CARE HOMES FOR OLDER PEOPLE
Woodlands Rest Home 19-23 Lovedean Lane Lovedean Portsmouth Hampshire PO8 8HJ Lead Inspector
Laurie Stride Unannounced Inspection 23rd April 2007 10:45 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 Rest Home DS0000049977.V333719.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 Rest Home DS0000049977.V333719.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Woodlands Rest Home Address 19-23 Lovedean Lane Lovedean Portsmouth Hampshire PO8 8HJ 023 92 594427 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) admin@brookvalegroup.co.uk Heatherland Healthcare Limited Ms Heather Saunders Care Home 31 Category(ies) of Dementia - over 65 years of age (31), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (5), Old age, not falling within any other category (31) Woodlands Rest Home DS0000049977.V333719.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th July 2006 Brief Description of the Service: Woodlands is a care home providing accommodation and care for 31 service users in the category of Older Persons (OP) and/or those over 65 years in age with dementia (DE). The home may also accommodate 5 service users who are over 65 years in age and who have mental health problems. The home is owned by Heatherland Healthcare Limited. The registered manager is Ms. Heather Saunders. Communal space comprises two lounges and dining room. Bedrooms are situated on two floors, accessed by a shaft lift. The main door is kept secure by the use of a keypad exit system. There are 28 single and 2 shared rooms, although one of these is traditionally used as a large single. Eleven single rooms have en suite facilities. There is a well-kept garden and patio area to the rear of the property and car parking space at the front. The home is situated in a quiet residential area, close to local amenities, shops and public transport. The fees for the home currently range between £415 & £475 dependent on need and whether the room has en suite facilities. Woodlands Rest Home DS0000049977.V333719.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An unannounced visit was carried out on the 23rd April 2007 as part of the key inspection of this service. Prior to the visit the registered manager had completed a pre-inspection questionnaire. Sixteen of the people who live in the home had returned postal survey questionnaires, some assisted by a family member or representative. This information, together with previous inspection reports and information gathered during the visit, provide the evidence on which this current report is based. The inspection visit took place over approximately seven hours and the homes registered manager assisted the inspector throughout. During the visit it was possible to meet some of the people who live in the home and talk in depth with two of them. The inspector also spoke with four members of the staff team and the registered manager, read samples of the home’s records and viewed the premises. What the service does well: What has improved since the last inspection?
Care plan recording has improved and is being monitored. The home has further developed the procedures for managing medication and residents’ monies and reviewed the staff recruitment process to better protect people who use the service. Upgrades to areas of the physical environment also
Woodlands Rest Home DS0000049977.V333719.R01.S.doc Version 5.2 Page 6 benefit those who live in the home. The registered manager is applying her training to continually improve the service. 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. The summary of this inspection report can be made available in other formats on request. Woodlands Rest Home DS0000049977.V333719.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Woodlands Rest Home DS0000049977.V333719.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective people to use a service and their representatives have the information needed to choose a home that will meet their needs and also have their needs assessed prior to admission. EVIDENCE: The home provides a Statement of Purpose and a Service User Guide and this information was available to read in the hall near the entrance to the premises. All sixteen people who returned survey questionnaires said they had received sufficient information to make a choice about moving to the home. In discussion with people who live in the home, one person said ‘I knew what I was coming into’. Another said they had telephoned the home after seeing an advertisement and staff had arranged for them to visit the home, prior to any decisions being made regarding admission. Woodlands Rest Home DS0000049977.V333719.R01.S.doc Version 5.2 Page 9 Of the twelve people who answered the survey question regarding contracts, eleven said they had received a contract, one person said a copy of the contract had been offered and was available in the office. Records of admission were seen in respect of five people who live in the home and each had been assessed as to what their individual needs were. The assessments had been completed by the registered manager and were also signed by the resident or their representative. The information gathered during the assessments had been used to complete written care plans for each person. Through discussion with people who live in the home and the information gathered by survey, it was evident that residents and their representatives felt that they receive the care and support they need. The home does not provide for intermediate care, therefore this standard is not applicable. Woodlands Rest Home DS0000049977.V333719.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements in monitoring and recording have been made to ensure that people who use the service receive appropriate health and personal care, based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: All the care plans seen contained general risk assessments as well as specific assessments related to the care needs of the individual, for example mobility and the use of supportive aids such as walking frames. The care plans identified support and assistance that staff needed to carry out and where residents remained independent how staff could encourage this. It was not possible to see from the care plans if or how individuals were involved in reviews of their plans, two people who use the service who were spoken to were not aware of their care plans. However the home does have a quality audit system that asks for people’s views on the care provided.
