Inspection on 21/09/05 for Woodlands Nursing Home

This inspection was carried out on 21st September 2005.

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.

Other inspections for this house

Woodlands Nursing Home 16/11/07

Woodlands Nursing Home 21/12/06

Woodlands Nursing Home 14/02/06

Woodlands Nursing Home 01/03/05

Woodlands Nursing Home 10/09/04

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 Gordon Road Ilford Essex IG1 1SN Lead Inspector Gwen Lording Unannounced Inspection 21 September 2005 11:00 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 DS0000025966.V251243.R01.S.doc Version 5.0 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 DS0000025966.V251243.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Woodlands Nursing Home Address Gordon Road Ilford Essex IG1 1SN 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) 0208 553 2841 0208 553 2946 Woodlands Total Care Nursing Home Limited Usha Patel Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Woodlands Nursing Home DS0000025966.V251243.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st March 2005 Brief Description of the Service: Woodlands Nursing Home is registered to provide nursing care for up to 30 people over the age of sixty-five years. The large converted property is situated in a residential area of Ilford in the London Borough of Redbridge. There are good transport links and the home is close to shops and other amenities and community facilities. The majority of the rooms are single and some have en suite facilities. The bedrooms are located on three levels with access by lift to all floors. The home is able to accommodate people from different cultural and religious groups. The manager and some of the staff team have the ability to speak a variety of languages, and key words are taught to staff to facilitate care for residents whose first language is not English. The home is able to meet the cultural dietary needs of all residents. The home employs an activity co-ordinator, catering, laundry, domestic and maintenance staff. Woodlands Nursing Home DS0000025966.V251243.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day, commenced at 11am and lasted five hours. Discussion took place with the registered manager, catering, domestic staff and several members of nursing and care staff. The Inspector spoke to a number of residents in the main lounge and three residents who were in their bedrooms. A tour of the home was made and a number of staff and care records were looked at. The Inspector would like to thank the residents and staff for their input during the visit. What the service does well: What has improved since the last inspection? 95 of care staff are qualified to NVQ level 2 or above and this demonstrates a very positive commitment to training from both the registered providers and the care staff. At the previous inspection there had been a small number of areas in which the home had to improve. The home had taken action on all these areas and this represents a very positive response and demonstrates the homes commitment to work with the Commission in order to further raise standards at the home. Woodlands Nursing Home DS0000025966.V251243.R01.S.doc Version 5.0 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 DS0000025966.V251243.R01.S.doc Version 5.0 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 DS0000025966.V251243.R01.S.doc Version 5.0 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): Standard 3 Appropriate pre-admission assessments are carried out for all residents prior to them moving into the home. Care plans are drawn up from the information in this assessment, ensuring that the needs of the residents are identified, understood and met. EVIDENCE: Individual records are kept for each resident and six files were examined. All records inspected have assessment information recorded and the information had been used to continue assessment following admission to the home and develop written care plans. The records showed that residents, where capable and their relatives/ representatives are involved in the assessment process. Where appropriate, information provided by the placing authority was also on file. The home does not offer intermediate care. Woodlands Nursing Home DS0000025966.V251243.R01.S.doc Version 5.0 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): Standards 7, 8, 9 and 10 Residents’ health, personal care and social care needs are set out in individual care plans but not all care plans accurately reflected the current needs and did not provide staff with sufficient information to ensure that care needs were being met on a daily basis. There are clear medication policies and procedures for staff to follow. However, there are some inconsistencies in the recording of medication, which may result in unsafe practices. Residents are treated with respect and the arrangements for their personal care ensure that their right to privacy is upheld. EVIDENCE: Individual care plans were available for each resident and a number of records were examined. The records for these residents were generally found to be generally detailed and comprehensive. However, there was inconsistent practice in some care plans and the following was discussed with the registered manager: Woodlands Nursing Home DS0000025966.V251243.R01.S.doc Version 5.0 Page 10 • On examination of one care plan it was noted that the resident is recorded as having an infected wound site. However, there was no specific care plan detailing the procedures to be followed by staff in accordance with Universal Precaution Standards in respect of control of infection, including the handling of soiled linen. On examination of the care plan of another resident with an infected wound site, there was a detailed care plan specifically relating to the management and control of the infection. • Although there was evidence that care plans were reviewed monthly, there was limited evidence on some of the care plans that reviews were meaningful as they did not always reflect changes to the care required or detail the progress of the individual. For example, one resident’s care plan indicated that his blood sugar should be monitored daily. The last recorded entry in the care plan was 31/08/05. In discussion with the manager it was evident that the daily monitoring was in response to a period of fluctuating blood sugar levels, which had stabilised and daily monitoring was no longer required. However, the care plan had not been reviewed accordingly to reflect this change. All the care plans examined indicated that residents are seen by other health care professionals such as dentists, chiropodists, specialist nurses and doctors. Where indicated, fluid