Inspection on 04/08/05 for Woodlands Nursing Home The

This inspection was carried out on 4th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Woodlands Nursing Home The 26/11/08

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 11/11/04

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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 Edenwynde 8-14 Primrose Valley Road Filey North Yorkshire YO14 9QR Lead Inspector M.A. Tomlinson Unannounced 4 August 2005 09:30 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 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. Edenwynde J53-J04 S61590 Edenwyne V242438 040805 Stage 41.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Edenwynde Address 8-14 Primrose Valley Road Filey North Yorkshire YO14 9QR 01723 513545 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Hexon Limited Post vacant Care home with nursing 34 Category(ies) of OP Old age (34) registration, with number of places Edenwynde J53-J04 S61590 Edenwyne V242438 040805 Stage 41.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 11.11.04 Brief Description of the Service: Edenwynde 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 registered to provide accommodation and personal care, with nursing, for a maximum of 34 older people. Specialist care is not provided. During the past year the home has changed owers and is now operated by Hexon Care Limited. The property consists of three flours with the service users accommodation being located on all floors. The home is currently undergoing a major programme of refurbishment which includes the reduction in the number of shared bedrooms to one. At the time of the inspection this one shared room was being used as single accommodation. The majority of bedrooms have ensuite facilities consisting of at least a toilet and a wash-hand basin. The communal areas, that includes a dedicated dining room, are located on the ground floor. Two passenger lifts plus conventional stairs provide access to all floors. The grounds are accessible to wheelchair users and service users with mobility problems. Car parking is available for several vehicles. The staff endeavour to meet the service users physical, emotional and social needs with good input being provided by health and social care professionals. Specialist lifting and bathing equipment is available. Social activities are provided on a regular basis both within and external of the home. Edenwynde J53-J04 S61590 Edenwyne V242438 040805 Stage 41.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first of two unannounced statutory inspections undertaken by the Commission for Social Care Inspection during this inspectoral year. The inspection took a total of twelve hours including five hours preparation time. This inspection also incorporated an investigation into a complaint. The complaint was substantiated in part. The inspection was conducted with the assistance of the General manager of Hexon and the home’s manager. A number of service users and staff were spoken to both as a group and as individuals. A tour of the premises was carried out and number of statutory records examined. Copies of specific care plans and associated records were provided by the home. What the service does well: What has improved since the last inspection? The most obvious improvement was the ongoing refurbishment of the premises that will eventually provide the service users with a good standard of accommodation and associated facilities. The reduction in shared bedrooms has improved the level of privacy for the service users. The manager has endeavoured to improve levels of communication within the home through the introduction of service users’ and relatives’ meetings and a formalised staff programme of staff supervision and appraisal. Greater emphasis has been placed on staff training and an expansion of social activities for the service users. The Requirements identified during the previous inspection had been addressed. Edenwynde J53-J04 S61590 Edenwyne V242438 040805 Stage 41.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Edenwynde J53-J04 S61590 Edenwyne V242438 040805 Stage 41.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Edenwynde J53-J04 S61590 Edenwyne V242438 040805 Stage 41.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3 and 6 Prospective service users, or their representatives, are provided with adequate information on which they can make a considered decision as to whether they wish to live in the home. EVIDENCE: Following the previous inspection the Statement of Purpose and the Service Users’ Guide had been revised to ensure that they contain all of the required information. The Guide was in the process of being produced in a large print format for service users who have poor sight. A copy of the Guide had been provided for every service user in their room. It was noted, that in some of the Guides, the details on how to contact the Commission for Social Care Inspection when making a complaint needed to be completed. A number of service users’ records were inspected. These contained recorded evidence that all new service users had been assessed and that this information was used as the basis of their care plan. It was noted that some assessments were not dated or signed and consequently it was not possible to ascertain whether these assessments were undertaken prior to the service Edenwynde J53-J04 S61590 Edenwyne V242438 040805 Stage 41.doc Version 1.40 Page 9 user’s admission into the home. There was also not