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Inspection on 12/05/06 for Woodlands Nursing Home

Also see our care home review for Woodlands Nursing Home for more information

This inspection was carried out on 12th May 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

From speaking with relatives and residents, it was clear that the majority found that the staff team were kind, supportive and attentive. They felt that the small size of the house led to a more homely environment. With the exception of a suggestion that the home would benefit from a visitors room, there were no adverse comments received from relatives.

What has improved since the last inspection?

Of the seven outstanding requirements mentioned above, three had been met. These related to the need to make it clear in the home`s Statement of Purpose that bedroom doors were not fitted with locks, to ensure that wound care documentation was up to date and accurate, and to ensure that safety covers were fitted to radiators. Some progress had also been made with the service user plans, the medication charts and a quality assurance system.

What the care home could do better:

Of most concern at this visit was the ongoing failure of the home to ensure that its recruitment practice was of an acceptable quality. A number of gaps in the records has led to the issuing of an Immediate Requirement Notice. This is the second such Notice to be served on the home as one was also served, for the same reason, last year. Continued failure to ensure the safety of service users through a robust recruitment practice can only lead to the Commission taking further enforcement action. This visit resulted in a further 15 requirements being made. Clearly, therefore, there remains room for improvement in number of areas.

CARE HOMES FOR OLDER PEOPLE Woodlands Nursing Home Woodlands Nursing Home 38 Smitham Bottom Lane Purley Surrey CR8 3DA Lead Inspector Margaret Lynes Key Unannounced Inspection 12th May 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Woodlands Nursing Home DS0000019048.V289691.R01.S.doc Version 5.1 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 DS0000019048.V289691.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Woodlands Nursing Home Address Woodlands Nursing Home 38 Smitham Bottom Lane Purley Surrey CR8 3DA 020 8645 9339 020 8668 9371 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) Guidebefore Limited Ms Mona Hooprajie Seegobin Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Woodlands Nursing Home DS0000019048.V289691.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. A variation has been granted to allow one specified resident with a learning disability to be admitted for as long as the home can continue to meet all of the resident’s assessed needs. 2nd February 2006 Date of last inspection Brief Description of the Service: Woodlands is a home registered for up to eighteen service users who, because of their age and general infirmity, require nursing care. Its relatively small size lends itself to the creation of a homely atmosphere not always seen in larger establishments. The home is situated in the pleasant suburb of Purley, within reasonably easy reach of the centre of Croydon and well placed for access to road and rail links. The home provides information about its services in a Service User Guide, which is made available to current and potential Service Users. Additional information can be found in the home’s Statement of Purpose. The current weekly fees (as provided at the time of this inspection) range from £530 to £550. Woodlands Nursing Home DS0000019048.V289691.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Due to concerns about the number of requirements that were not being met within stated timescales, this home received an additional visit in February 2006. At that visit, it was found that nine of seventeen outstanding requirements had still not been met. Subsequently, a meeting was held with the proprietors and registered manager to discuss why requirements were not being met, and to determine an action plan for the future. The seven outstanding requirements were reviewed at this inspection visit. Some improvements had been made in that three requirements had been met, three partially met, while one remained unmet. The Inspector was greatly concerned at the unmet requirement as it related to staff recruitment. Gaps in documentation were again found, and as a result an Immediate Requirement notice was left. This visit has resulted in a further 15 requirements being made. Evidence to support the comments below was gathered from a range of sources – the service users themselves, relatives, members of staff and inspection records. What the service does well: What has improved since the last inspection? Of the seven outstanding requirements mentioned above, three had been met. These related to the need to make it clear in the home’s Statement of Purpose that bedroom doors were not fitted with locks, to ensure that wound care documentation was up to date and accurate, and to ensure that safety covers were fitted to radiators. Some progress had also been made with the service user plans, the medication charts and a quality assurance system. Woodlands Nursing Home DS0000019048.V289691.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Woodlands Nursing Home DS0000019048.V289691.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodlands Nursing Home DS0000019048.V289691.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (6 is not applicable) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The files of five service users were examined. From the documentation available it was felt that service users were adequately assessed prior to being admitted to the home. This means that each service user can be reassured that the home has taken into account their individual needs, and feels that it can meet them; and the staff in the home can be as familiar as possible with new service users, and have an understanding of what specific service they will need to provide. EVIDENCE: Each of the files examined contained and in-house pre-admission assessment. These have recently been revised so that the proforma in use is much more detailed. A number of these in-house assessments were supplemented by an assessment from the Placing Authority. Woodlands Nursing Home DS0000019048.V289691.