Inspection on 16/05/07 for Woodlands Nursing Home

This inspection was carried out on 16th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 19/01/09

Woodlands Nursing Home 12/08/08

Woodlands Nursing Home 12/02/07

Woodlands Nursing Home 12/05/06

Woodlands Nursing Home 27/10/05

Woodlands Nursing Home 11/07/05

Woodlands Nursing Home 04/01/05

Woodlands Nursing Home 29/07/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Woodlands Nursing Home Woodlands Nursing Home 38 Smitham Bottom Lane Purley Surrey CR8 3DA Lead Inspector Michael Williams Key Unannounced Inspection 16th May 2007 9:30am 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.V338459.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 DS0000019048.V338459.R01.S.doc Version 5.2 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 F/P 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 Post Vacant Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Woodlands Nursing Home DS0000019048.V338459.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th February 2007 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. Fees as at May 2007 range from £525 to £600. It is proposed by the Commission to modify the registration certificate but not the criteria for admission. Woodlands Nursing Home DS0000019048.V338459.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit commenced on 16th May 2007. In addition to this inspection visit, which latest approximately seven hours, a number of questionnaires were distributed to interested parties, including residents, relatives/friends, care managers, health professionals and to staff working in the home. In compiling this inspection report the CSCI also noted information received into the commission including details of complaints, untoward incidents and general correspondence. During the course of the inspection visits we met the residents and interviewed several staff. The premises were toured and documentation, including records, were checked. What the service does well: What has improved since the last inspection? What they could do better: There are a number of fundamental issues that will not be easily resolved - this includes the small number of registered beds, which may affect its viability; the premises are small even for just 18 residents and so there is a lack of communal space, in particular the lounge and dining are each too small for the whole resident group to assemble. Although the home has a passenger lift its other facilities such as bathrooms, shower rooms and toilets are too small for the less ambulant. Bedrooms do not meet modern standards and whilst the National minimum Standards have been modified to take account of older, ‘existing’ homes double rooms are increasingly less popular than single ensuite bedrooms. There is insufficient storage space so essential items such as continence aids and hoists are being stored inappropriately in resident’s bedrooms and ensuite bathrooms. Woodlands Nursing Home DS0000019048.V338459.R01.S.doc Version 5.2 Page 6 We are recommending a revision of the menus; whilst the current ones are not unsuitable the kitchen is not delivering what is offered on the menu; for example on the day of the inspection “Curry and Rice” was listed but a “savoury mince and vegetables” was provided. The acting manager wishes to revise menus in consultation with a dietician, and of course the residents - this approach to menu planning is endorsed by the Commission. Bedrooms and some bathrooms/toilets do not have door locks for privacy. Some bedrooms still do not have a lockable cabinet. A bathroom also had no curtains at the window, which also compromises privacy. A number of potential safety issues arise such as the single door fire protection for a bedroom on the ground floor, (it appears that a secondary fire door has been removed in this area near then office). There is a lack of signage to show the exit routes in case of emergency. Staff are not receiving the correct fire drill training, they are merely expected to attend when the weekly tests takes place. As a matter of accident prevention handrails and guardrails are recommended in the garden where there is drop from the patio to ground level (near the ramp) and handrails on the concrete steps down from the fire exit. One radiator in a bathroom is not ‘cool-touch’ nor covered and protected - but it was not excessively hot when we checked it. The hot water supply to baths and wash hand basins is controlled by a central thermostat and by thermostats (which appear to be ‘Pressure Reducing Valves’) fitted just to the hot water supply. Whilst sinks and baths do have fail-safe mixer valves these are too easily accessible to residents who may adjust them to an unsafe temperature. Carpets in communal areas such as corridors are now quite unsightly and appear dirty or stained with wear and age. Some staff police checks are now more than three years old and it is recommended that they are repeated at three-yearly intervals for all staff. We also recommend that as few residents have visiting relatives that advocacy is arranged or made readily available to residents; suitable volunteers may also help to advocate on behalf of residents if they wish. The Commission is initiating a change to care home registration certificates to ensure they more accurately reflect the homes’ statements of purpose. Woodland’s certificate will therefore be modified with the agreement of the owners. The Home’s Statement of Purpose will therefore need to be modified to take account of residents would do not wholly met the main admission category of ‘older people with nursing care’ [OP/N] for example those who are aged and also have mild learning disabilities. The home’s Guide also needs to be modified to reflect residents’ views and to indicate that if residents are dissatisfied with the way complaints are handle in-house they may draw this to the attention of their care manner in the local authority as well as to the Commission, which monitors how complaints are being handled. It was noted that there are no complaints or comments recorded in the complaints book – which may indicate that residents need advocates to support them if they have any concerns. Woodlands Nursing Home DS0000019048.V338459.