evidence that the assessments involved the service user and/or their representative. In at least one instance a newly admitted service user had not been weighed as part of their nutritional assessment. Another was only weighed at the request of a dietician when there were concerns about the service user’s health. There was only limited evidence of detailed nutritional assessments and fluid/food intake monitoring systems in place particularly for the more frail service users. The home had a comprehensive contract or statement of the terms of residence that, according to the manager, was provided for prospective service users. A respite care service user admitted at the latter end of 2004 was not, however, issued with a statement or contract. Intermediate care was not provided by the home. Edenwynde J53-J04 S61590 Edenwyne V242438 040805 Stage 41.doc Version 1.40 Page 10 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 standard(s) 7,8 and 10 The service users’ health needs are met with good support and input from health care professionals. EVIDENCE: The service users’ care records contained the care plan for the respective service user. The care plans were based on the initial assessment and were implemented soon after a service user’s admission into the home. Respite care service users had also been provided with a care plan. The care plans were subdivided into elements of care need along with the actions to be taken by the staff to meet those needs. The care plans were comprehensive, tailored to the individual service user and were clear and unambiguous. In addition to physical needs, the care plans addressed a service user’s social and emotional needs. There was evidence that the care plans were regularly reviewed and updated. The care plans were cross-referenced into other care records including the daily record maintained on each service user. The ‘in-house’ care plans were in addition to any care plan provided by a service user’s placing agency. The care records confirmed that the service users’ needs were met with, where necessary, good levels of input from health and social care professionals. There was little recorded evidence, however, that the service users or their representatives were involved in the development of the care Edenwynde J53-J04 S61590 Edenwyne V242438 040805 Stage 41.doc Version 1.40 Page 11 plans. It was also apparent that a service user’s next of kin were not automatically informed of the service user’s wellbeing and change in their care needs. The care staff were directly involved with the development of the care plans through the use of a ‘key worker’ system. The nursing staff completed the daily records with little information being directly recorded by the care staff. A member of the care staff was of the opinion that the person involved in an action or incident, and not someone on behalf of that person, should complete the appropriate records. This was discussed with the manager. It was not entirely possible to audit or case track using the records as some of the information, particularly that contained in the daily records, was not consistent or cross-referenced into other records and in some cases, lacked continuity. From discussions with the more able service users and observation of the staff, it was evident that the service users were treated with appropriate respect by, for example, the staff speaking to them in a mature manner and using the service users’ preferred form of address. It was observed that the staff knocked on the service users’ bedroom doors before entering thereby acknowledging the service users’ privacy. The service users’ privacy was further promoted by the reduction in shared bedrooms and by ensuring that those service users who share have requested to do so. As part of the programme of refurbishment, appropriate locks had yet to be fitted to some bedroom and bathroom doors. It was observed that the visiting hairdresser provided a service in the dining room after the completion of the meal. This arrangement, it could be argued, was not only unhygienic but afforded the service users minimal privacy for what is a reasonably personal service. Edenwynde J53-J04 S61590 Edenwyne V242438 040805 Stage 41.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15 Systems are being developed to ensure that the social needs of the service users will be met. EVIDENCE: Due to their frailty or level of confusion, it was not possible to ascertain from the majority of the service users whether they were satisfied with life in the home. They did, however, look relaxed and it was apparent that they had established a good relationship with the staff. It was also observed that the staff did not ‘fuss’ over the service users but allowed them to live their lives at their own pace. One problem identified by a more able service user was the range of needs and the apparent incompatibility of some of the service users. This service user said that they found it difficult living with people who had confusion and had particular difficulty in sitting with them in the dining room. It was, however, observed that the staff had listened to this service user’s concerns and made alternative arrangements for her to have lunch. The manager was fully aware of this problem. Examples were provided of social activities provided for the service users both within and external of the home. A trip out was planned for approximately eight service users the day following the inspection. It was the stated aim of the general manager that the