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Inspection on 27/10/05 for Woodlands Nursing Home

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

This inspection was carried out on 27th October 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

While the views of the service users were mixed (see overleaf), it has to be acknowledged that there were a number who did express their satisfaction with the home and the services being provided. The majority of the staff were described as kind and caring.

What has improved since the last inspection?

As mentioned above, the home has managed to fully meet four of the previously made requirements. Those successfully dealt with related to fire safety, staffing and service user privacy. Additionally, although they will reappear in this report, the requirements concerning complaints, the installation of grab rails and the fitting of safety covers to radiators had been partially met.

What the care home could do better:

Clearly, with 14 unmet requirements, the home still has a number of areas in which it must do better. Some of these requirements relate to improvements that are now necessary to the premises. Most, more worryingly, relate to reoccurring aspects of client care that should have been resolved. These are issues surrounding accurate documentation, adequate medication administration protocols, and more thorough client assessments and regular reviews. Since the last inspection the views of some of the service users were not as positive as they had been. Had quality assurance systems been put into place (as required) then this discontent would have been recognised and steps taken to resolve it.

CARE HOMES FOR OLDER PEOPLE Woodlands Nursing Home Woodlands Nursing Home 38 Smitham Bottom Lane Purley Surrey CR8 3DA Lead Inspector Margaret Lynes Unannounced Inspection 27th October 2005 10:15 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.V258750.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 DS0000019048.V258750.R01.S.doc Version 5.0 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.V258750.R01.S.doc Version 5.0 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. 11th July 2005 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. Woodlands Nursing Home DS0000019048.V258750.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced, and was conducted over the course of four hours. During that time a number of records were examined, a tour was made of the premises, and time was spent talking with service users, visitors and staff. In addition to the statutory two annual visits (of which this report represents one), two additional visits have been made to Woodlands this year. One to investigate a complaint, the other to follow up an Immediate Requirement Notice, which was served on the home. This Notice was served following the July inspection, when it was found that a considerable number of requirements remained unmet, including some that concerned fire safety, staff recruitment and staffing levels. The visit made to follow up the Immediate Requirement Notice was conducted at the end of September. At that visit it was found that of the 3 issues that needed urgent attention, the one relating to fire safety was in the process of being met, while the two relating to staffing had been partially met but further work was needed. On this visit, as the manager was on leave, it was not possible to determine if the urgent requirement re the quality of the staff recruitment process had further improved. The fire safety matter had been satisfactorily dealt with, while the rota provided indicated that staffing levels were, on this visit, adequate. The July inspection resulted in 8 new requirements being made, while 12 remained outstanding. Of these 20 requirements, this visit determined that some 14 requirements were still wholly or partially unmet; 4 had been met while in the absence of the manager it was not possible to ascertain if 2 had been dealt with. This visit has resulted in one further requirement being made. It is appreciated that several of these requirements demand monetary input, however most actually relate to aspects of the care service that should have been dealt with when first raised, and measures put into place to reduce the likelihood of them reoccurring. The fact that this has not been done remains a cause for concern. What the service does well: While the views of the service users were mixed (see overleaf), it has to be acknowledged that there were a number who did express their satisfaction with the home and the services being provided. The majority of the staff were described as kind and caring. Woodlands Nursing Home DS0000019048.V258750.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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.V258750.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 DS0000019048.V258750.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): 3 The Inspector was not be satisfied that the needs of potential service users were being fully identified in the pre-admission process. This means that service users cannot be reassured that the home has taken into account their individual needs, and will be able to meet them; while the staff in the home cannot be as familiar as they might be with new service users, or have an understanding of what specific service they will need to provide. EVIDENCE: It was previously required that the manager ensure that detailed preadmission assessments are carried out by the home, or supplied by the placing authority. The files of three relatively new residents were examined. All contained an in-house assessment however these were still very brief. It was also of concern to note that in each case, there was information to indicate that the client in question had some level of cognitive impairment. This home is not registered for the dementia category, and as such it is questionable whether these residents are appropriately placed. This will be dealt with in separate correspondence with the manager. Woodlands Nursing Home DS0000019048.V258750.