Inspection on 27/11/07 for Woodlands Nursing Home The

This inspection was carried out on 27th November 2007.

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.

Other inspections for this house

Woodlands Nursing Home The 26/11/08

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

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Woodlands Nursing Home The 8-14 Primrose Valley Road Filey North Yorkshire YO14 9QR Lead Inspector Jean Dobbin Unannounced Inspection 09:45 27 November 2007 th 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 The DS0000061590.V349949.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodlands Nursing Home The Address 8-14 Primrose Valley Road Filey North Yorkshire YO14 9QR 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) 01723 513545 01723 513545 Hexon Limited Judith Anne Lucas Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th June 2007 Brief Description of the Service: 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 home’s 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. Details provided in November 2007 outline the weekly fees as £378 plus the nursing care contribution. Additional charges are made for hairdressing, chiropody services and individual items like newspapers and toiletries. Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is what was used to write this report. • • • Information about the home kept by the Commission for Social Care Inspection. Information asked for, before the inspection. This is called an Annual Quality Assurance Assessment. (AQAA) Information from surveys, which were sent to people who live at Woodlands Nursing Home, their relatives, and other professional people who visit the home. 10 were sent to people at the home and 9 were returned 3 were sent to people’s relatives and 1 was returned. 3 were sent to GPs, 3 to Care Managers and 7 to other healthcare professionals. 3 in total were completed and returned. 10 were sent to members of staff and 6 were completed and returned. A visit to the home by two inspectors, which lasted about 8 hours. This visit included talking to residents and visitors, and to staff and the manager about their work and training they had completed. It also included checking some of the records, policies and procedures that the home has to keep. • Information about what was found during the inspection was given to the registered manager and her line manager, at the end of the visit. What the service does well: There is a homely feel to the home. One person said “it’s warm, it’s comfortable and I can go to bed when I want”. Visitors are welcomed at any time. People like the meals. One person said “ the new cook has improved the meals served at the home”. People are assessed before they move to the home so that everyone can be satisfied that they can be supported properly if they choose to move there. Nursing staff have attended extra training to make sure they have more up to date knowledge so that they can care and support people more appropriately. Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 6 Some of the staff enjoy spending time sitting and chatting with the people living there. This provides a more homely environment and helps people to get to know each other better. What has improved since the last inspection? What they could do better: Recruitment systems are not good enough. People may be at risk of harm, because proper checks are not carried out before people start work. Better recruitment processes have been a requirement in the last three inspection reports. So that people know what to do if they are not happy about something the complaint’s procedure, which could include the company’s address, could be more prominently displayed in the home. This would also show the home’s willingness to listen and respond to people’s concerns. Care records could be added to, to describe very individual needs and preferences, so that staff could support one person very differently to another. Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 7 Staff could think about how they talk and respond to people living at the home so that they are always showing respect and promoting people’s privacy and dignity. More records could be kept about the way the home monitors itself so that the manager can show that they are listening and responding to what people say. Information about when different parts of Woodlands are going to be refurbished would keep people informed of what is going on in their home. There could be closer monitoring of health and safety processes in the home to make sure that people are being protected from harm. The call bell system at the home could be looked at again so that staff can always hear it, regardless of where they are working in the home. This could mean that bells would be responded to more quickly. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People who use this service experience good quality outcomes in this area. People have their care needs assessed before they move to the home. This is to make sure the home can meet their needs, and to reassure the person and their family that their individual needs can be met. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: All the care plans looked at contained an assessment completed before the individual moved to the home. This assessment looked at the person’s physical, emotional and social needs, and helped the manager to determine that the home had the facilities and the staff had the knowledge and skills to support the person properly. This assessment also reassures the person and their family that the home can care for them properly. Either the manager or her deputy completes this assessment. Two people spoken with were unable to remember moving to the home, so could not confirm this process. Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 10 One person was staying at the home for just a short period. Although this person was known to the staff as they had stayed there before, one of the senior nurses had still completed an assessment to make sure that the person’s needs had not changed since the last admission. This had been a requirement following the last inspection earlier this year. People interested in moving to the home are invited to spend a few hours there to see what it is like. Written information about the home is also provided to all prospective residents. However four out of the nine surveys completed by people living at the home said that they would have liked more information to help them to reach that decision. The manager needs to be sure that the information provided is in sufficient detail to help people in making that choice. Intermediate care is not provided at Woodlands Nursing Home. Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use this service experience adequate quality outcomes in this area. Whilst health and personal care needs are being met, more individualised care plans would help to promote person-centred care so that people’s particular needs could be met. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Three people’s care plans were looked at in detail, and another two briefly. These describe the care and support that people need, to live as independent a life as possible. Following the last inspection, the manager has supported a senior nurse to have time each week to look at all the plans of care to make sure they are accurate and relevant. The records now are much more detailed and provide information about people’s day to day care, as well as assessing whether they are at risk of, for example, falling, developing pressure sores or becoming Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 12 malnourished because of a poor appetite or health problem. All the records looked at contained a moving and handling assessment saying how people can be moved in a safe way. There are assessments describing why bedrails are needed and one care plan described how a review had led to the rails being removed. These records are reviewed at least monthly to make sure they are still relevant. However some risk assessments that were seen needed reviewing. For example one person’s assessment described them as ‘at risk of choking, especially of chicken’ and the need for meat to be minced or pureed. The individual though had a normal chicken meal, and ate this away from the dining room, so was not supervised. This risk assessment though was not current and they were able to eat this type of food. Another person was assessed as at high risk of falling, but apart from the use of bedrails there were no plans to say how this risk would be minimised. Although the care plans contain a lot of information the nurses need to develop them to be more individualised so that people can clearly identify what makes one person different from another. Then staff can adapt the way they work so that people receive care and support that is tailored to their personal needs and interests. For example one person was using adapted cutlery, but this was not written in their care plan. People have a care plan for ‘rest and sleeping’, however those looked at did not describe specific preferences around bedtime routines but recorded generally how to promote good sleep. Information is also being gathered about people’s life history, dietary likes and dislikes and interests. This helps staff to recognise people as individuals with different values and life goals. Staff need to determine how these interests can be maintained and enhanced. For example one person’s plan described that they liked to watch the birds from their bedroom window and their bedroom chair was sited accordingly. However in the lounge a large occasional table prevents people from sitting close to the large bay window. A well maintained bird table and rearrangement of the furniture might provide that individual with a more interesting and meaningful life. There were records of contacts with healthcare professionals such as the dietician, speech therapist, chiropodist and doctor. One visitor said that the home always informed them if their relative became unwell or had to attend hospital. Since the last inspection the nurses have attended some training sessions to update some of their clinical skills. This up to date knowledge should enable them to provide appropriate care. The medication systems at the home were looked at and were generally satisfactory. The home uses two systems depending on which GP practice the individual is registered with. Medication charts and the controlled drug records were completed properly. One person looks after their own medicines and an Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 13 assessment has been carried out, to check their understanding. All the boxed drugs are counted each week to make sure that the expected number of tablets is the same as the actual number. This helps to show that the drugs are being given and signed for according to the prescription. An audit of the drugs prescribed on four charts demonstrated two anomalies, where these numbers did not tally. Whilst the nurses spoken with said that anomalies were investigated, the manager should keep records of the discrepancies so that any trends can be identified. People spoken with were generally very happy with the support provided by care staff. Whilst seven people said in their survey that staff listened and acted on what they said, one person said, “sometimes I think the staff don’t listen”. With a number of male carers at the home it would be good practice to find out if any of the people living there would prefer to be helped with personal care by someone of the same sex. This preference could then be respected, wherever possible. All the people spoken with said the staff were very busy. Whilst generally staff were observed behaving in a respectful and courteous manner staff must maintain people’s privacy at all times. One relative in their survey response said, “from what I see when I visit each resident is treated with kindness and respect”. A staff member though was observed asking a person sitting in the lounge, in a very loud voice, whether they wanted to use the toilet. This does not respect people’s dignity and privacy and this type of behaviour was discussed with the manager. Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use this service experience adequate quality outcomes in this area. People’s day to day lives are starting to become more interesting, and they receive a varied nutritious diet. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Staff at the home are now organising some activities for the people living there. Entertainers visit each month and a carer is alloted an hour, on four afternoons, to carry out an activity of their choice with the people living there. There was a programme for the week displayed, which included hand massage, making Christmas cards and making woollen dolls. There is no activities organiser though who can arrange activities in a planned manner and can tailor activities to what people want. One person said in their survey that they “wanted activities like cards or dominoes to keep their brain active”. People spoken with said that they enjoyed the musical sessions. One person wrote in their survey that they liked the singalongs and another said that ‘the music man’ was very popular. Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 15 Staff spoken with said that increased staffing levels meant that they had more time to sit and talk with people in the afternoon and some of the records completed by the carers confirmed this. There was television on in both lounges throughout the day although videos and radios were available. The manager has started holding residents’ meetings, however the first one was poorly attended. She needs to record the views of people who are unable or unwilling to attend these meetings so that they can have the opportunity to influence how the home runs. Clergy visit the home and visitors are welcomed any time. One person confirmed they were welcomed and always got a cup of tea when visiting. Another person living there said that their relative who lives a distance away had been invited to have Christmas lunch with them. People generally spoke positively about the meals at the home, where a three weekly menu operates. There is now a cook working in the kitchen until after the evening meal. This means carers no longer have to work in the kitchen at teatime. Care staff spoken with felt this was a big improvement. Most staff have also received training in food hygiene this autumn so that they are more aware of how good food handling practices can protect people. There are two dining rooms, with people requiring more assistance being supported in one room. There are tablecloths and napkins. Cruets and condiments were not on the tables, although they were offered in Oak dining room, where the meal was observed. People spoken with said that the chicken pie or quiche with sprouts, carrots and potatoes was “very nice”. Pureed meals were prepared separately. The cook had a good understanding of catering for someone with diabetes and has a list of people’s likes and dislikes. All the kitchen records were satisfactory. There was a good supply of fresh fruit and vegetables and following discussion the manager plans to make the fruit more available for the people living there. Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service experience adequate quality outcomes in this area. Whilst people feel able to complain if they are unhappy about something and staff are alert to signs of abuse that may be carried out towards people living there, some systems still need improving to protect people’s welfare. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home has a complaints procedure and it was displayed in the hall. However it was not easily seen and did not have details of the company’s address, so people would not know how to contact them. This was discussed with the manager, who agreed to amend the information and display it in a more prominent place. The Commission for Social Care Inspection has received no complaints in the last six months. The home has received two ‘concerns’, which have been addressed by the manager. However records of these concerns are kept in the person’s care file and not in the complaints file. It would be good practice to record and keep concerns and grumbles in one place, so that trends can be identified and information easily located. Records of investigations carried out should also be kept to show that they took place. Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 17 Two people spoken with said they would “speak with Judy”, the manager, if they had concerns. Both were confident that she would sort things out. One person though said in their survey that they felt their concerns were not taken seriously unless their relative got involved. The manager needs to promote an open culture where everybody’s views are seen as important. The home has a Safeguarding policy and staff spoken with were very clear about their responsibilities should they hear or see something, which causes them concern. The manager is also aware of her role in promptly reporting any incident where a vulnerable person may have been harmed. The manager has displayed information about the services of a local advocacy group and had arranged a visit, where people could get more understanding of the services they offer. Recruitment systems at the home are not as robust as they need to be. (See Standards 27-30). Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use this service experience adequate quality outcomes in this area. The improvement to the environment is making it a more comfortable place for the people who live there, however more work is still required. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: A tour of the home showed it to be warm and clean. In the last six months the company has carried out some redecoration and refurbishment of the home, and more is planned. The dining room on Chestnut wing is in the process of being redecorated however there were no decorators at the home on the day of the visit. Some bedrooms have been redecorated and new furnishings and carpets have been provided. The corridor on Chestnut wing has been repainted and the home is expecting the delivery of some new curtains. The home no longer smells of urine. Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 19 People are encouraged to have ornaments and personal possessions in their bedrooms. The communal areas are clean and tidy. Both lounges have a large television and one has a wide screen so that people can see it more easily. There are videos, but these could be stored in the bookcase, to make them easier to find, rather than in a cardboard box on the floor. Storage at the home is still a problem. The weighing scales are stored in the dining room on Oak and the dining room on Chestnut wing had 15 wheelchairs, 2 walking aids and a hoist stored there. People could be at risk of hurting themselves and all the clutter means the room is not very homely. The manager has already requested that these be removed but has no date for when this will happen. There are currently a number of empty bedrooms and several of these are also being used as informal storage spaces. The only access to the outside for people in wheelchairs is via a fire exit and