social aspects of care are to be improved. For example, a member of staff had been identified to develop a programme of social activities and part of the Edenwynde J53-J04 S61590 Edenwyne V242438 040805 Stage 41.doc Version 1.40 Page 13 refurbishment programme included the development of a dedicated activity area in the lounge. Those staff spoken to expressed considerable enthusiasm for this. It was apparent from discussions with the staff that the staffing level had to an extent, limited the programme of social activities. The introduction of ‘residents and relatives’ meetings went someway in addressing and planning the social programme. From discussions with the service users it was evident that the majority had regular visitors. The home employed a dedicated cook who had extensive catering experience. The cook demonstrated a good understanding of the dietary needs of the service users and the need to monitor the service users food and fluid intake. Good lines of communication existed between the cook and the management. The menus indicated that the meals provided were varied and ensured that the service users’ personal preferences were met. Examples of special and alternative diets were provided. Without exception the service users commended the quality of the meals. One service user stated, “The meals have improved no end since this cook came”. Edenwynde J53-J04 S61590 Edenwyne V242438 040805 Stage 41.doc Version 1.40 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 standard(s) None EVIDENCE: Not assessed on this occasion. Edenwynde J53-J04 S61590 Edenwyne V242438 040805 Stage 41.doc Version 1.40 Page 15 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 standard(s) 19,21,24 and 26 On the completion of the current programme of refurbishment, the service users will be provided with a homely and comfortable environment. EVIDENCE: As previous stated in this report the home was undergoing a major programme of refurbishment and decoration. This included the service users’ private space as well as the communal or shared areas. Whilst there had been some disruption to everyday life, efforts had been made by the staff and the home’s management to minimise this. Only one service user commented adversely by stating that it was inconvenient to have the passenger lift inoperative. The home had two lifts and one was out of commission for a short period of time. The primary aim of the refurbishment was to improve the service users’ living accommodation, provide increased and improved bathing facilities and improve the communal areas. It was apparent from discussions with the service users that they had been kept informed of the progress of refurbishment. It was, for example, on the agenda/minutes of the most recent service users’ meeting. The programme of refurbishment had been delayed by the ingress of rainwater during recent storms. It was hoped by the manager that the refurbishment Edenwynde J53-J04 S61590 Edenwyne V242438 040805 Stage 41.doc Version 1.40 Page 16 would be completed by 21st September 2005. Those bedrooms inspected were of an appropriate size and either had been, or were to be, redecorated. It was evident that the service users had been encouraged to furnish their rooms with their personal belongings. The furniture in the bedrooms was of a good standard and provided a lockable facility for use by the service users. It was noted that some bedroom doors and the doors to associated en suite facilities were not fitted with locks. Those service users spoken to expressed satisfaction with their accommodation. In order to further promote the service users’ privacy and dignity, the number of shared bedrooms had been reduced to one. The majority of the bedrooms had en suite facilities consisting of a toilet and a wash-hand basin. There were an adequate number of baths, including a special bath, plus two recently built ‘walk-in showers’. The hot water accessible to the service users was thermostatically controlled to prevent scalding. Two sluices were available one having a disinfectant facility. Edenwynde J53-J04 S61590 Edenwyne V242438 040805 Stage 41.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30 A period of instability and poor levels of staffing has had a marked effect on staff morale. EVIDENCE: It was acknowledged by the general manager and the manager of the home that considerable difficulty had been experienced in recruiting suitable care staff. This had led to a short-fall in the number of care staff available, generally one below that required by the staffing notice during the day, with the consequence that social activities for the service users and the ‘quality time’ spent by staff with service users had been limited. This shortfall in staffing was also stated by the staff and was discussed during the recently held residents’ meeting. Evidence was provided to confirm that a recruitment drive was in process and that action was being taken to address this staffing issue. From discussions with the staff it was apparent that the service users were not at risk and that the quality of care provided had not been undermined. The home is registered for 34 service users but at the time of the inspection only 28 were being accommodated which compensated for the shortfall in care staff. Adequate numbers of ancillary staff were available. A staff roster was available for inspection. The roster did not include ancillary staff. Abbreviations were used but there was not a ‘key’ to interpret them. The care staff spoken to presented as