intake/ output monitoring charts and turning charts were being accurately maintained by staff. An audit was undertaken of the management of medications within the home. The following issues were noted and discussed with the manager: • Handwritten entries on Medication Administration record (MAR) charts must be signed and dated by the person making the entry i.e. registered manager, nurse. The entry must also include the source of the information i.e. GP, Community Nurse. • The medicine trolley must be securely anchored when not in use. Staff talked about and were observed to treat residents in a respectful and sensitive manner. They understood the need to respect an individual’s dignity through practices such as in the way they addressed residents and when entering bedrooms, bathrooms and toilets. Residents spoken to said that all staff were respectful and thoughtful when attending to their personal care. The Inspector was told that the day prior to the inspection the funeral cortege of a recently deceased resident had left from the home. The resident’s family lived some considerable distance away and the manager had arranged for the Woodlands Nursing Home DS0000025966.V251243.R01.S.doc Version 5.0 Page 11 family to have a small buffet reception in the home following the funeral for family and friends. Woodlands Nursing Home DS0000025966.V251243.R01.S.doc Version 5.0 Page 12 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): Standards 12, 13 and 15 The lifestyle within the home matches the expectations and preferences of residents and individual cultural and religious needs are understood and met. The meals in the home are good and individual preferences and specialist dietary needs are catered for. Visiting times are flexible and people are made to feel welcome in the home so that residents are able to maintain contact with their family and friends as they wish. EVIDENCE: The home employs a part time activity co-ordinator, who works in the home three days a week. There is a programme of both individual and small group activities for example hand/ foot massage, quiz sessions and visiting entertainers and activities outside the home, and residents can choose whether to participate or not. As well as books, magazines and newspapers there is a small video library including a selection of Asian videos. The home has links with local places of worship including a Catholic Church and Hindu Temple. Holy Communion is held in the home once a month for those residents wishing to participate and one resident is occasionally taken to the Woodlands Nursing Home DS0000025966.V251243.R01.S.doc Version 5.0 Page 13 local Temple. Wheelchair access to the Temple is restricted however; the manager is actively addressing this with the Hindu priest. Meals are served in the dining room or residents may choose to eat in their rooms. Most residents eat all meals in the large lounge from small tables in front of lounge chairs, though it is not clear if this is through choice. Menus were examined, discussions held with the Assistant Cook, residents were asked about the meals and the lunchtime meal served during the visit was seen. The cook and assistant cook have been at the home for a number of years and know what each resident likes to eat and which residents require a special diet, for example vegetarian, diabetic diet. The cook is able to prepare Asian meals and there is a separate Asian menu. Those residents spoken to who were able to express a view said that they enjoyed the food and that there was a good choice. Menus were examined and found to be well balanced and a choice is offered each day. Several staff have received training around “Nutrition in the Elderly” and there is also information in the home provided by the Dietician. Visiting times are flexible and residents are able to receive visitors in the lounge, small visitors room or in their own rooms. Relatives are encouraged and welcomed to be involved in activities/ special events held in the home. The husband of one resident chooses to spend most of the day with his wife. This is well accommodated by staff and arrangements can be made for the provision of a meal if required. . Woodlands Nursing Home DS0000025966.V251243.R01.S.doc Version 5.0 Page 14 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): Standards 16 and 18 The information in the complaints policy/ procedure must be amended to provide residents and their relatives with the appropriate information and ensure that their complaints are dealt with promptly, effectively and to their satisfaction. All nursing and care staff have received training in Adult Protection/ Abuse Awareness. However, this training must be extended to all staff working in the home including the activity co-ordinator, ancillary and maintenance staff to ensure that there is a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a complaints policy/ procedure and the records indicate the number of complaints received and includes details of the investigation, any action taken and the outcome for the complainant. However, some of the residents would not have the capacity to use a written, formal process. The complaints procedure is also produced in three Asian languages i.e. Gujarati, Punjabi and Hindi. Those residents spoken to, who were able to express a view said that they felt able to make complaints and raise issues if they needed to and would speak to “The manager or one of the nurses”. The information contained in the complaints policy must be amended/ updated to include information for referring a complaint to the Commission for Social Care Inspection (CSCI), at any stage should the complainant wish to do so and include the correct details for contacting the local Commission office. Woodlands Nursing Home DS0000025966.V251243.R01.S.doc Version 5.0 Page 15 There is a written policy and procedure for dealing with allegations of abuse and whistle blowing. Nursing and care staff have received training in Adult Protection/ Abuse Awareness but this must be extended to all staff working in the home. Those staff spoken to during the inspection were aware of the action to be taken if there were concerns about the welfare and safety of residents. Woodlands Nursing Home DS0000025966.V251243.R01.S.doc Version 5.0 Page 16 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): Standards 19, 20 and 26 The overall atmosphere in the home is very welcoming, with access to indoor and outdoor communal facilities which adequately meet the needs of the people living in the home. However, there are a small number of areas in the home in need of re-decoration and minor repair, to improve the comfort of the residents. EVIDENCE: The building was toured, accompanied