ramp. The steps to the front door, even with a moveable ramp would be difficult although the owners are considering different options. There are no grab rails though so access for people with better mobility could still be difficult. There are mature gardens but these are not very accessible to people living there, although some paving has recently been laid. Work has been carried out on the call bell system with audible alarms fitted on the first and second floors. However these are sometimes ‘silenced’ by staff, which is completely unacceptable and may be why staff spoken with said that they could not generally hear the bell when on the second floor. This way of working means people can be waiting for some time for assistance. One person spoken with said they could wait “up to an hour” for assistance. However when the call bell was activated on the day of the visit a carer responded within two minutes. The manager said that a new system of ‘pagers’ was going to be bought so that staff could be easily notified when a bell was activated. There is still only one call bell in each of the communal areas. However a carer now stays in the dining room at mealtimes and one person in the lounge uses the call bell on other people’s behalf. New central heating boilers have been fitted this year. There have been some problems with the heating in the home since then, and the manager is monitoring the situation. One person spoken with said that the home was warm and comfortable. Another said in their survey, “there are still some times when it has been cold”. A third person spoken with referred to the night times by saying they had “never been so cold and miserable in my life”. These comments were discussed with the two managers who agreed to immediately put extra night heating into that person’s bedroom. The managers need to properly address the intermittent problems so that the heating system is totally reliable. Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 20 The laundry area is well equipped. There are named net bags so that people’s socks and stockings can be returned to the right person. The manager makes sure that appropriate aids are available and used to make sure that people living in the home are protected against infection. Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use this service experience adequate quality outcomes in this area. There are sufficient numbers of staff to respond to the needs of the people living there. Poor recruitment practices could be putting people at risk. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Staffing levels have been increased in the last six months with the recruitment of more care staff and nurses. On the day of the visit there were a total of six care staff on the morning shift, six on the late shift and three at night. At least one trained nurse is on duty at all times. There is a deputy manager and administrative support is provided one day each week. The manager, also a trained nurse has supernumerary hours at the home. Agency staff are sometimes used but where possible staff who are familiar with the home and the people living there are used. Care staff confirmed this. The care staff spoken to confirmed that the number of staff at the home have increased and the work “feels less rushed”. People living there though, who were spoken with, still felt staff were very busy. One person said in their survey that they were “happy with the care but could do with more staff so you can get the care faster”. Care staff spoken with said they had more time to sit and talk to people in the afternoon. Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 22 A cook now works at the home until after the evening meal. This means that care staff no longer have to work in the kitchen. There are domestic and laundry staff working every day, so again care staff can concentrate on care duties. A maintenance person is employed by the company to support all their homes. Some mandatory training has been provided in the last six months. Nurses have attended training in clinical areas like wound care, tube feeding and palliative care. People are more likely to receive appropriate nursing care from nurses who have up to date knowledge. A computer has been bought for staff so that an ‘electronic library’ can be established and people’s care records are more accessible for carers, so that they can read about people’s needs. A more structured induction programme has now been set up for new staff. This means all staff receive the same support, and one carer spoken with confirmed that they had spent the first day having some training and working with a senior nurse. Staff meetings are now held three monthly and these have an agenda and are minuted. These enable information to be shared as well as providing staff with the opportunity to say what is important for them. Although the home has not reached the target of 50 of care staff having a National Vocational Qualification Level 2 in Care, a number of people are working towards that award. On the day of the visit an external assessor was visiting and assessing a carer’s work. People are more likely to receive safe consistent care from people who have a good understanding of their role. Recruitment processes at the home are still not robust. This has been found to be the case at the last three inspections. On this occasion written references could not be found and one carer started work before a police check had been done. A PoVAfirst check had been requested. (This is a national check that an individual hasn’t previously harmed vulnerable people). The person though started work before this check was back. Good recruitment systems need to be in place to protect people from harm. Not following them properly can place people at risk. This failing was discussed again with the two managers who agreed that this process in the home was still not right. Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use this service experience adequate quality outcomes in this area. Whilst the way the home is managed is improving and people are beginning to influence how it runs, there needs to be a sustained improvement over the coming months. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The manager is an experienced nurse, who has achieved the Registered Manager’s award. She has worked at the home for several years. A deputy manager is also employed. People at the home who were spoken with said they knew the manager and saw her on a day-to-day basis around the home. One person said, “I think a lot about Judy”. The visitor and care staff spoken Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 24 with said that they would feel happy speaking with the manager if they had a problem. Management systems have improved at the home in the last six months. During this time the manager has been getting regular support and visits from her manager and much of this improvement may be because of this extra outside support. The registered manager needs to focus on managing the service in a pro-active manner, rather that reacting to problems as they arise. However a quality monitoring system has now been set up and a programme of checks established. A relatives’ and residents’ meeting has been held, though this was poorly attended. Questionnaires given to people living there have been completed and evaluated and staff meetings have been held. Changes to some of the meals and planned activities have been carried out as a result of these questionnaires. These results need to be displayed so that people know that the manager is responding to their comments. All these systems are relatively new and the manager needs to demonstrate over the coming months that these can be acted upon and developed more so that all interested parties can have a say in how the home operates. Finance records were checked and found to be in order. People’s money is safely stored for them and receipts are kept for all financial transactions. All the bedrooms contain a drawer, which is lockable, so that people have a secure place for keeping valuables or things that matter to them. One person has their own bank account into which their money is paid, so that they are able to accrue interest. The manager has set up a plan to provide regular supervision for staff at the home. This is not completely up to date, however all staff have received at least one session since July. This needs to be made more robust so that staff recognise supervision as very important for their professional development. Health and safety certificates are now more readily available. The home has had new gas boilers fitted since the last inspection. The gas safety certificate though, for the remaining appliances, needed renewing by the beginning of November. Although this check has been requested the manager needs to be more pro-active and request these before they expire. Fire safety checks are completed appropriately. One person smokes in their room and this decision has been risk assessed to make sure the individual isn’t putting themself or others at risk. Bed rail checks are carried out regularly and these records can be seen in people’s rooms. The manager needs to be satisfied that staff carrying out these checks know what they are checking for so that she can be confident that people living there are protected from harm. Whilst hot water temperature checks are monitored regularly the records showed that abnormally high or low temperatures are not being acted upon. Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 25 The manager must make sure that any abnormalities are reported promptly so that they can be sorted. The home has made proper provision to ensure that there are safe working practices by providing staff training in first aid, fire safety, food hygiene, and safe moving and handling techniques. Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 26 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 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 1 Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 27 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 OP10 Regulation 12, 18 Requirement People living at the home must be treated in a respectful manner and have their dignity recognised at all times. The call bell system must be audible to all staff wherever they are working so that people can get prompt support. There must be a thorough recruitment process in place at the home. This includes: A fully completed application form with gaps in employment explored. A satisfactory CRB check. Two written references including one from the previous employer. This will contribute to service users safety. Previous timescales of 19/6/07, 2/10/06 & 7/2/06 not met. The Commission must be informed how the home plans to Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 28 Timescale for action 27/11/07 2. OP19 23. 27/11/07 3. OP29 OP31 19, 9 27/11/07 ensure that all future prospective employees do not start work without these recruitment checks. 4. OP38 13, 23 A current gas certificate is required to be sent to the Commission for Social Care Inspection to show that gas appliances in the home are safe. Hot water temperatures must be maintained at around 43°C so that people can be protected from harm, and identified high and low temperatures must be addressed promptly. 27/11/07 5. OP38 13, 23 27/11/07 Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 29 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 OP7 Good Practice Recommendations Care records could be written to reflect people’s very specific needs so that they can be supported in a more individual manner. Investigative records could be kept of when the counted numbers of tablets do not agree with the projected number. This would help to demonstrate when errors in medication processes are taking place, so that corrective action can be taken. Social activities in the home could be developed to take into account people’s personal interests and goals so that some of these needs could be met. It would be useful to record conversations and comments from people made about how the home operates. These comments can then be considered when the home monitors how it is working. It would be good practice to have the contact details of a company representative on the displayed complaints policy for people to contact if they wish. Consideration could be taken to have a planned programme of refurbishment for the home. This would help people to be aware of what is likely to be happening in their home. It would be good practice to publish and display the results of surveys, and what changes the home is going to make as a result. Then interested parties would know that they are being listened to. 2 OP9 3 OP12 4 OP14 5 OP16 6 OP19 7 OP33 Woodlands Nursing Home The DS0000061590.V349949.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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