Inspection on 26/11/08 for Woodlands Nursing Home The

This inspection was carried out on 26th November 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Woodlands Nursing Home The 27/11/07

Woodlands Nursing Home The 19/06/07

Woodlands Nursing Home The 16/01/07

Woodlands Nursing Home The 29/08/06

Woodlands Nursing Home The 10/01/06

Woodlands Nursing Home The 04/08/05

Woodlands Nursing Home The 11/11/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Woodlands Nursing Home The 8-14 Primrose Valley Road Filey North Yorkshire YO14 9QR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jo Bell     Date: 2 6 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Woodlands Nursing Home The 8-14 Primrose Valley Road Filey North Yorkshire YO14 9QR 01723513545 F/P01723513545 judyannelucas@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Judith Anne Lucas Type of registration: Number of places registered: Hexon Limited care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The Woodlands is a large detached property set in secluded gardens approximately 2 miles from the seaside town of Filey and 8 miles from Bridlington. The home is a short walk from a bus route. It is registered to provide personal and nursing care for up to 34 older people. The property is on three floors and there is a passenger lift providing access to all areas. The building is separated into two wings, Oak wing and Chestnut wing. The majority of bedrooms provided are single with en suite facilities. Basic information about the home and what services are offered is provided in the homes Statement of Purpose. Prospective service users and their families are given a copy of this document when they express an interest to live at Woodlands. 0 Over 65 34 Care Homes for Older People Page 4 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We have reviewed our practice when making requirements,to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. We went to the home without telling them that we were going to visit. This report follows the visit that took place on Wednesday 26th November 2008. The visit lasted from 10:30 until 16:30. The purpose of the visit was to make sure that the home was operating and being Care Homes for Older People Page 5 of 27 managed in the best interests of people living there. Information has been used from different sources for this report. These sources include- Reviewing information that has been received about the home since the last inspection. The annual quality assurance assessment. This is information which details what has happened during the past 12 months. 6 Surveys from people using the service, and 4 from health care professionals. Notifications (Regulation 37) relating to incidents in the home affecting people using the service. Details of complaints and allegations raised by people connected to the service. Details from a random inspection which took place in July 2008. Progress of the previous recommendations made at the last site visit. At the site visit one inspector spent 6.0 hours at the home. During this time observations of care practices took place. People using the service were spoken with along with some relatives. Discussions with the manager regarding meeting needs, mealtimes, protecting people and the environment took place. The lunchtime meal was observed and time was spent inspecting care plans, looking at individual rooms and reviewing a selection of health and safety information. Staffing and management issues were discussed and feedback was given to the manager at the end of the inspection. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get Care Homes for Older People Page 7 of 27 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed, though more consideration should be given to the type of person admitted to the home. Evidence: The three pre-admission assessments looked at confirmed that a senior person completes an assessment before an individual moves to the home. This is to check what type of care and support the person needs and whether the staff have the skills and knowledge to provide that care if the individual chooses to move there. The process also reassures the individual and their family that they will receive the right support. Assessments are completed if the person has a care manager or is privately funded. These detail health, personal, nursing, social and mental health needs. All the surveys completed by people living there report that people are given enough information Care Homes for Older People Page 10 of 27 Evidence: about the service and what it provides. This means they can make an informed choice about whether to move there or not. A discussion took place with the manager regarding nursing and mental health needs. The home currently has ten people with aspects of dementia, this was detailed in the annual quality assurance assessment. Staff feel their nursing needs outweigh the mental health needs of these individuals, though this client group has a big impact on the home and the levels of supervison needed to meet their needs. The manager is aware that the home is not registered to take people solely with dementia needs. The home does not provide intermedicate care services, though emergency and respite admissions take place. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People generally have their health and personal care needs met in a dignified manner. Evidence: Three care plans were looked at during this visit. These describe the care and support people need to stay in charge of their own lives as much as possible. The plans looked at contained a lot of information, so that an unfamiliar carer could look at them and would be able to work out how much support they needed. There were written assessments as to whether people were at risk of developing pressure sores, of losing weight because of poor appetite or a health problem or needing help with moving and handling. Those identified as at risk had a care plan in place describing how that risk was to be managed. People looked generally well cared for, though staff do need to pay more attention to detail regarding cleanliness of hair, nails and teeth. Surveys confirmed that the majority of people have thier medical needs met . The home have good links with healthcare professionals and these include wound care specialist, palliative care nurse, Care Homes for Older People Page 12 of 27 Evidence: dietician and care co-ordinators. Local Doctors visit people in the home and communicate effectively with staff regaridng peoples well-being. People were observed thorughout the day in communal areas and staff interacted well with people in a pleasant attitude and manner. It was evident that some people were spending time in wheelchairs and on occasions staff did not use the footplates correctly, at