being enthusiastic and demonstrated a good understanding of the needs of the service users. They understood their primary roles and that as a key worker. Recorded evidence confirmed that over 50 of care staff had achieved, or were in the process of achieving, a Edenwynde J53-J04 S61590 Edenwyne V242438 040805 Stage 41.doc Version 1.40 Page 18 National Vocational Qualification at level 2 or 3. A programme of staff training was in place that covered statutory and professional subjects. A staff supervision and appraisal process had been developed. The manager had recently completed a course on the subject. Three staff records were inspected that included the most recently recruited member of staff. Documentation was available to confirm that these staff had undergone a CRB/POVA check and two references had been received before they commenced their employment in the home. A structured induction training programme had been introduced. All of the service users spoken to during the inspection had only praise for the staff and their efforts to provide a homely and friendly environment. Edenwynde J53-J04 S61590 Edenwyne V242438 040805 Stage 41.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,37and38 The manager has a clear vision for the home, which she has endeavoured to communicate to the staff, service users and their relatives. EVIDENCE: The current manager was not registered with the Commission for Social Care Inspection but was in the process of applying to be so. The manager was undertaking the Registered Manager’s Award. She demonstrated a good understanding of the service users’ needs and of the those elements of care such as independence and choice that go to provide the service users with a good quality of life. She had a clear idea on how she would like to see the service develop and improve. In particular she wanted greater involvement by the service users and their relatives in the planning of social activities. A quality assurance process had been introduced and the initial findings of an internal survey were displayed on a notice board. Edenwynde J53-J04 S61590 Edenwyne V242438 040805 Stage 41.doc Version 1.40 Page 20 A number of records were inspected and were generally maintained to an acceptable standard although, as previously indicated in this report, some care records had not been signed or dated and some information was missing or inconsistent. Certificates were available to confirm that the gas and electrical systems along with the passenger lifts and lifting aids had been serviced. Risk assessments had been undertaken although these will need to be reviewed on the completion of the refurbishment work. According to the manager close liaison had been maintained with the statutory agencies particularly with regard the refurbishment. Staff had been provided with training in fire, first aid and health and safety procedures. The fire system and the fire fighting equipment had been serviced and regularly checked. A record was maintained of this. Edenwynde J53-J04 S61590 Edenwyne V242438 040805 Stage 41.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 1 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x 3 x x 3 x 3 STAFFING Standard No Score 27 1 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 x 3 x x x 2 3 Edenwynde J53-J04 S61590 Edenwyne V242438 040805 Stage 41.doc Version 1.40 Page 22 Yes Are there any outstanding requirements from the last inspection? 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 3 Regulation 14 Requirement A pre-admission assessment must be undertaken on all prospective users that involves the service user concerned and/or their representative. Where a service users care needs change, their care plan must be revised after consultation with the service user and/or their representative. The staffing level must satisfy the requirements stated in the most recent Staffing Notice issued by the regulatory authority. The staff roster must identify all staff working in the care home. All records must be complete and up to date. Timescale for action Immediate 2. 7 15 Immediate 3. 27 27 5th September 2005 Immediate 4. 37 17 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 1 Good Practice Recommendations The Service Users Guide should provide the service users with the contact details of the Commission for Social Care J53-J04 S61590 Edenwyne V242438 040805 Stage 41.doc Version 1.40 Page 23 Edenwynde 2. 3. 2 3 4. 7 5. 6. 10 27 Inspection. All service users, regardless of length of stay, should be provided with a Statement of the Terms and Conditions of their residence in the home prior to their admission. Assessments should be signed and dated by the member of staff undertaking the assessment. The pre-admission assessment should include details of a service users weight. Detailed nutritional assessments should be developed at the point of a service users admision into the home. A service users representative or next-of-kin should be kept informed of any changes to a service users wellbeing and of the involvement of any health care professionals. Consideration should be given to providing appropriate hairdressing facilities that ensures that the service users dignity is not undermined. Abbreviations used on a staff roster should be identified through the use of a key. Edenwynde J53-J04 S61590 Edenwyne V242438 040805 Stage 41.doc Version 1.40 Page 24 Commission for Social Care Inspection Unit 4, Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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