Inspection on 10/10/08 for Woodlands Park Care Centre

This inspection was carried out on 10th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Woodlands Park Residential Home Wendover Road Great Missenden Buckinghamshire HP16 9LS     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: Jane Handscombe     Date: 1 1 1 0 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 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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 35 Information about the care home Name of care home: Address: Woodlands Park Residential Home Wendover Road Great Missenden Buckinghamshire HP16 9LS 01494862535 01494868500 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Joan Marie Shouler Type of registration: Number of places registered: Calvercare Ltd care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 40. The registered person may provide the following category/ies of service only: Care home only ? (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Woodlands Park Residential Home is a large Victorian House, which has been renovated and refurbished, and is set in extensive grounds. The home is situated two miles from the village of Great Missenden. There are no local amenities or public Care Homes for Older People Page 4 of 35 Over 65 0 0 40 40 40 0 Brief description of the care home transport facilities close to the home, however Great Missenden has a main line railway station, is served by local bus routes and possesses a variety of shops and local amenities. The home is registered to provide personal care for up to forty older people with a dementia type illness. Accommodation is a mixture of single and shared rooms of varying sizes, some of which possess en-suite facilities. A number of additional bathrooms and toilets are placed throughout the premises. The home possesses day space including lounges, conservatories and a dining room. Care Homes for Older People Page 5 of 35 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: This was an unannounced key inspection, which took place over 2 days. The visit took place on the 10th and 11th October 2008. The purpose of the visit was to see how the home is meeting the National Minimum Standards. Results of this inspection report are derived from feedback gained from surveys given out to people using the service and their family members during our visit, discussions with service users and with staff during the visit, viewing client’s records held within the service, viewing policies and procedures, staff personnel files and general observation throughout the day, along with information provided to us within the AQAA and any other information that CSCI has received about the service in order to gain an understanding of how the service meet the service users’ needs, and impact upon their lives. A tour of the home was undertaken, care plans were examined and meeting the residents to see if the care Care Homes for Older People Page 6 of 35 plans gave a true reflection of their care needs and how these were being met followed this up. The inspector met with residents, staff, visiting professionals, relatives and friends to find out their views on how well the service is doing. Records required by regulations were examined, including staff files and the home’s policies and procedures. We looked at how well the home was meeting the key standards set by the government and have in this report made judgements about the standard of the service. Fees range from 650 pounds to 800 pounds per week. Our thanks and appreciation goes all those who gave their time during the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: Whilst the home works to provide a good level of service to their service users there are a number of issues highlighted within this report which do not meet the national minimum standards/ regulations for which recommendations and requirements have been made. Ensure that service users prescribed medication is administered as prescribed by their GP to meet their health care needs appropriately. Accommodation is to be improved as indicated in the report to provide more comfortable surroundings for people living at the home. Ensure to provide grab rail in downstairs WC for service users use. Radiators must be guarded or have guaranteed low temperature surfaces to prevent service users from scalding. Ensure that whilst awaiting radiator guards, a risk assessment is undertaken and a plan of action be drawn up detailing how the risk is to be reduced and managed. Carpets and flooring must be kept in a good state of repair, clean and offensive odours eliminated to provide a pleasant environment in which to live, free from any unnecessary risks to the safety of those using the service. Ensure to verify references without a company stamp or on letterheaded paper to ensure the authenticity of such references. Care Homes for Older People Page 8 of 35 Ensure that in situations in which peoples emergency call bells are activated, staff respond to the situation in a timely manner to ensure people can be confident of getting assistance in an emergency situation and thus ensuring their health, safety and welfare. It would be good practice to consider GPs, social workers and any other stakeholders involved with the home in the care services annual quality assurance to allow for a more ‘rounded’ view of the service. It is reccommended that an audit trial of staff personnell files be undertaken to ensure that staffs training is up to date and logged appropriately on the staff training matrix and where this is not the case, provide the necessary training to ensure that the staff have the knowledge and skills appropriate to the work they are to perform. 