manager, provider and staff had worked together to comply with the requirements made and to improve the service. People spoken with were positive about the manager, commenting that she was approachable and that the home was “well organised”. Woodlands Nursing Home DS0000002099.V355225.R01.S.doc Version 5.2 Page 24 The main issue at the previous inspection was insufficient staffing levels. This had been addressed and staffing levels had improved. A further increase in staffing levels was planned. However, the number and dependency of people living in the home had increased since the last inspection. Although the manager and staff were clearly aware of individual dependencies, this was not formally assessed. If people were assessed in this way, the manager would have a clear picture, properly documented, of the dependency levels at the home and would have evidence for the providers and CSCI for appropriate staffing. Notifications of events at the home had generally been made as required by CSCI. There was one recent event that had not been notified. When brought to her attention, the manager to steps to rectify this. Personal money was held securely for some people living in the home. Since the last inspection the system had been improved by ensuring two signatures for each transaction. The Annual Quality Assurance Assessment (AQAA) was received from the home prior to the last inspection in August 2007 and showed that all equipment and systems at the home had been maintained as required. Records sampled at this inspection showed that health and safety matters were satisfactorily attended to. Woodlands Nursing Home DS0000002099.V355225.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 X X 3 X X 3 Woodlands Nursing Home DS0000002099.V355225.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO 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 OP19 Regulation 23(2)(b) Requirement The flooring in the first floor medication room must be repaired or replaced to ensure a safe and hygienic surface. All staff at the home must have training to meet the needs of people with dementia. This will ensure that staff understand the needs of all the people at the home and are competent to support them. Timescale for action 31/03/08 2 OP30 18(1)(c) (i) 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP12 Good Practice Recommendations People living in the home, and/or their representatives should sign care plans and risk assessments to indicate their involvement, understanding and agreement. The activities coordinator should have training to enhance and extend their skills and knowledge so that the social needs and preferences of people will be more fully met. DS0000002099.V355225.R01.S.doc Version 5.2 Page 27 Woodlands Nursing Home 3 OP12 4 OP12 5 OP12 6 OP27 Sensory or other programmes of stimulation should be explored and developed for people who have dementia and/or complex care needs. This will help to ensure that activities are provided to meet the needs and preferences of these people. Local contacts, other than the church ones, should be explored and developed e.g. with local schools/ youth/community groups. This will ensure people living in the home maintain local links and are involved in the local community. More residents should be taken on outings than the few that can be accommodated on the home’s vehicle when it is available. This will ensure more people have access to activities and opportunities outside the home. There should be a formal assessment of the dependency of people living in the home so that appropriate staffing levels can be determined to meet assessed needs. Woodlands Nursing Home DS0000002099.V355225.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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. 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