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): 7, 8, 9 and 10 While the service user plans seen adequately covered the health and personal needs of the service users, they still did not include reference to their social care needs. This means that the staff team are not aware of the differing needs of their residents, and cannot fully know what specific care should be given. Staff ensure that each resident is able to access community based health facilities as and when required. Staff were still not, however, fully completing wound care documentation. Obviously, this can have a detrimental effect on the service user. The medication administration records were examined, and a number of errors again noted. Clearly any mistakes made in giving out medication can have serious consequences for the service users. From observation the Inspector was satisfied that service users right to privacy was being upheld. Woodlands Nursing Home DS0000019048.V258750.R01.S.doc Version 5.0 Page 10 EVIDENCE: It was previously required that the service user plans make reference to residents’ social care needs. While each file seen contained an activities preference sheet, the information gathered was not then incorporated into the plan of care. In spite of a previous requirement the wound care documentation was still not up to date, although it had improved. In some instances it has not been recorded if dressings had been changed at the due date, or even if there was still a need for a dressing. Yet again, errors were noted in the medication administration records. In addition to staff ensuring that they sign the administration record when they dispensed medication, they must also ensure that medication is not placed in a pot, which is then stood in a row of other pots for later administration. If staff remove medication from is packaging, then it is beholden on them to ensure that it is given, and to sign the appropriate record. It is not acceptable for staff to put medication into a pot and then expect colleagues on a later shift to give it. The manager also needs to ensure that staff do not use Tippex, and that the times stated on the charts for dispensing medication match the written instructions provided. At the time of the last inspection concerns were expressed that staff did not always pay due regard to the right to privacy of each service user. The Inspector felt that on this visit, matters had improved. Woodlands Nursing Home DS0000019048.V258750.R01.S.doc Version 5.0 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): 14 The Inspector did not consider that all residents were being afforded the opportunity to exercise choice and control over their lives. This means that they were not able to maintain as much independence as perhaps they could. EVIDENCE: In the case of one resident it was found that they were not able to exercise choice in deciding when and where they could carry out some of the basic functions of daily living. While it is acknowledged that mobility and privacy need to be taken into account, staff should not arbitrarily make a decision about a service user without first seeking the service user’s views. Woodlands Nursing Home DS0000019048.V258750.R01.S.doc Version 5.0 Page 12 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 The home has a satisfactory complaints procedure in place, which is accessible to service users, however as mentioned in the last inspection report, it was still not felt that complainants had any confidence that their concerns would be fully listened to or acted upon. The Inspector was still not satisfied that service users were adequately protected from abuse, as no further training in this vital area had taken place, and the home had, with regard to one particular incident, failed to complete the necessary investigation. EVIDENCE: It was noted that there had been 5 complaints since the last inspection. The documentation pertaining to these was examined and it was not felt that the issues raised, in most cases, had been fully and satisfactorily dealt with. This will be raised as a separate matter with the home manager. As indicated in the comments above, following on from an adult abuse investigation, it was evident that staff needed more training in this area. This additional training has yet to take place. Woodlands Nursing Home DS0000019048.V258750.R01.S.doc Version 5.0 Page 13 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, 20, 22 and 25 A brief tour was made of the premises, to determine if previously made requirements had been met. While some of the recommendations made by an occupational therapist had been carried out (albeit some grab rails remain to fitted), the other requirements are still outstanding. This means that the accommodation is not as comfortable, safe and well maintained as it should be. EVIDENCE: Following the last inspection a number of requirements were made with regard to the premises. While it has to be acknowledged that the first floor bathroom has been pleasantly refurbished, the failure to act on the majority of the requirements is of continuing concern. These requirements include the need to ensure that the electric water heater is fitted with a failsafe thermostatic valve, to regulate the hot water temperature. At present, if has a simple dial that can be altered by anyone. The water produced can scalding, and there is an urgent need for a more robust, tamper-proof valve to be installed. There remains a need for a rolling maintenance programme so that all areas of the home are periodically refreshed/refurbished. Woodlands Nursing Home DS0000019048.V258750.R01.S.doc Version 5.0 Page 14 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 The Inspector was satisfied, on this visit, that the needs of the service users should be able to be met as the minimum staffing levels previously agreed were now being adhered to. EVIDENCE: The