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 DS0000019048.V338459.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 DS0000019048.V338459.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): NMS 1 and 3: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The statement of purpose will need to be reviewed (to reflect the Commission’s proposed modification of the registration certificate) so that it will provide up to date information about the service and the criteria for admission. There have been no admissions since the previous inspection in February 2007 but the documentation to assess prospective residents has been modified to ensure sufficient information is collected by the home so as to ensure both the home and resident will be able to gauge whether or not the home can meet care needs. EVIDENCE: The home provides a Statement of Purpose that is specific to Woodlands and the resident group but we are asking for it to be refined so as to include details of conditions currently reflected in the certificate but which will in future only appear in the statement of purpose. The existing statement already clearly sets out the objectives and philosophy of the service supported by a service user Guide. The guide details what a prospective resident can expect and gives a clear account of the services provided which includes nursing care, the Woodlands Nursing Home DS0000019048.V338459.R01.S.doc Version 5.2 Page 10 quality of the accommodation, qualifications and experience of staff, how to make a complaint, it does not however contain a summary of the Commission’s most inspection findings nor does it contain comments and experiences of residents living at the home; these are matters that can be easily remedied as the information is available in the home. All people who use services are given a copy of the Guide. Areas of strength are the existing statement of purpose and residents’ guide that includes the contract whilst matters that need attention include a revision of both the statement and guide to bring them up to date; so this section, about choice of home, is assessed as good. Woodlands Nursing Home DS0000019048.V338459.R01.S.doc Version 5.2 Page 11 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. The arrangements for care planning, the provision of health care and the procedures for dealing with medication are now satisfactory so as to ensure the social, and health care of service users can be met. EVIDENCE: To evaluate this part of the report we read a sample of case files, spoke to residents or observed care being provided to them; we also interviewed staff and the manager and noted written feedback from residents and relatives. Preadmission information is in place and this helps direct the in-house assessments and care planning but as the acting manager is introducing a new format not all care plans are as well organised as the newer ones. A range of documents were seen to be in place in the new format and this includes items such a photograph, basic personal data, health and social care needs, professional and family involvement and so forth. Care plans and reviews are in place for each residents and the daily notes record that staff are providing suitable care and support for each resident. People who use services have access to health care services both within the home and in the local Woodlands Nursing Home DS0000019048.V338459.R01.S.doc Version 5.2 Page 12 community. It was noted in the case files that staff make prompt contact with health care professionals such as a Nurse or Doctor if the need arises. On this occasion no errors were identified in the procedures for recording, storing, administering and returning medication. In most instances staff assist residents with their medication. Few residents have a lockable facility to enable to hold their own medication (and/or money) safely in their own bedrooms. The privacy of residents was compromised in several respects; the bedrooms do not have a suitable door-lock, in fact no lock at all, nor do all the bathroom/toilets have a suitable door lock. Curtains are needed in a bathroom with just frosted glass. It is also inappropriate to use residents’ private bedrooms as store cupboards/rooms. The lounge and dining room are both very small (for the number of residents), which gives residents little choice about where and with whom they might sit each day. The acting manager advised us that there have been no new admissions since the previous inspection and only one resident discharged; nearly all the remaining residents are of advanced years and very frail – several are close to celebrating their hundredth birthday and this appears to be a testament to the care provided. It is regrettable that few have regular visitors to act as their advocates so a recommendation is made to encourage volunteers (who must be suitably vetted) to visit the home or arrange more formal advocacy where appropriate. The acting manager advises us that at present no residents have complex clinical needs but they do of course need a lot of basic nursing care. Areas of strength are the general level of care and the improvements to medication procedures and to care planning documentation. Matters for improvement are the need to ensure residents right to privacy is respected and their bedrooms are not used as storage spaces; advocacy or voluntary visitors are recommended for residents without support. So this section, about health and personal care, is assessed as adequate. Woodlands Nursing Home DS0000019048.V338459.