CARE HOMES FOR OLDER PEOPLE
Woodlands Nursing Home 23 Silverdale Road Burgess Hill West Sussex RH15 OED Lead Inspector
Mrs L Driver Unannounced Inspection 29th November 2005 10:00 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 DS0000024241.V268700.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 DS0000024241.V268700.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Woodlands Nursing Home Address 23 Silverdale Road Burgess Hill West Sussex RH15 OED 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) 01444 243579 Mr Sri Krishna Ratnasinkam Mr Sri Krishna Ratnasinkam Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Woodlands Nursing Home DS0000024241.V268700.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th July 2005 Brief Description of the Service: Woodlands is a care home registered to accommodate 23 service users, both male and female, in the category Old age with nursing care. The provider/ manager is Mr S R Ratnasinkam who is in charge of the day to day running of the home. The home is a large Victorian property situated in a residential area of Burgess Hill, West Sussex. The accommodation is laid out over 3 floors, ground, first and second floor. There are 19 single rooms and 2 doubles. The home has large grounds with a patio area to the rear and a decking area at the front of the house. There is a vertical lift to access both first and second floors. Woodlands Nursing Home DS0000024241.V268700.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was carried out by Mrs Liz Driver Regulatory inspector and Mrs Judith Chandler Regulation Manager for CSCI. It was an unannounced inspection carried out over one morning in the presence of the Registered Provider/Manager Mr Ratnasinkam. Since the last inspection an adult protection investigation involving two service users has taken place. There have been two additional visits from CSCI since then, to follow up the requirements made at the last inspection and also recommendations resulting from the adult protection investigation. These visits were made on 19/08/05 and 02/09/05. A meeting between CSCI and Mr Ratnasinkam has also taken place at the care home. This inspection is to follow up the requirements from the last inspection and to look at how the home has developed its procedures. Pre inspection planning consisted of reading the last inspection report, discussing the two additional visits made by CSCI regulation managers and outcomes of the adult protection investigation. During the inspection the inspectors took a tour of the home, viewed relevant records, chatted to service users and had an interview with one newly appointed member of staff. What the service does well:
This is a care home that provides a homely environment. The Provider/Manager is visible in the home on a daily basis. The home makes contact with relatives and service users as part of its quality assurance programme. During the recent adult protection investigation CSCI received many letters from relatives offering their support to Mr Ratnasinkam. Quotes such as “excellent staff”, “staff acknowledge individual needs”, “ I would recommend this care home” and “ happy with every aspect of this home”. It was noted in many letters received from relatives that the social services investigation was a very intrusive and disruptive one that caused much distress to relatives and service users alike. It was clear from the letters that Mr Ratnasinkam is well thought of by many relatives and they offered their support to him during the period of investigation. Some letters were strongly worded in their content regarding their full support of the home, staff and manager. The home provides a very good standard of food provision with home made meals/cakes and fresh food every day. The provider/manager worked in full co-operation with all agencies during the recent adult protection investigation.
Woodlands Nursing Home DS0000024241.V268700.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
The home needs to continue with the new processes recently put in place and ensure standards are maintained. The home needs to ensure that all fire exits are easily opened if a fire occurred. Maintenance work needs to be monitored to ensure minor work is not left undone. The home needs to continually look at redecorating and updating furnishings and fittings as necessary. The fire training records, although in place, would benefit from being more structured and easily readable. The home should use this time to review its adult protection policy following completion of the recent investigation.