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 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 35 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 10 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides information, which is used by prospective service users, to help them choose a home that is right for them and have their needs assessed prior to moving into the home to ensure it can meet their needs. Evidence: Information provided to the Commission prior to the inspection and files viewed during the inspection process indicated that all prospective service users are provided with a pre-admission assessment to ensure that both the manager of the home and the prospective service user are satisfied that their needs can be met appropriately before being offered a permanent place. Additional information is sought from GPs, district nurses, hospital staff, social workers, relatives and any other relevant person who could contribute to such an assessment. The prospective resident and/or their next of kin are invited to visit the home prior to Care Homes for Older People Page 11 of 35 Evidence: making a decision, and are provided with a copy of the home’s service users guide which includes information about the qualifications and experience of the manager and the staff team, the services that are provided at the home, a summary of the homes statement of purpose, the fee structure, details on how to make a complaint, . The residents’ guide can be made available in formats to suit the needs of those using the service. Those spoken to during our visit informed us that they received enough information about the home before they moved in, enabling them to decide if it was the right place for them. From the evidence seen by the inspector and comments received, the inspector considers that this service is able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Care Homes for Older People Page 12 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All users of the service have an individualised plan of care, although daily notes within their files are brief in detail and fail to evidence that care is being provided, as detailed in their care plans. Whilst the service have a robust medication policy in place, poor procedures are taking place which could compromise the health, safety and well being of those using the service. Evidence: Information provided to the Commission, prior to the inspection, informed the inspector that each user of the service has an individualised plan of care detailing their health, personal and social care needs and how these needs are to be met. They contain relevant moving and handling assessments as well as any risk assessments identifying any risks that could impact upon their health and the provision of care, and how these identified risks are to be minimised. An assessment of peoples nutritional needs is undertaken on admission and regularly thereafter, so that any service users at risk from poor diet are identified and action taken to improve their nutrition and Care Homes for Older People Page 13 of 35 Evidence: health. During the inspection, three service users’ files were observed and each contained an individualised detailed plan of care giving an all round picture of the service user and the care and support required to meet their assessed needs taking into account their cultural, religious and social preferences where appropriate. Each file viewed contained a care plan consent form, indicating that service users and/or their representatives had been included in the care planning and assessment process and agreed to its contents. The three care plans viewed were very person centred and tailored to their individualised needs although the daily notes describing the care given were brief in detail. The deputy manager informed us that a management report is to be added with the aim of undertaking this on a weekly basis. Each resident’s plan of care is reviewed regularly with input from the resident and/or their representative where possible and updated to reflect any changes as necessary. The home has good working relationships with the local GPs and community health services and accesses them when appropriate. Evidence of any healthcare treatment, which service users receive, was found documented within their care plans. The home has appropriate aids and pressure relieving equipment for those who require. The home has a visiting chiropodist, and optician, and arrangements can be made for dentists to provide dental treatment in the home for those who require. The GP visits on a weekly basis and the district nurses visit at least twice weekly. As part of the inspection process we looked at the medication systems within the home. Whilst the home has a robust medication policy and procedures to ensure the health, safety and well being of those who use the service, these were not always being adhered to and poor procedures were evident on the day of inspection. It was noted that three service users prescribed creams were kept in their bedrooms with their Medication Administration Records and upon viewing the MAR sheets there were numerous gaps indicating that their prescribed creams were not being administered as prescribed by their GPs. Two service users MAR sheet informed us that over the course of twenty-eight days their prescribed creams had only been administered for four of the twenty-eight days. Likewise another service users records highlighted that over the course of the same period (twenty eight days), their prescribed cream had only been administered on two days. An immediate requirement was made during our visit requiring the registered manager to ensure that arrangements were made to ensure the safe recording and administration of peoples medications to ensure their health, safety and welfare. We received confirmation, following our visit that actions had been taken, within the timescale given to ensure their health and well being. Care Homes for Older People Page 14 of 35 Evidence: Feedback from residents indicated that the staff treat them with respect and support their privacy and dignity at all times. During our visit, it was noted that a couple of service users were displaying some challenging behaviours at various points of our inspection, the carers always responded despite the ongoing display of behaviour speaking to them in a gentle manner and were seen to be sensitive to their needs. Service users and family members spoken to overall