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 to 15: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst this is a small homely service there was little evidence of individually tailored social/activity plans for each resident; residents appear to receive few visitors and because of their frailty have little capacity to exercise choice and control over their daily lives. The published menu is reasonable but is not what is actually being provided. EVIDENCE: Most residents in this home are very frail and very dependent upon the care staff for their care. Generally staff seem to be aware of the need to support residents to maintain so far as possible their skills and abilities, including social, emotional, communication, and daily living skills but this process could be improved. In reality residents appear to spend much of the day grouped together in the small lounge dozing between meals. It cannot be expected that frail residents of 80 and 90 years of age will want to take part in boisterous physical activity but a programme of events both passive and more active (mental or physical) is recommended so that they are given the opportunity to take part in a variety of activities both within the home and in the community. Where possible staff should gather information on community based events and try to make individual arrangements for people to attend. Woodlands Nursing Home DS0000019048.V338459.R01.S.doc Version 5.2 Page 14 The care planning format can be used as an opportunity to revise the information about residents’ wishes and expectations. If residents are sleepy during the day this may mean there this is little activity to occupy them or their medication may need reviewing. Judged by the menus given to us the food in the home is of a satisfactory quality, but the cook had not provided what was published – she served mince meat in the form of a savoury mince and vegetables not a curry with rice, although many residents need a soft/pureed diet anyway. The acting manager was resolved to revise the menus and to ensure residents’ preferences are met and a dietician is to be consulted to ensure they provide adequate nutrition. The cook was unaware of the Food Hygiene Regulations 2006 and in particular the food hazard analysis; indeed the cook did not even have a cleaning schedule to work to and not surprisingly the kitchen, which is very small, was not very clean. The (fire) door to the kitchen was wedged open despite a magnetic door holder being in place and this undermines its safety value. Areas of strength are the friendly, relaxed atmosphere of the home and the homely meals listed on the menus – although not always actually served as promised. Matters requiring improvement include the need to revise activity plans and opportunities to pass the day more purposefully; refinements to the menus and improve catering arrangements; the small size of communal areas cannot be easily remedied but must affect the delivery of a fulfilling and worthwhile lifestyle in this home. So this section, about daily lives, is assessed as adequate. Woodlands Nursing Home DS0000019048.V338459.R01.S.doc Version 5.2 Page 15 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. The home has appropriate procedures in place re complaints and the protection of vulnerable adults. This means that service users and their relatives/friends should be confident that their complaints will be listened to and dealt with appropriately; and also that the service users are as protected as is possible from abuse. EVIDENCE: There have been no substantive changes to the home’s procedures for dealing with complaints, which includes details about to complain in the home’s Guide. These procedures remain acceptable but it is recommended that when revised they include details of the care managers arranging placements and that the Commission oversees complaints procedures and the manner in which the home deal with those complaints – this does not mean that the Commission will always re-investigate matters that should be properly dealt within the service or by other agencies. It remains the case that the new manager put into place a new complaints record book; however there have still not been any complaints made since she took up her post. It was pleasing to note that the proprietors had made it clear on the notice board that they were happy to be approached by any service user or their representative if they had concerns. It is a little surprising to find not one resident had any concerns (recorded) in the last six months. As there have been no complaints for some considerable time this maybe an indication that residents need support and advocacy to make their wishes, their concerns and any complaints known. Woodlands Nursing Home DS0000019048.V338459.R01.S.doc Version 5.2 Page 16 Staff that were interviewed were aware of the need to report allegations of abuse to a higher authority such as the manager or directly to the Social Services or the Commission. Areas of strength are the written procedures and records whilst matters that are recommended for revision include the information about how and to whom residents and their representatives may complain. This section, about complaints and protection, is good. Woodlands Nursing Home DS0000019048.V338459.R01.S.doc Version 5.2 Page 17 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, 24, 25 and 26: Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Environmental standards in this home are poor; it is not a wholly safe and well maintained care home and it is not entirely clean and comfortable for residents. It is however small, homely and with a pleasant atmosphere. EVIDENCE: The proprietors have acknowledged that Woodlands is in need of redecoration/ refurbishment, and this is included in their long term development plans for the home. This may include for example extending the property. In the interim, every effort must be made to ensure that the premises are well maintained, and kept as clean and safe. The lounges and dining room are far too small for 18 residents to assemble and so not everyone will get any choice about where they sit or who they sit with. Some may eat in the dining room but many residents