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service user plans were better, although there was still room for further improvement with regard to social care needs, and also to the recording of the wishes of service users in the event of their serious illness/death. Similarly, the accuracy of the medication charts had improved. Service users generally felt that they were treated with respect and their right to privacy upheld – however there were exceptions to this, which means that the home needs to improve its overall approach to service user privacy and right to choice. EVIDENCE: The previous inspection visits had resulted in requirements being made regarding the service user plans, wound care documentation and the medication administration records. The documentation relating to wound care was much improved, and while there were also improvements to the other two documents, an unsigned for drug on the medication charts, and lack of evidence as to an actual assessment of social needs (as oppose to a social Woodlands Nursing Home DS0000019048.V289691.R01.S.doc Version 5.1 Page 10 needs care plan the first goal of which is to conduct a needs assessment) meant that the requirements have been repeated. A number of service users were spoken with during the inspection. Most were complimentary about the home and the service provided. While no resident had any concerns that they wished to be taken further, the issue of male carers giving personal care to female residents was raised during a recent Local Authority visit. Staffing rotas notwithstanding, if a female service user raises objections to receiving intimate personal care from a male carer (or, indeed, vice versa) then this needs to be respected and the manager would be expected to take measures to minimise such occurrences, rather than trivialise them – as appeared to be the case. There was little information on the service user files with regard to the resident’s wishes in the event of their serious illness/death. Such information is of crucial importance, and should be ascertained as soon after arrival in the home as possible. The home also needs to have in place a policy and procedure with regards to resuscitation. Woodlands Nursing Home DS0000019048.V289691.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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. The home provides a number of recreational activities through the services of a recently recruited activities co-ordinator. This means that the lifestyle in the home should more closely match residents’ expectations and preferences. Visitors are made welcome. While the meals that were seen appeared satisfactory, the choice given to residents was sometimes negligible. This means that it is feasible that not all preferences are catered for, and service users right to choice is not adequately promoted. EVIDENCE: The home has recently recruited an activities co-ordinator. They were not present during the inspection, so the staff team tried to engage residents in table-top games during the course of the afternoon. Mention has been made in the previous section with regard to the need for the manager to ensure that all service users are assessed to determine their social needs. Once this has been done staff will be in a better position to offer relevant and suitable activities to each service user. Woodlands Nursing Home DS0000019048.V289691.R01.S.doc Version 5.1 Page 12 Several relatives were present during the course of the inspection, and the inspector is grateful that they were willing to spend some of their visiting time talking about their views of the home. These views were positive, with no concerns raised at all. While the main meal observed during the inspection was hot, well presented and looked appetizing, the menu on offer did not always offer adequate choice. For example, a choice between chicken in sauce or a chicken salad is hardly a choice! Woodlands Nursing Home DS0000019048.V289691.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of accurate complaint records means that it was not possible to determine that complaints were being appropriately dealt with. Staff have not been able to access adult protection training which means that they may not have the skills to be aware of any possible abuse issues, or to be able to deal with them if they arise. This puts the service users at unnecessary risk. EVIDENCE: While there had only been one complaint made to the home since the last inspection visit, it was of concern to find that brief mention of it had been made in the communication book, but an appropriate record had not been made in the complaints log. Indeed, the only entry regarding this matter had been made by the manager who was on leave at the time the complaint was made. An integral part of any complaints procedure is accurate record keeping so that the complaint, any subsequent investigation, the outcome and the feedback given to the complainant are all recorded. The home does have an adult protection procedure in place however training for the staff team has not yet been forthcoming. The manager gave assurances that staff were on a waiting list for places at the Local Authority courses, and in the interim she proposed to do some in-house training. Provided the material available is up to date and appropriately cross-referenced to the Local Woodlands Nursing Home DS0000019048.V289691.R01.S.doc Version 5.1 Page 14 Authority multi-agency procedure then this would be a satisfactory temporary measure. Woodlands Nursing Home DS0000019048.V289691.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While there were some matters that required attention it was generally felt that the premises were adequately maintained and offered a pleasant and comfortable environment for the service users. EVIDENCE: A tour of the home showed that in most areas the premises were adequately maintained, comfortable and homely. Just three areas of concern arose – the emergency alarm pull-cord in the newly refurbished shower must be removed from the inside of the shower casing; the wardrobe in bedroom 12 must be replaced and the manager must put into place a risk assessment for the oil heater found in one of the bedrooms. Requirements will be made with regard to these three issues. Woodlands Nursing Home DS0000019048.V289691.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of any significant staff training and incomplete recruitment documentation means that service users may not be receiving the standard of care they should, and are neither supported nor protected by the home’s recruitment practice. EVIDENCE: It was of concern to find that a number of the more recently recruited staff had not provided all of the documentation that is required in the Regulations. Missing documents included application forms, photographs and previous employment history. This poor standard has resulted in an Immediate Requirements Notice being issued. Taking into account that over 20 of the beds are currently vacant, the actual staffing levels were just above the minimum expected. Additional comment re the need to have to manager in a supernumerary role will be made in the following section. Some discussion was had with the carers, who were asked what training had been made available to them recently. It transpired that very little had been done, other than infection control. New staff could not recall having undergone Woodlands Nursing Home DS0000019048.V289691.R01.S.doc Version 5.1 Page 17 manual handling training, while evidence of induction of new staff was not available (with one exception). On a more positive note, six of the care staff have achieved an NVQ level II or level III award. Woodlands Nursing Home DS0000019048.V289691.