felt that the care provision was good and that the staff were kind and considerate, respecting their privacy and dignity at all times. Screens are provided in shared rooms to ensure service users privacy and respect. Care Homes for Older People Page 15 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are able to take part in meaningful activities suited to their needs and abilities and maintain contact with families, friends and the wider community. The food provided in the home is of good quality, freshly prepared and cooked on the premises, offers choice and meets the dietary needs of those using the service. Evidence: Discussions with service users and family members visiting was generally very positive acknowledging that the lifestyle experienced at Woodlands Park matches their expectations and enables them to exercise choice and control over their lives. The home employs an activities co-ordinator who ensures there is a varied programme of daily activities providing a range of stimulating, therapeutic, interesting activities for those who wish to partake and based upon their likes and dislikes. Activities are offered both in groups and on a one to one basis, according to peoples needs and wishes and include cards, ball games, armchair exercises, manicures, music and singalongs and there is a visiting hairdresser who visits the home once a week for those who require. Professional entertainers are invited to the home on a monthly Care Homes for Older People Page 16 of 35 Evidence: basis to provide entertainment. During our visit, two such entertainers were in the home providing musical entertainment in which residents were seen to participate and was enjoyed by all. The registered manager informs us that she has organised the loan of a minibus to enable trips out for those using the service and is in the process of organising a couple of trips this month which will include trips out to local pubs for lunch, visits to local areas of interest and drives around the countryside. Discussions with the registered manager informs us that the home have been working to address peoples spiritual needs; contact with the local church has recently been made to enquire into the provision of a regular service within the home, however this has proved difficult. Whilst the home is unable to provide for a regular weekly service at present, a local catholic priest visits the home on a weekly basis for those who require. We are informed that the home would support residents to access the local churches and attend services when required. The home recently celebrated harvest festival to which relatives and friends were invited to take part, which was enjoyed by all. Woodlands Park is a pet friendly home and is registered with the Cinnamon Trust, a national charity for the elderly and their pets. A recent addition to the home is a pet rabbit, called Tiny, who can be seen mingling with those using the service and a risk assessment is in place in relation to Tiny. There is also the recent addition of a fish tank stocked with colourful fish in the communal lounge area for the service users to enjoy. The tank was donated to the home from a previous service user. On the morning of our visit, a user of the service accompanied the activities co-ordinator and visited the local garden centre to select and purchase some fish to add to the tank. People who use the service are provided with good quality food, which is freshly cooked on the premises and are offered a choice. Special diets are available to meet residents’ health and cultural needs and the chef always endeavours to take individual tastes into account. During our visit, we chose to take lunch with those using the service, which consisted of battered cod, chips and peas followed by chocolate and pear crumble with custard, which was tasty, well presented and of good sized portions. Menu holders were placed on tables and a large print daily menu was displayed within the home. Pictorial menus are also made available. The dining environment was relaxed and comfortable and people were able to enjoy their lunch at their own pace, staff were observed to offer assistance to those who required in a sensitive manner. However we did note that one user of the service was not provided with any cutlery for their dessert and was attempting to make do without. We made a point of informing a staff member discreetly, on two occasions, however it became apparent that the staff member had Care Homes for Older People Page 17 of 35 Evidence: not understood the request due to language barriers, and upon speaking to a further member of staff, the service user was provided with cutlery removing him/her from the situation in which he/she had been placed. Those spoken with during their lunch said they had enjoyed the meal. The majority of the residents sat in the dining room or small conservatory for their meals, however users of the service are enabled to choose to eat in their rooms or in the comfortable seating area in the wide hallway by the stairs if preferred. The home welcomes visitors at any time and a number were visiting at the time of this inspection. Feedback indicates that they are made to feel welcome and that they enjoy visiting. Care Homes for Older People Page 18 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints policy and complaints are taken seriously. Safeguarding procedures are in place to protect residents from harm. Evidence: Information about the complaints procedure is given to service users on admission to the home and is also displayed within the home copies of which are also available on request from the manager. The timescale for dealing with complaints is 28-days, as stated in the homes written procedure. There have been five complaints received into the service during the last 12 months, which were dealt with in line with the services documented policy. The commission has not received any complaints in relation to the service during this period. Discussions with service users, family members and visitors to the home, informed us that they were aware of how to make a