will need to eat in the lounge or in their own rooms with little choice in the matter. It does not adequately deal with the matter to claim as the acting manager stated that some residents because of their frailty eat in their rooms. It is noted however Woodlands Nursing Home DS0000019048.V338459.R01.S.doc Version 5.2 Page 18 that this is an ‘existing care home’ (registered before 2002) and as such the National Minimum Standards have been modified to take account of this fact but it remains the case that the size and layout of the home does not meet modern standards. Of particular note is the shortage of storage space leading to one very poor example where a resident’s ensuite bathroom and a large cupboard are being used for storage. The acting manager agreed to move these items whether or not the bathroom is used by the resident. He owners might consider refurbishing the garages as storage space to avoid improper use of residents’ facilities for storage. We identified a number of other less significant matters; these include the quality of the furniture and fittings; old and worn furniture in bedrooms gives a poor impression. Carpets that appear worn and dirty in corridors are also unsightly. More significantly bedrooms do not have suitable door locks – these should be fitted as standard fitments whether or not individual residents ask for them and each resident should have a lockable unit in their bedroom. Not all toilets/bathrooms have suitable a lock and should do. A number of much more serious matter were noted. The fire risk assessment (required as part of the Fire Safety Order) must be revised. In particular the home may need to consult the Fire Authority about ‘two door protection’ and escape routes (and what signs are need to direct evacuation). It appears that a secondary fire door has been removed from the hallway. There may be fire escape routes through bedrooms but this is not clearly signed and the acting manager was unsure if these were in fact escape routes; bedrooms have ‘slammers’ which are not as effective as overhead closing devices; Clearly it is not an ideal situation to have fire escape routes through bedrooms, it compromises privacy and reduces the usable space in the bedroom. Under the staff section it will also be noted that staff are not receiving the correct fire training drill. No immediate fire risk was identified during the inspection but this matter requires prompt attention to confirm fire safety measures in the home are safe. The laundry is very small; it is in a separate annex to the side of the house and is not adequate to provide washing and drying facilities so sheets and towels are provided by a laundry service. Laundry deliveries were left on fire escape route first floor. We are advised that the home was inspected to ensure compliance with the Water Regulations and the acting manager understands that all requirements have been addressed. We did however identify one anomaly in that the thermostats fitted to sinks (and possibly baths) are too readily accessible to residents who may turn them to a higher and therefore unsafe temperature; the manager has agreed to ask a plumber to make them safer. The kitchen is very small even for just 18 residents. It is in need of a thorough clean including the walls and corners of the floor. A cleaning schedule that includes deep cleaning should be in place. A safe ands secure cupboard is needed for ‘ready use’ cleaning materials used by kitchen staff. It is also advised that the cook makes herself familiar with the food hazard analysis and the wider implications of the amended Food Safety Regulations 2006. The fire door to the kitchen, which is a high risk area must not be wedged open – a Woodlands Nursing Home DS0000019048.V338459.R01.S.doc Version 5.2 Page 19 magnetic device has already been installed to allow access when food is being served or stores delivered and this must be used in preferences to a wedge. In the garden it is advisable to consider the height of the patio and whether or not guard rails should be fitted to prevent falls. At the foot of the secondary fire escape there are several steps leading to the side entrance – a handrail may be required here. As the home has insufficient storage space the proprietors might consider refurbishing the double garages as storage space. Areas of strength are homeliness of the premises but there are a considerable number of matters requiring improvement, including décor, furnishings, carpets, storage space, fire safety and water safety. so this section, about the environment, is assessed as poor. The Commission is aware that the proprietors plan to improve the quality if the environment but this year we find the premises rather poor and must be improved with or without extensions. Woodlands Nursing Home DS0000019048.V338459.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 to 30: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels mean that the needs of service users can be attended to promptly. Carers have the competencies to carry out their duties to a satisfactory standard. Service users are assured that they will be supported and protected by the home’s recruitment policy and practices. EVIDENCE: We are advised that there have been no substantive changes to the staffing arrangements in this home since the most recent inspection earlier in 2006. The rota provided indicated that there were usually five staff on duty in the morning, four in the afternoon/evening and two at night. So on the day of inspection and for 15 residents ether were two qualified Nurses plus three carers. At present the acting manager is supernumerary to the rota. It would be good practice for this to remain the case but as resident number decrease it may be acceptable for the Nurse/Manager to undertake some hands-on nursing duties if the home can still be properly managed and the care needs of residents fully met. The files of two staff were examined. Both contained all of the documentation required in the