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A number of concerns regarding staff supervision, health and safety, quality assurance and the lack of a supernumerary manager means that the health safety and welfare of both service users and staff is neither promoted or protected. EVIDENCE: A number of requirements will have been made as a result of this inspection, and it appears that some of them are in part due to the manager not having enough supernumerary time to carry out all of the management tasks that are required. She is unable to fully discharge her responsibilities, thus leading to elements of the service being below the standard expected and, indeed, Woodlands Nursing Home DS0000019048.V289691.R01.S.doc Version 5.1 Page 19 required. A requirement will be made, therefore, for the manager to become wholly supernumerary. Progress has been made with the quality assurance systems. The manager has drawn up checklists of each of the areas she needs to audit, and now needs to outline how often each audit will be carried out and how it will be recorded. Seeking the views of service users, their relatives and friends, staff and other stakeholders is one of the best ways to get feedback on how a service is performing. Such surveys should be conducted at least annually, and the results published. Quality assurance systems also need to give due consideration to equality and diversity within the service – something which has not been covered to date in this home. Only two of the service users have pocket money looked after by the home. For all expenditure receipts are obtained and annually the records passed to an accountant for auditing. The remaining service users finances are looked after by family or by their placing Authority. One of the most noticeable effects of having a manager who is not supernumerary is that it is difficult for them to carry out staff supervision at regular intervals. None of the qualified staff have received supervision, while supervision of the carers was infrequent. This was particularly noticeable with the newer staff, where one would have expected to find more frequent supervision. One had not received any supervision, while another, without any prior care experience had received just one session. Most of the maintenance contracts that are needed were in place and were up to date. There were three exceptions to this – the servicing of the Parker bath; testing of the water for Legionella; and evidence that the gas installation had a current safety certificate. After almost two weeks out of service, engineers were able to repair the lift, which became usable again the day before this inspection. It was of concern that this breakdown was not notified to the Commission, particularly as it meant that several service users were unable to come downstairs. The manager is hereby reminded that any occurrence where the wellbeing of service users is compromised must be notified, without undue delay, to CSCI. Woodlands Nursing Home DS0000019048.V289691.R01.S.doc Version 5.1 Page 20 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 3 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 1 X 2 Woodlands Nursing Home DS0000019048.V289691.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Service user plans must include reference to social needs; they should be cross-referenced to the daily notes and reviewed on a monthly basis. The previously set timescale for this requirement has not been fully met. The manager must ensure that medication administration records are accurately maintained. The previously set timescale for this requirement has not been fully met. Appropriate quality assurance systems must be implemented. The previously set timescale for this requirement has not been met. The previously set timescale for this requirement has not been fully met. The manager must ensure that all staff provided the DS0000019048.V289691.R01.S.doc Timescale for action 30/05/06 2. OP9 13 12/05/06 3. OP33 24 30/05/06 4. OP29 19 12/05/06 Woodlands Nursing Home Version 5.1 Page 22 documentation listed in the Regulations before commencing work. The previously set timescale for this requirement has not been met. 5. OP10 12 The manager must ensure that, where possible, service users wishes regarding the giving of personal care is respected. The manager must ensure that there is a policy/procedure in place re resuscitation, and that the wishes of service users in the event of their serious illness/death are recorded. The manager must ensure that service users are given an adequate choice of meals. All complaints must be appropriately recorded. Staff must receive training in the protection of vulnerable adults. The emergency pull-cord in the shower must be within reach at all times. Where stand-alone heaters are used in bedrooms the manager must ensure that an appropriate risk assessment has been carried out (and recorded). A new wardrobe is required in bedroom 12. The manager must ensure that new staff provide all the required documentation prior to them commencing work at the home. The registered person must ensure that there is an adequate training and development programme in place for staff. In order to be enabled to perform all of the required management tasks, the manager must be supernumerary. The manager must ensure that DS0000019048.V289691.R01.S.doc 12/05/06 6. OP11 12 30/05/06 7. 8. 9. 10. 11. OP15 OP16 OP18 OP19 OP19 16 22 13 23 13 12/05/06 12/05/06 30/06/06 12/05/06 12/05/06 12. 13. OP19 OP29 16 19 30/06/06 12/05/06 14. OP30 18 30/06/06 15. OP31 18 30/06/06 16. OP36 18 12/06/06 Page 23 Woodlands Nursing Home Version 5.1 17. 18. 19. OP38 OP38 OP38 13 13 13 all staff receive regular supervision. The manager must ensure that all equipment is regularly serviced. The water system must be tested annually for Legionellosis. A current gas safety certificate must be produced. 30/06/06 30/06/06 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Woodlands Nursing Home DS0000019048.V289691.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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