complaint if the need arose. They said that they were confident that any complaint made would be taken seriously and acted upon appropriately. The home has safeguarding systems in place to protect service users; the safeguarding of vulnerable adults is taken seriously, any allegations are dealt with appropriately and in line with the local multi agency procedures and staff members Care Homes for Older People Page 19 of 35 Evidence: receive training at induction and regularly thereafter to enable them to recognize and respond to any incidences or allegations of abuse. A copy of the Buckinghamshire local interagency policy and procedure for safeguarding adults was available in the home. Staff are provided with and understand their responsibility to use the homes whistle blowing policy if the need should arise. The service has dealt with three safeguarding incidences during the last 12 months, all of which were referred and investigated appropriately. Care Homes for Older People Page 20 of 35 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. Whilst the home provides people with a comfortable environment in which to live, there are some areas which need attention to ensure their health, safety and welfare. Evidence: The accommodation at Woodlands Park consists of 27 bedrooms situated on the ground floor and first floor and are served by a passenger lift. 17 rooms are of single size with a further 10 double rooms, all of which have wash basins and eleven of which have ensuite facilities. There is a spacious lounge, sun lounge, large conservatory and a separate dining room for service users and their families to enjoy, all of which are centrally heated. Whilst there is a no smoking policy within the home, there is a designated smoking area outside the building for those who require. A tour of the premises found that the home was cleaned to a good standard although there were odours evident in the communal lounge and 2 bedrooms. The deputy manager assured us that these would be deep cleaned to remove the odours and provide for a pleasant environment for people to live. A requirement has been made within this report to address this issue. Discussions with service users informed the inspector that they were happy with their bedrooms and their surroundings and that the home is kept to a good standard of cleanliness. Service users are encouraged to bring personal possessions with them, Care Homes for Older People Page 21 of 35 Evidence: many of which were seen to be on view in their bedrooms. Several bedrooms have interlinked doors and cannot be locked since they are part of the fire exit route. Where two people share a room, there are screens available to ensure their privacy. There were a large number of service users bedrooms, which did not have radiator guards, eleven in total, which could pose a risk to people burning themselves upon them. The deputy manager noted these and a requirement has been made within this report to attend to them to ensure the health, safety and welfare of those using the service. The showers in two further bedrooms were not working and further bedroom had some water damage, due to a leak from a sink in the upstairs sink in the staff quarters, which needs redecorating. Further areas in need of attention were found in some of the communal areas of the home, which were highlighted, to the deputy manager who accompanied us whilst viewing these areas. Areas that need attention were noted as the lounge in which plants were seen to be growing through the windows from outside and the carpet was very odorous, the downstairs large conservatory had an unguarded radiator which could pose as a risk to service users scalding themselves upon it and the carpet was seen to be frayed in front of the fire escape door and in another doorway of this room which could pose as a trip hazard to both the users of the service and staff members working in the home. The ground floor WC facilities did not have a grab rail fitted for users of the service to use if needed. The upstairs landing contained a radiator, which was unguarded, and two bedrooms with en suite facilities contained showers that were not in working order. Sufficient washing, bathing and WC facilities are available for service users use, which contain specialist equipment required to ensure maximisation of their independence although one communal bathroom has suffered some bad water damage to the wall and is in need of redecoration. Toilets were stocked with all necessary items and were clean The laundry facilities are situated in the basement of the home and provide adequate separation of clean and dirty laundry – a separate room is used for sorting service users laundered personal clothing before returning it to their rooms. It was noted that there has been some water damage to the ceiling in the laundry, which needs attending to. There are infection control policies and procedures in place and the staff were observed to be washing their hands and wearing appropriate protective clothing. There is a safe enclosed garden area, equipped with garden furniture and a gazebo, which users of the service and their visitors have been using and enjoying to enjoy during the warmer summer months. We are informed that the service is looking to add Care Homes for Older People Page 22 of 35 Evidence: a pond in the garden area as an added feature for the service users and plans are in place to add a sensory garden, both of which will add to the service users enjoyment. Care Homes for Older People Page 23 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a good recruitment procedure to ensure that only suitable staff are employed to work with the users of the service, although verification of references which do not contain a company stamp needs attention. The staff team are provided with a good range of training and ongoing support and supervision to ensure they have the relevant skills and knowledge to enable them to deliver the care safely and competently. Evidence: Information provided to us in the AQAA completed by the home, prior to our visit, showed that