Woodlands Nursing Home DS0000024241.V268700.R01.S.doc Version 5.0 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. Woodlands Nursing Home DS0000024241.V268700.R01.S.doc Version 5.0 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 DS0000024241.V268700.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 People who use this service are provided with an updated Statement of Purpose and guide that enables them to make a choice about whether they wish to live at the home or not. All service users are provided with a contract so they know the terms of agreement. The pre admission assessment format has recently been reviewed and now meets the National Minimum Standards. EVIDENCE: The home has recently rewritten its Statement of Purpose and provided a copy to CSCI. It clearly states what it can and cannot offer. All service users were seen to have a service users guide in their bedrooms during the inspection together with an Advocacy policy. The registered manager carries out pre admission assessments and is aware as to whether current staff can meet the needs of prospective service users. This was an area raised during the recent investigation and one the manager has seriously taken on board. Some rooms, especially those on the second floor are restrictive for service users with high needs and no concerns are raised as to the service users currently accommodated in these rooms. The home has
Woodlands Nursing Home DS0000024241.V268700.R01.S.doc Version 5.0 Page 10 invested in a new record system that has provided a more comprehensive pre assessment format for the home to follow. Woodlands Nursing Home DS0000024241.V268700.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9,10 People who use this service have individual care plans to ensure all staff understand their needs that meet the recommendations of the National Minimum Standards for Older People. Assessing and reviewing needs have improved to a satisfactory standard. Medication administration is sound and regularly monitored by the Manager and the local Pharmacy provider. Service users are treated with respect and dignity. EVIDENCE: Since the last inspection the home has invested in a new recording system that provides a comprehensive record of all areas of a service individual needs, from pre admission assessment through to care when dying. The senior qualified member of staff on duty during this inspection stated she is monitoring and reviewing these records. She evidenced her commitment in ensuring this is done. Records now show in depth information around areas such as wound care and risk assessments of tissue viability. All areas recommended in the National Minimum Standards for Older people relating to care plans are recorded in the new system now in place.
Woodlands Nursing Home DS0000024241.V268700.R01.S.doc Version 5.0 Page 12 Training for staff that was commented on in the last inspection report has been addressed, with wound care and catheter care included. Practice in dealing with wound care was not observed during the inspection but was commented on by both Mr Ratnasinkam and the senior staff member who both acknowledged an improvement since attending training. There are currently no pressure sores, one service user with an ulcer who is visited by a district nurse. The home has made good contacts with professionals such as wound care specialists and will use their expertise if necessary in the future. During the recent investigation service users were assessed as to the suitability of the pressure relieving mattresses they were provided with. All service users were seen to have appropriate mattresses and in good working order. Waterlow scores relating to individual vulnerability of the risk to pressure sores are now reviewed regularly. The registered manager stated he reviews adaptations and specialist equipment on a regular basis. The home has worked hard to implement the new recording system and records viewed during the inspection were well maintained and seen as working records. Medication administration is now being more closely monitored and the manager informed the inspector that training sessions on accountability have taken place. The registered manager monitors the records and practice of administration. The local pharmacy provider has visited the home to assist with stock control and is due to visit again in December 2005. The inspectors observed service users being treated with respect and dignity and no areas of concern were voiced by service users during the inspection. Woodlands Nursing Home DS0000024241.V268700.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,15 People who use this service are provided with a very good standard of home cooked food with fresh food on offer daily. The home aims to meet individual service users wishes around social, cultural, religious and recreational needs. EVIDENCE: During the recent adult protection investigation it was commented that the home could provide more social activities for service users. Feedback from relatives was critical of imposing activities on their relatives if they wish not to participate. The home has carried out a recent survey for service users around activities and individual likes and dislikes are recorded in care plans. The home now employs an activities person five times a week. An activity poster was seen on display in the home during the inspection. The activity person will carry out activities either in the communal lounge or in individual bedrooms, as requested. The food provision continues to be of a very good standard with wholesome home cooked food and fresh home cooked cakes daily. During the inspection service users were seen to be enjoying lunch together in the dining room with staff providing sensitive assistance to some service users who needed help. Woodlands Nursing Home DS0000024241.V268700.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): 16,18 People who use this service have access to a clear complaints procedure to voice concerns. The adult protection investigation is now complete and recommendations resulting from it have been addressed. Policies and procedures are in place to ensure protection for all service users. EVIDENCE: The home has a complaints procedure on display in the entrance hall. The registered manager informed the inspector that there are no current complaints being investigated. CSCI have not received any complaints since the last inspection. The recent adult protection investigation has now been completed and the home has addressed recommendations resulting from it. These recommendations are in line with the requirements resulting from the last CSCI inspection. CSCI carried out two additional visits to the home during the investigation. CSCI received many letters of support from relatives during the investigation who offered their support to the manager and staff. Complimentary comments about, care and the homes staff were voiced, some quite strongly. The investigation had a negative effect on staff moral and the manager stated this is now improving. There has been some movement of staff during and after the investigation but new staff have also been employed. It is advised that the home now review its adult protection policy to ensure it was a workable policy, taking the recent investigation into account. The home has a copy of the West Sussex Adult Protection Policy.