rota provided indicated that the number of staff on duty was in line with the minimum levels previously prescribed. In this home, the manager is not always supernumerary to the rota. As the manager was on leave at the time of this visit, it was not possible to determine if the requirement regarding staff recruitment procedures had been met. Woodlands Nursing Home DS0000019048.V258750.R01.S.doc Version 5.0 Page 15 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): 33 and 38 The Inspector was still not satisfied that the home was being run in the best interests of the service users as there was no evidence of systems which could determine the quality of the service being provided. The home has now taken action regarding previously made requirements about fire safety, and has partially met the requirements for radiator covers. This improvement is noted however there is still a little work to be done before it can be said that the home is being maintained to an appropriate level of safety. EVIDENCE: The last two inspection reports have contained a requirement re the need for a quality assurance system to be implemented in the home. While a start had Woodlands Nursing Home DS0000019048.V258750.R01.S.doc Version 5.0 Page 16 been made on this at the time of the last inspection, a more comprehensive system still needs to be developed. The home has now installed doorguards on all bedroom doors where the resident has indicated that they wish their door to be open. The manager has also discussed with the local fire officer the appropriateness of having a fire escape route which leads through a service users’ bedroom. A copy of the fire officer’s response needs to be sent to the local CSCI office. Work has commenced on the installation of radiator guards, which will protect the service users from accidental scalding. Woodlands Nursing Home DS0000019048.V258750.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 X 2 X X 2 X STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X X 2 Woodlands Nursing Home DS0000019048.V258750.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement The manager must ensure that thorough pre-admission assessments are carried out prior to any new service users being admitted. The previously set timescale for this requirement has not been met. 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 met. The manager must ensure that wound care documentation is up to date and that treatment is consistent. The previously set timescale for this requirement has not been met. The manager must ensure that medication administration records are accurately maintained. The previously set timescale for this requirement has not been met. The manager must ensure that each service user is enabled to maintain as much independence DS0000019048.V258750.R01.S.doc Timescale for action 27/10/05 2 OP7 15 30/11/05 3 OP8 12 27/10/05 4 OP9 13 27/10/05 5 OP14 12 27/10/05 Woodlands Nursing Home Version 5.0 Page 19 6 OP16 22 7 OP18 13 8 OP19 16 9 OP19 16 10 OP22 23 11 OP22 23 12 OP24 23 as possible, and that their right to choice and consultation is not overlooked. The manager must ensure that the complaints procedure is accessible and that service users and their families are confident that any complaints made will be appropriately dealt with. The previously set timescale for this requirement has not been met. The manager must ensure that all staff have received training in the protection of vulnerable adults, and that refresher training is also available. The previously set timescale for this requirement has not been met. A new microwave is required for the kitchen. The previously set timescale for this requirement has not been met. The previously set timescale for this requirement has not been met. A new carpet is still required in one of the bedrooms. The previously set timescale for this requirement has not been met. The previously set timescale for this requirement has not been met. Grab rails must be fitted as recommended by the occupational therapist. The previously set timescale for this requirement has not been fully met. An additional hoist is required for the safe moving of service users. The previously set timescale for this requirement has not been met. Bedroom doors must be fitted with suitable locks and each room provided with a lockable item of furniture. The previously set timescale for this requirement has not been met. DS0000019048.V258750.R01.S.doc 27/10/05 31/12/05 30/11/05 31/12/05 31/12/05 31/12/05 31/12/05 Woodlands Nursing Home Version 5.0 Page 20 13 OP25 13, 23 14 OP33 24 15 OP38 13 16 OP29 19 17 OP32 8 An appropriate thermostatic valve must be fitted to the electric hot water heater. The previously set timescale for this requirement has not been 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 met. Safety covers must be fitted to all bedroom radiators. In the interim period before covers are fitted, staff must carry out risk assessments and take any necessary measures to ensure the safety of service users. The previously set timescale for this requirement has not been fully met. The manager must ensure that all staff provided the documentation listed in the Regulations before commencing work. It was not possible on this visit to assess if this requirement had been met. The proprietors must ensure that the role of the Registered Manager is clearly defined and made known to all staff. It was not possible on this visit to assess if this requirement had been met. 15/11/05 31/12/05 30/11/05 27/10/05 30/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Woodlands Nursing Home DS0000019048.V258750.R01.S.doc Version 5.0 Page 21 Woodlands Nursing Home DS0000019048.V258750.R01.S.doc Version 5.0 Page 22 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. Extracts may not be used or reproduced without the express permission of CSCI Woodlands Nursing Home DS0000019048.V258750.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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