there has been a high staff turnover amongst care staff in the past 12 months. Staff on duty confirmed this during the inspection. Recruitment of permanent staff is in process and we are informed that the home has recently appointed a further six members of staff and are looking to appoint a further senior carer and a care assistant to work during the day and a further two care staff at night. In the meantime the home employs the services of an agency and generally uses the same carers to ensure continuity of care. The staffing levels on the day of inspection were sufficient to meet the needs of the residents. The home has a good recruitment procedure to ensure that suitable staff are employed to look after their vulnerable clients. Application forms are completed, references are Care Homes for Older People Page 24 of 35 Evidence: collected and face-to-face interviews are undertaken. Relevant POVA (protection of vulnerable adults) and CRB (criminal records bureau) checks are undertaken to ensure the persons suitability with working with vulnerable people. Three staff files were sampled for inspection, which contained all the relevant pre-employment checks, references and their relevant qualifications. However, it was noted that whilst references are sought those without a company stamp are not always followed up, for which a requirement has been made within this report. All newly appointed members of staff undergo induction training upon appointment to their posts, and are provided with mandatory training, offered ongoing training and encouraged to undertake the National Vocational Qualification (NVQ) in Care, which equips them to meet the assessed needs of the residents within the home and allow for personal development. The inspector was informed that of the 15 permanent care staff six have obtained their NVQ qualifications at level 2 or above in care and the remaining 9 care staff are working towards their NVQ Level 2 in Care. Staff training is recorded in individual staff files and the home has a training matrix on which they record all training undertaken by the home’s staff of which we were given a copy. Whilst the personnell files viewed during the inspection contained up to date training certificates, it appears that the training matrix supplied to us has not been updated in that it highlights a number of gaps in which staffs mandatory training has either not been undertaken or is in need of update. A reccommendation has been made within this report to undertake an audit trial of staff personnell files to ensure that staffs training is up to date and where this is not the case, provide the necessary training to ensure that the staff have the knowledge and skills appropriate to the work they are to perform. There is a good feeling of teamwork amongst the staff and those spoken to are happy to be working at the home. Care Homes for Older People Page 25 of 35 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. Whilst the manager is qualified and has the experience to run the home competently evidence of poor practices taking place around medication, the number of unguarded radiators and the poor response when the emergency call bell is activated do not serve the service users best interests and could compromise the health safety and welfare of those using the service. Evidence: The registered manager is experienced, knowledgeable, has the required qualifications and competency to manage the home. She displays a good sound knowledge of matters related to the management and running of the care home for older people and is presently adding to her skills and knowledge in dementia care, in that she is studying for the Diploma in Dementia Care. The registered manager has recently completed the NVQ qualification in operational management at level 5 and the registered managers award. Care Homes for Older People Page 26 of 35 Evidence: The inspector discussed health and safety issues and saw appropriate maintenance records relating to maintaining a safe environment for residents. Regular safety checks are undertaken relating to fire safety and infectious diseases and regular servicing and maintenance of equipment, all of which were seen to be documented appropriately. An appointment is booked for an external consultant to visit the home to review and update the homes fire risk assessment as necessary. Whilst touring the home with the deputy manager, we chose to activate the call bell system to ensure that it was working and that staff reacted appropriately to any emergency calls. Whilst the alarm was raised, staff members did not respond, although staff did deactivate the call, we activated it a second time and this was not responded to either. A further attempt was made whilst touring upstairs at which point a member of staff did respond. A requirement has been made within this report requiring the registered manager to ensure that in situations in which peoples emergency call bells are activated, staff respond to the situation in a timely manner to ensure people can be confident of getting assistance in an emergency situation and thus ensuring their health, safety and welfare. The home does not act as agent or manage monies on behalf of residents. Service users’ pocket monies are managed appropriately. There is a named key holder to the safe and records are kept of all transactions. The records of six service users were audited and appropriate documentation and receipts were held of all transactions made. All those viewed were well documented and balances tallied with that documented. The home engages regularly with users of the service to gain feedback on the service it provides; this is undertaken on both an informal and formal basis through feedback and suggestion forms, noting any comments or concerns when undertaking residents care reviews, resident meetings and an annual questionnaire. It is recommended that the annual questionnaire allows for GP’s, social workers and any other health professionals or stakeholders involved with the home to take part. The home deals with a number of diverse care needs and offer