Woodlands Nursing Home DS0000024241.V268700.R01.S.doc Version 5.0 Page 15 There have been no concerns raised to CSCI since the investigation has been completed. Staff training in Adult Protection has taken place with attendance by all staff at the local social services training in September/October 2005. The registered manager also stated he has provided in-house training on this subject. Woodlands Nursing Home DS0000024241.V268700.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): 19,22,24,26 People who use this service live in a comfortable and homely environment that is satisfactory maintained. It is clean and safe for service users. Both indoor and outdoor communal areas are safe and pleasant for service users to enjoy. Service users are able to furnish their rooms with their own possessions if they wish enabling them to maintain contact with memories of their lives. The home is clean and hygienic. EVIDENCE: A tour of the home resulted in some minor maintenance work being identified. These are ensuring all fire doors are not too stiff to open, all guttering is cleared of leaves, work to the sink in room three in the very near future. The home was seen to be clean and free from offensive odours. The manager is reminded that a continual need to address redecorating and updating of facilities is needed. All rooms showed service users are able to bring their own possessions into the home. Service users spoken with during the inspection stated they were happy with their rooms and the facilities they had. All
Woodlands Nursing Home DS0000024241.V268700.R01.S.doc Version 5.0 Page 17 communal rooms were safe, clean and pleasant. All cleaning materials were seen to be locked away. Specialist equipment is in place to aid day to day living for service users. Records show regular checking of equipment. The manager stated his commitment to ensuring pre admission assessments cover the homes ability to care for service users with the correct adaptations and specialist equipment in place. Regular reviewing of individual needs will enable the home to address any shortfalls and rectify. Woodlands Nursing Home DS0000024241.V268700.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): 27,28,30 People who use this service are cared for by a staffing team that is led by an experienced manager who is supported by a team of qualified staff and care staff. Numbers of staff on duty met the needs of the current service users. Recent training has provided staff with extra skills and knowledge. EVIDENCE: The numbers and skill mix of staff on duty during the inspection were satisfactory for the needs of the current service users. The home has lost a small number of staff during the adult protection investigation but has employed a very experienced qualified nurse who is providing day to day support to the manager. Many of the staff have worked at the home for long periods of time. The homes recruitment process ensures all staff are employed via a robust recruitment process. All records were in place and well maintained. Training is provided by an external company as well as in house training. All staff have recently attended Adult Protection training at the local Social and Caring Services offices, a recommendation of the adult protection investigation. CSCI were given a copy of the training programme in place in the home which showed it to be regular and appropriate to the service users it cares for. Training around the new recording system has also occurred, together with more specialist training around wound care and catheter care. Staff receive regular supervision with all qualified staff receiving supervision from the manager.
Woodlands Nursing Home DS0000024241.V268700.R01.S.doc Version 5.0 Page 19 Woodlands Nursing Home DS0000024241.V268700.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): 31,33,36, The home is managed by an experienced manager who has many years experience of caring for the elderly. He is also the registered provider. He has recently employed a very experienced qualified nurse who supports him in the day to day running of the home. All feedback from relatives and service users indicate the home is run in the best interests of the service users. Staff are supervised appropriately. EVIDENCE: The manager is a very experienced qualified nurse who is committed to the home. He co-operated fully with the adult protection investigation, returning to the country early whilst on holiday to attend a meeting at the local social services at the start of the investigation. He has acted swiftly and professionally in the outcomes of the investigation and last inspection report of CSCI. The home has certainly moved forward as a result of the last inspection report and the adult protection investigation and the Registered Provider/Manager
Woodlands Nursing Home DS0000024241.V268700.R01.S.doc Version 5.0 Page 21 has employed a senior qualified nurse to support him on a day to day basis. This appears to be working well. Records show that staff are supervised regularly with all qualified staff being supervised by the manager. Woodlands Nursing Home DS0000024241.V268700.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 3 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x 3 x 3 x 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x x 3 x x Woodlands Nursing Home DS0000024241.V268700.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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP19 OP38 OP38 OP19 Good Practice Recommendations It is advised that the minor maintenance work needed for the sink in room 3 be carried out in the very near future. It is advised that all fire doors be inspected regularly to ensure they are not too stiff to open. It is advised that all gutters be cleared of winter leaves. It is advised that continual redecorating and updating of furnishings take place.
DS0000024241.V268700.R01.S.doc Version 5.0 Page 24 Woodlands Nursing Home 5 OP18 It is advised that the home now review their own adult protection policy following the recent investigation. Woodlands Nursing Home DS0000024241.V268700.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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