by the manager, at the start of the visit, and all floors of the home were visited unaccompanied later during the day. Some bedrooms were seen either by invitation of the residents, whilst others were seen because the doors were open or rooms being cleaned. All areas of the home were clean, tidy and free from odour throughout. The dining room on the ground floor was previously a bedroom. The room is bright and has the potential to provide a small attractive room in which residents can eat. However, the sink, soap dispenser and towel rail were not Woodlands Nursing Home DS0000025966.V251243.R01.S.doc Version 5.0 Page 17 removed when the use of the room was changed and this unfortunately spoils the overall surroundings. It is strongly recommended that these hand-washing facilities be removed and any damage to the décor made good to provide more pleasant and appropriate dining facilities. Both the bathroom/ toilet and disabled toilet on the ground floor are in need of re-decoration and the floor covering needs to be replaced. The bathroom on the top floor was noted to have some broken tiles, which had been repaired with sellotape, and the wooden skirting requires attention. All areas of the home need to be adequately maintained to improve the comfort and safety of residents. The registered providers must ensure that there is an ongoing programme of renewal for the fabric and decoration of the premises. Woodlands Nursing Home DS0000025966.V251243.R01.S.doc Version 5.0 Page 18 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): Standards 27, 28 and 29 Staffing levels are satisfactory and there are sufficient staff on duty to meet the individual assessed needs of the residents. Resident’s benefit from a committed staff team who have the skills and training to meet their needs. The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. EVIDENCE: The home has a relatively stable workforce and in discussion with staff it was evident that they fully support the main aims and values of the home. In addition to qualified nurses and care staff Woodlands employs an activity coordinator, catering, laundry, domestic and maintenance staff. The information on the duty rota was consistent with the names and delegations of staff on duty. The registered manager must ensure that her times of working are detailed on the rota and that the full name of each member of staff is also recorded. Staff files showed that staff had done training in essential areas, such as first aid, infection control, manual handling and nutrition in older people. 95 of care staff are qualified to NVQ level 2 or above and this demonstrates a very Woodlands Nursing Home DS0000025966.V251243.R01.S.doc Version 5.0 Page 19 positive commitment to training from both the registered providers and the care staff. The files of four staff employed since the last inspection showed that the home is undertaking all the necessary recruitment checks to ensure the protection of residents. Woodlands Nursing Home DS0000025966.V251243.R01.S.doc Version 5.0 Page 20 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): Standards 31, 32, 36 and 38 The manager is a very experienced and well-qualified person and residents benefit as the home is run in their best interests. EVIDENCE: The registered manager has been in post for more than six years, is a registered nurse and has the relevant clinical and management qualifications. She has a good understanding of the needs of the residents and the areas in which the home needs to improve and further develop. She has a visible presence in the home and staff and residents commented that she is very approachable and helpful. Regulation 26 visits are undertaken by the responsible person on a monthly basis and a copy of the report is supplied to the Commission. Woodlands Nursing Home DS0000025966.V251243.R01.S.doc Version 5.0 Page 21 There is a system in place for all staff to receive regular formal supervision to ensure that they are effectively supported in their work and clinical practice. Each member of staff has a supervision handbook and those staff spoken to confirmed that they have supervision approximately every 2-3 months. However, the registered manager herself is not receiving supervision on a regular basis. The registered providers have a number of care homes and the registered managers of four homes are currently working on the production of a Health and Safety Handbook, which all staff will receive a copy of when it is finalised. Woodlands Nursing Home DS0000025966.V251243.R01.S.doc Version 5.0 Page 22 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 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X 2 2 3 Woodlands Nursing Home DS0000025966.V251243.R01.S.doc Version 5.0 Page 23 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 OP7OP37 Regulation 15 & 17 Requirement Timescale for action 31/10/05 2 OP9 13 All care plans must accurately reflect the current needs of residents and provide staff with sufficient information to ensure that care needs are being met on a daily basis. All handwritten entries on 30/09/05 Medication Administration Records (MAR) charts must be signed and dated by the person making the entry and include the source of the information. The medicine trolley must be securely anchored when not in use. The information contained in the complaints policy must be amended/ updated to include information for referring a complaint to the CSCI, at any stage should the complainant wish to do so and include the correct details for contacting the local CSCI office. It is a requirement that all staff working in the home, including the activity co-ordinator, ancillary and maintenance staff DS0000025966.V251243.R01.S.doc 3 OP16 22 31/10/05 4 OP18 13 & 18 30/11/05 Woodlands Nursing Home Version 5.0 Page 24 5 OP19 23 receive training in Adult Protection/ Abuse Awareness. All areas of the home must be adequately maintained to improve the safety and comfort of residents. The duty rota must record the working hours of the registered manager and the full name of each member of staff. The registered provider must ensure that the registered manager receives regular formal supervision in line with the standard. 30/11/05 6 OP27OP37 17 30/09/05 7 OP36 18 31/10/05 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 19 Good Practice Recommendations It is a recommendation that the hand washing facilities be removed from the dining room and any damage to the décor made good, to provide more pleasant and appropriate dining facilities. Woodlands Nursing Home DS0000025966.V251243.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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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