times the brakes were not used on wheelchairs and more consideration was needed to the correct positionbing of these chairs. This will prevent injuires occurring. The manager was made aware of this. The medication system was robust. Staff were aware of how to administer, store and record medication. There are two system in use which may lead to errors occurring. However staff were aware of how to manager both the tablets in boxes and the tablets in the blister pack system. Medication charts were well maintained with regular audits of the number of tablets kept in the home. Controlled drugs were stored correctly and two staff sign for these tablets when administered. Daily fridge temperatures are taken and these were within the expected range. Staff need to ensure they dispose of medicaiton in a consistent manner, for example either in the clinical waste or by destroying the medication. This needs to be done in line with the homes medication policy. The medication room could be more secure, this would mean changing part of the environment (see Standard 19). Staff are aware of privacy and dignity, and evidence of staff knocking on bedroom doors prior to entering was available. Staff enjoy friendly banter with people using the service and interactions were positive. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People participate in some activities and visitors are welcomed. Staff encourage autonomy and choice, and people enjoy the food and drink provided, though more consideration is needed to the suitability of the dining room furniture. Evidence: The home offers structured activities once a week with an organizer. These are recorded and include bingo, ludo dominoes and cards. At other times staff chat with people on a one to one basis as time allows. There are singers and musicians visiting the home and recently this included a harpist which many people enjoyed. Views from the surveys returned had mixed comments regarding the activities provided. The home does not have a mini-bus and it is located approximately four miles from Filey. People would benefit from more trips outside, and the home is close to the seaside. Visitors are welcomed into the home and people can access church services to meet their religious needs on a monthly basis. The visitors book confirmed that people can come into the home at different times during the day. The lunchtime meal was observed and the catering staff were spoken to. One main meal is offered with alternatives been available. People using hate service and some Care Homes for Older People Page 14 of 27 Evidence: staff were unclear as to what the lunchtime meal was until it arrived. The food looked appetizing with consideration given to different portion sizes. Plate guards and a mix of cups and beakers were used depending on peoples needs. People may prefer glasses rather than plastic cups. Homemade food was evident and staff were aware of who needed a soft or pureed diet and which people needed assistance. The dining room was pleasant with tables for up to four people available. It was evident that the majority of people in one of the dining areas were left in wheelchairs at the table rather than been transferred to a dining chair. Part of the reason for this was the style of dining chairs available. These had no arm support and could make sitting unsafe for long periods of time. The environmental health officer had visited recently and the home have acted on the recommendations made. Catering staff have completed food hygiene training and routinely ask people whether they enjoy the food they have. An audit of peoples likes and dislikes may be useful. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their concerns listened to and acted upon, though staff need to be more alert to signs of abuse. This will help keep people safe Evidence: The home have a complaints procedure in place which people and their visitors are aware of. It is unclear from the Annual Quality Assurance Assessment how many complaints the home have received in the past year. The procedure is discussed with people at the admission stage and a copy of this is displayed in the home. Staff spoken to were aware of the safeguarding procedures in place. For example they were aware that abuse needed to be reported, but they were unclear on the types of abuse and the immediate action they would need to take to protect a vulnerable person. Very few staff have completed abuse awareness training. The home have a policy in place and staff are encouraged to use the Whistle Blowing policy. Further training is needed in this area. However, during the visit people looked safe and staff interacted well with people using the service and their visitors. Care Homes for Older People Page 16 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean though some redecoration to the inside of the home would improve the environment. The medication room could also be made more secure. This would make the sytem more robust. Evidence: The home is located in a pleasant area where people can access peacful gardens and have views overlooking Filey. The environment has improved since the last inspection twelve months ago. There is a patio and garden area for people to access and repainting and new signage is in place. The manager is aware that some work is needed inside the home to maintain the standard of the bedrooms and communal areas and corridors. There are many chips of paint off the skirting boards, and door areas. This is partly due to the use of wheelchairs in the home. The medication room needs to be reviewed. Currently there is a small window which looks outside which people coold see through. The entrance to the room is kept locked though the wooden doors and frosted glass still enables people to see through into the room. This door could be replaced and made more secure, this will prevent any breaches of security occurring. The home have some infection control procedures in place. Staff were observed using Care Homes for Older People Page 17 of 27 Evidence: handwashing techniques and wearing protective clothing. People had their clothes washed and ironed effectively and domestic staff were available to promote a pleasant smelling home. It was evident that staff have not compelted infection control training recently. This will keep them up to date with prevention of cross contamination, and keep them alert to any infectious outbreaks. Care Homes for Older People Page 18 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by staff who are competent, and safely recruited. Though more emphasis needs to be placed on the induction programme for new staff. This will help understand their role more effectively. Evidence: The home has twenty six older people and there are registered nurses, mental health nurses and carers to meet their