Regulations. It was noted that in both cases the staff had indicated, via a simple tick box, that they did not have any health problems. However the home does have a more comprehensive health declaration, which is normally used. The manager was advised that it would be good practice to use this documentation for all new staff members. The acting manager has decided to improve the layout of staff files so that they are properly indexed Woodlands Nursing Home DS0000019048.V338459.R01.S.doc Version 5.2 Page 21 and in a set order – this will ensure consistent recruitment practice. The home has achieved the minimum about 50 of care staff with an NVQ award, as outlined in the National Minimum Standards. Of the twelve carers in the home, it is commendable that seven have already achieved NVQ awards (one level I, three level II, two level III and one level IV), while two are working towards a level II award. Mention has been made of the forthcoming adult protection training course that has been arranged for staff. In addition refresher training has been held for some staff in moving and handling, and there are plans to arrange a Food Hygiene course. The new manager acknowledged that there was a need for a staff training and development plan to be drawn up, and she is currently discussing training needs with the staff team and relevant training bodies. Less tangible but as important as staff numbers and staff training is the moral and attitude of staff and this is less easy for visiting inspectors to analyse – the acting manager was of the opinion that a period of staff team-building was warranted. Some staff police checks [CRB] are now three years old. It is recommend that these checks be redone every three years as recommended minimum or at any other time in between if warranted, for example if a member of staff changes role or duties. Areas of strength are improvements in staff files; the qualifications of staff, the stability of the staff team and matters for improvement include the need to update police checks; team-building and the proper indexing of all staff files. So this section, about staffing, is assessed as good. Woodlands Nursing Home DS0000019048.V338459.R01.S.doc Version 5.2 Page 22 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, 36, 37 and 38: Quality in this outcome area adequate. This judgement has been made using available evidence including a visit to this service. The acting manager is not yet registered and will need to so if she is to demonstrate that she has the skills to run a care home. This home is being run in the best interests of the residents. Systems are in place to ensure that the property and money of service users can be held securely. The home is ensuring that in so far as it is reasonably practical to do so, the health, safety and welfare of service users and staff, is being promoted and protected. EVIDENCE: The new manager has only been in post for a few of months, therefore it is unreasonable, at this stage, to try to ascertain her skills and competency to run this home; she will be assessed as part of her registration process when she applies to register as the manager. As the previous inspector observed, it is noticeable that her arrival has had a positive impact on the staff team, and she has already begun to introduce new systems and practice which should, Woodlands Nursing Home DS0000019048.V338459.R01.S.doc Version 5.2 Page 23 over time, enable the home to improve the overall quality of the service provided. One way to determine if the quality of the service is satisfactory is to make use of quality assurance systems. Some have already been newly introduced – such as audits of the laundry, medication, food and nutrition. The manager acknowledged that there was a need to seek the views of service users, their families and friends and other relevant stakeholders and to include the outcome of these surveys in the residents’ Guide. The proprietors must also continue to ensure that they visit the home on a monthly basis, and produce a report of each visit. An independent element is also advisable, perhaps from a care home association of a professional person such as doctor or nurse who is familiar with the work of care homes. Advocates for residents may also prove invaluable in this quality auditing. The financial records for service users were examined on this visit. At previous inspection visits it was determined that the majority of service users had their finances looked after by their family or by their placing authority. Just a couple of residents had personal allowances looked after by the home. For all expenditure, receipts are obtained and annually the records passed to an accountant for auditing. However, its is strongly recommended that the home ask the local authority making placements to handle the resident’s money so that there is no conflict of interest between the home or its representatives drawing the money and controlling its expenditure within the same organisation. It was previously required that the amount of staff supervision be increased, so that the level recommended in the Standards be achieved. The manager had already drawn up a supervision plan, which is now working in practice and enables all care staff to receive formal supervision on a two-monthly basis. The documentation relating to maintenance appears to be up to date according to the information supplied by the manager. This included the servicing of the lift; hoists; Parker bath; electrical equipment, fire fighting equipment and the fire alarm system. The certificate of registration is to be changed in many homes and this may include Woodlands so as to reflect a new approach by the Commission to ‘conditions of registration’. Unnecessary conditions will be removed and replaced by an agreed modification to the Statement of Purpose to make clear which residents can be cared for in Woodlands. There were several safety issues that require attention:Hot water supplies must be reviewed and risk assessed and