a personalised service to meet the needs of their service users. There is a commitment to ensure that all clients, however diverse their needs may be, receive a person-centred package of care, which meets their needs appropriately. However there are a number of areas highlighted elsewhere in this report which highlight that service users health, safety and welfare is being compromised for which a number of requirements have been made within this report to ensure that peoples health safety and welfare is protected at all times, thereby working in their best interests at all times. The requirements are namely around poor practices in relation to medication (see section headed health and personal care) and some environmental factors (see section headed environment) Care Homes for Older People Page 27 of 35 Evidence: which need addressing since they could compromise the health safety and welfare of those using the service. These include ensuring that emergency call bells are answered swiftly upon being activated, that peoples medication is administered as prescribed by their GP, providing radiator guards to radiators to reduce the risk of possible scalding and attending to frayed carpets to reduce the risk of tripping. Care Homes for Older People Page 28 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 29 of 35 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 9 13 Ensure that service users prescribed medication is administered as prescribed by their GP to meet their health care needs appropriately. Regulation 13(2) of the Care Homes Regulations 2001 requires that (2) The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Failure to comply with this regulation is an offence. 08/12/2008 2 19 23 Accommodation is to be 31/01/2009 improved as indicated in the report to provide more comfortable surroundings for people living at the home. Regulation 23(2)b of the Care Homes Regulations 2001 requires that: Care Homes for Older People Page 30 of 35 the registered person shall having regard to the number and needs of the service users ensure that: the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally. Failure to comply with this regulation is an offence. 3 22 23 Ensure to provide grab rail 31/12/2008 in downstairs WC for service users use. Regulation 23(2)n of the Care Home Regulations 2001 requires that: The registered person shall having regard to the number and needs of the service users ensure that: suitable adaptations are made, and such support, equipment and facilities, including passenger lifts, as may be required are provided , for service users who are old, infirm or physically disabled. Failure to comply with this regulation is an offence. 4 25 13 Ensure that whilst awaiting radiator guards, a risk assessment is undertaken and a plan of action be drawn up detailing how the risk is to be reduced and managed Regulation 13(4)c of the Care Homes Regulations 05/12/2008 Care Homes for Older People Page 31 of 35 2001 requires that: The registered person shall ensure that - (c) unnecessary risks to the health or safety of service users are identified and so far aspossible eliminated. Failure to comply with this regulation is an offence. 5 25 13 Radiators must be guarded 31/01/2009 or have guaranteed low temperature surfaces to prevent service users from scalding. Regulation 13(4) of the Care Homes Regulations 2001 requires that: The registered person shall ensure that— (a) all parts of the home to which service users have access are so far as reasonablypracticable free from hazards to their safety; (b) any activities in which service users participate are so far as reasonably practicable free from avoidable risks; and (c) unnecessary risks to the health or safety of service users are identified and so far aspossible eliminated. Failure to comply with this regulation is an offence. 6 26 16 Carpets and flooring must 31/12/2008 be kept in a good state of repair, clean and offensive odours eliminated to provide a pleasant environment in which to live, free from any Care Homes for Older People Page 32 of 35 unnecessary risks to the safety of those using the service. Regulation 16(2)k of the Care Homes Regulations 2001 requires that: The registered person shall having regard to the size of the care home and the number and needs of service users keep the care home free from offensive odours.Failure to comply with this regulation is an offence 7 29 19 Ensure to verify references 12/12/2008 without a company stamp or on letterheaded paper to ensure the authenticity of such references. Regulation 19(1)c requires that: The registered person shall not employ a person to work at the care come unless (c) he is satisfied on reasonable grounds as to the authenticity of the references referredto in paragraph 5 of Schedule 2 in respect of that person. Failure to comply with this regulation is an offence. 8 38 13 Ensure that in situations in which peoples emergency call bells are activated, staff respond to the situation in a timely manner to ensure people can be confident of getting assistance in an emergency situation and 08/12/2008 Care Homes for Older People Page 33 of 35 thus ensuring their health, safety and welfare. Regulation 13(4)c of the Care Homes Regulations 2001 requires that: The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. Failure to comply with this regulation is an offence. 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 30 A reccommendation has been made within this report to undertake an audit trial of staff personnell files to ensure that staffs training is up to date and where this is not the case, provide the necessary training to ensure that the staff have the knowledge and skills appropriate to the work they are to perform. It is recommended that the annual quality assurance questionnaire allows for GP’s, social workers and any other stake holders involved with the home to take part to allow for a more ‘rounded’ view of the service. 2 33 Care Homes for Older People Page 34 of 35 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. 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