needs. At the site visit there was one mental health nurse on duty with six carers. Normally there are two nurses (one is a general nurse). There are some people who have high dependancy level needs and those who have elements of dementia. Up to sixteen people need two staff to help with their personal care needs. This was detailed in the Annual Quality Assurance Assessment. Staff were observed generally meeting needs though more specific training in dementia care is needed. The call bell system has been updated with control panels on each floor. Currently the call bell rings and has to be turned off where it has been called from. However, if an emergency call bell goes off at the same time it is difficult for staff to differentiate between them. Some staff have completed NVQ Level 2 in Care this is well over the 50 expected. New staff are only employed following a robust recruitment procedure. Two written references, a police check and protection of vulnerable adults checks were in place on Care Homes for Older People Page 19 of 27 Evidence: three staff files which were isnpected. This helps to protect people from harm. The home orientate new staff to the home and an induction programme is in place. This covers a range of care practices and expectations of the role. However, this has not been fully implemented and there was no evidence that any new staff had worked their way through the induction programme. Care Homes for Older People Page 20 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is starting to be run in the best interests of the people using the service. Evidence: The manager is an experienced nurse and manager with many years experience working with older people. Visitors feel they can approach the manager and staff if they have any concerns. The annual quality assurance assessment was completed though this contained limited information regarding the improvements that that have taken place in the past twelve months. However, the manager has only been in post for a few months and whilst she is extremely experienced shie is not familiar with allthe paperwork and records kept in the home. The evidence relating to what the service does well again was limited. This was discussed with the manager. The home have a limited quality assurance system in place which includes client questionnaires. Though there are no formal monthly visits from the provider (Regulation 26) and a range of audits which relate to health and safety, the Care Homes for Older People Page 21 of 27 Evidence: environment and care practices need to be implemented. An annual development plan needs to be implemented. People can keep personal money in the home. This may be used for chiropody, hairdresing, clothes or toiletries.Well-maintained records are kept of all transactions and invoices are available which confirm the money coming in and going out. Health and safety was discussed and a selection of policies were inspected. A fire risk assessment is in place but has not been reviewed since 2007. Staff receive some fire, moving and handling, infection control and food hygiene training though more training needs to be planned and clear records need keeping. Water temperatures are taken and both the electrical wiring certificate and gas safety checks are in place. In a minority of rooms the water temperature was too high (4751.4 degrees centigrade). This was recorded over a four month period but no action has been taken to resolve this. The manager has informed the provider though this still remains outstanding. This may pose a risk of burning or scalds to people and needs to be addressed. Care Homes for Older People Page 22 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 3 14 ,Sch 3 (1) People must only be 01/07/2008 (a) admitted to the home when their primary need is nursing and not dementia. 18 People must be cared for by 15/07/2008 a sufficient number of staff on order to have their needs met. A review of daytime staffing levels is needed. 2 27 Care Homes for Older People Page 23 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 People must be moved in 03/12/2008 wheelchairs correctly. Footplates need to be considered and staff must be aware of maintaining safety when moving peoplke around the home. This will promote dignity and prevent injuries occurring. 2 15 16 There must be enough suitable chairs for people to use at mealtimes. Dining chairs need to be sturdy with arm supports. This will give people a choice as to whether they wish to use a dining chair or wheelchair when having food and drink. 26/12/2008 3 18 13 Staff must be aware of different types of abuse and know what action to take if they suspect abuse has taken place. 26/12/2008 Care Homes for Older People Page 24 of 27 This will help protect people from harm. 4 19 23 A review of the medication room security is needed. People must not be able to see into the room where the medication is stored. As this may allow breaches of security regarding the medication. 5 26 13 Staff need to be aware of all the infection control procedures in the home., This will prevent cross contamination and promote hygiene. 6 33 24 A detailed quality assurance system needs to be implmented. This will ensure people are able to express their views and opinions regarding the service they receive, and clear audits evidence what systems are working and what areas need improving. 7 38 23 The home must maintain all fire safety records. This inclkudes a recently reviewed fire risk assessment. Emergency lighting checks and regular fire alarm testing and fire drills. This will ensure staff know what action to take in the event of a fire. 26/01/2009 26/02/2009 26/02/2009 26/12/2008 Care Homes for Older People Page 25 of 27 8 38 12 Hot water must be 26/12/2008 distributed at a safe temperature. Action must be taken to maintain this. This will prevent injuries occurring to people who use water which is too hot. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 Pre-admission assessments undertaken need to relate to the persons nursing needs as their primary need. The manager needs to decide how suitable people are for the home with dementia care needs. People would benefit from more activities which are outside the home. People should be made more aware of the food and drink on offer at mealtimes. A plan of refurbishment is needed to ensure all aspects of the environment are updated at regular intervals. People should be cared for by enough registered nurses and carers. New staff should have access to the oritentation and induction programme when they are first employed by the home. Staff training needs to be reviewed to ensure it includes all mandatory training. 2 3 4 5 6 12 15 19 27 30 7 38 Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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