the current thermostatic valves re-assessed to ensure they are of fail-safe mixer type that cannot be tampered with. All dangerous (COSHH) substances must be kept in a locked cupboard – including kitchen cleaning fluids and cleaning materials. The home must review and revise its fire risk assessments and seek the advice of the Fire Authority in respect of two-door protection of bedrooms and fire escape routes; signs may be required to make clear those routes. Staff must undergo regular fire drills (on a quarterly basis, with at least one at night). These drills are to be separate from the weekly alarm testing. And it is Woodlands Nursing Home DS0000019048.V338459.R01.S.doc Version 5.2 Page 24 to be noted that staff should not leave residents completely unattended when responding to the fire warning system. A new strategy for responding to the fire, or any other alarm, is indicated. The garden (and any other areas that may pose a hazard) is to be risk assessed and guard rails installed in locations, such as the patio, that might pose a hazard. The acting manager advises us that on the day of our visit there were 15 residents (in care home that caters for up to 18). She also advises us that so far as she is aware the service remains viable at present but the proprietors are aware of the need to improve standards and possibly increase bed numbers if possible. Areas of strength are the introduction of a new manager, improvements in administration, a commitment towards improvement in the quality of the service, which was assessed as only ‘adequate’ in February 2007. Matters requiring improvement are the numerous safety issues and the need to register the acting manager. This section, about management and administration, is assessed as adequate but the Commission acknowledges that improvements are being made to improve this judgement. Woodlands Nursing Home DS0000019048.V338459.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 2 X X X 2 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 3 3 1 Woodlands Nursing Home DS0000019048.V338459.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 2 3 Standard OP10 OP24 OP10 OP10 OP24 Regulation 12(4)a 12(4)a 12(4)a Requirement Privacy: The bedrooms must provide privacy for residents including suitable door locks. Privacy and dignity: each resident must be provided with a suitable locked cabinet. Privacy: The bathrooms and toilets must provide privacy for residents by having suitable door locks and curtains to the windows. Social activity: The home must make arrangements for suitable activities for the group of residents and for each individual resident so they may spend their time in fulfilling activities if they wish to do so. Community contact: Residents have little contact with the outside world and some have few visitors so the home must work towards improving community contact, perhaps by using volunteer visitors and/or more formal advocacy. The registered person must ensure that where appropriate carpets are regularly cleaned (and replaced when necessary). DS0000019048.V338459.R01.S.doc Timescale for action 30/09/07 30/07/07 30/06/07 4 OP12 16(2)m, n 30/07/07 5 OP13 OP14 16(2)m, n 30/07/07 6 OP19 23(2)d 31/07/07 Woodlands Nursing Home Version 5.2 Page 27 7 OP19 23(2)d 8 OP38 13 9 OP38 23(4) and 23(4A) 10 OP38 23(4) and 23(4A) 11 OP38 OP19 13(4) 12 OP38 OP25 OP26 13(4) 13 OP31 8(1)(a) (b)iii 14 OP18 20 Kitchen hygiene; the kitchen must be thoroughly cleaned, a ‘deep clean’ to ensure it can provide food that will not be contaminated. The registered person must ensure that all cleaning materials and COSHH substances are securely kept including the kitchen to ensure the safety of residents. Fire safety: The home must revise its risk assessment including the layout of the home, the fire doors, two door protection, exit routes and their markings so as to ensure the residents are protected by adequate fire safety measures in the home. Fire safety: Staff must receive adequate fire safety training that includes unannounced drills and fire safety training (in addition to the weekly tests) so that staff will be able to protect residents in case of emergency. Garden safety: The garden must be risk assessed to evaluate potential hazards such as high steps and drop from patio. This is to protect residents from falls. Hot water: Hot water supplies including taps and valves must be checked to ensure a safe and adequate supply of hot water is delivered at a safe temperature to all parts if the home throughout the day for the safety and comfort of residents. Manager Registration: The registered provider must appoint a suitably competent person to be in full-time day-to-day charge of the home Resident personal allowances: The home must seek to ensure that wherever possible an DS0000019048.V338459.R01.S.doc 30/06/07 30/06/07 30/07/07 30/07/07 30/07/07 30/06/07 30/07/07 30/07/07 Woodlands Nursing Home Version 5.2 Page 28 15 OP33 24/26 external agency manages residents’ allowances if residents are unable to manager their own affairs; Social Service Departments may assist in this matter. The registered person must ensure that there are appropriate quality assurance systems in the home, including ascertaining the views of service users to include in the residents’ guide. 28/07/07 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 OP1 Good Practice Recommendations Statement of Purpose: It is recommended that the statement be amended as discussed so as to reflect the client group this home caters for including any variations that arise after admission. Menus: It is recommended that the menus to take account of residents’ nutritional needs and choices and that the cook makes clear when there are to be variations form the published menu so that residents’ individual tastes are catered for. 2 OP15 Woodlands Nursing Home DS0000019048.V338459.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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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