Woodlands Rest Home DS0000049977.V333719.R01.S.doc Version 5.2 Page 11 Through discussion with people who live in the home and the information gathered by survey, it was confirmed that people generally felt that staff assistance was received when required in a timely way. All felt that they receive the medical support they need. One person commented ‘medical help is good and prompt when needed. Staff are very good at spotting when I need help even if I don’t ask’. People who use the service also confirmed that staff provide support in a sensitive manner and respect their privacy and dignity. The previous inspection report for this service had identified requirements relating to records of meeting healthcare needs and managing medication. The evidence from this inspection shows that the home had taken action to meet these requirements. The home operates a system whereby daily records are kept separately from the main care plan, which is reviewed on a monthly basis. During this inspection, samples of information from care plans, daily records and the accident book were ‘tracked’ to see if the home was monitoring people’s needs consistently. The results showed that staff are now keeping better records to demonstrate how the home is responding to and meeting individual’s changing needs. There was one gap in the daily records for one individual after this person had suffered a fall, however there had been no adverse outcome and the registered manager reported that a system of checks on records by senior management is now in place. Comments from people who use the service and the samples of the homes’ records showed that the home supports people to manage their own healthcare and professional healthcare support is available when needed. People can choose to keep their own doctor or the home can support them to register with a doctor locally. A sample of the medication records was seen and had been completed correctly and signed by an authorised member of staff. Medication was stored appropriately in a locked cupboard and blister packs were used. Staff were observed using a small trolley to transport the medication, with nothing being taken from its original packaging. A previous requirement relating to the procedures for managing controlled drugs in the home had been met. The home’s written policy and procedure had been updated to include the disposal of controlled medication patches and there is a list of staff who are authorised to sign the records. The controlled drugs register had been signed by two authorised staff members. The registered manager confirmed that there were no other controlled drugs currently held in the home. Woodlands Rest Home DS0000049977.V333719.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to make choices about their lifestyle. Social and recreational activities generally meet individual’s expectations and the home seeks people’s views on these. EVIDENCE: A survey questionnaire asked people if there are activities arranged by the home that they can take part in, 6 said always, 5 said usually, 5 said sometimes. Discussion with two people who live in the home confirmed that they were happy with the choices of daily activities available to them. People were observed spending time alone or visiting each other in their rooms, or socialising in the communal areas. One person commented that they could go out as they please, they had only to inform the staff. It was seen that a number of people who use the service had personal televisions and equipment for playing music in their rooms, and there were books and puzzles available in the lounge. The home provides in-house activities, facilitated by staff or visitors, such as exercise, arts and crafts, reminiscence sessions, hairdressing, singing and
Woodlands Rest Home DS0000049977.V333719.R01.S.doc Version 5.2 Page 13 entertainment, bingo and games. There is a notice board with information about activities on offer. An outing was also planned. Care plans and assessments generally contained information about individual’s recreational interests and leisure preferences, although there were a small number of gaps in the samples seen and these were pointed out to the registered manager. There is a visitors policy, which states visitors are welcome at any time of the day or evening, and visitors were observed coming and going throughout the time of the inspection visit. Individuals are able to attend church services if they wish and the home offers support to do this if required. The registered manager reported that many people who lived in the home had a private telephone. There are also three chord-less telephones situated around the home, which can be taken into residents’ rooms for privacy. At 11.50 a.m. residents were informed by a member of staff that lunch would be served. One resident remarked to the registered manager that lunch was always served at this time and felt it was too early. The registered manager told the resident that a meal could be put by for them to eat at a later time if they wished. Staff members said that people who live in the home have breakfast at around 7:30, lunch at 12:00 and tea at 5p.m. At lunchtime, a number of residents were observed having a meal in the dining area while others chose to eat in their rooms. Staff were available to provide support if it was needed. There was a menu board in the dining room and meals were varied. Special diets are provided for, such as vegetarian for one individual, and the registered manager confirmed that the dietary needs and wishes of people from minority ethnic groups could be catered for if needed. The manager also spoke of plans to make further use of knowledge she had acquired through training of the nutritional needs of older persons. Fresh fruit was available in the lounge area. People who live in the home gave a variety of comments about food and drink, some said the food is good and choice was given, others felt more priority should be given to these things. The majority of people who returned questionnaires indicated that they ‘always’ or ‘usually’ liked the meals provided. The home has a quality questionnaire that is issued to people who use the service and which includes the subject of meals and mealtimes. Woodlands Rest Home DS0000049977.V333719.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service feel able to express their concerns and are protected by the home’s policies and procedures. EVIDENCE: The registered manager stated that no complaints or adult protection concerns had been received at the home. The Commission for Social Care Inspection had also not received any concerns or allegations related to the home. Residents who were spoken with or who returned questionnaires felt they are treated with respect and confirmed that staff listen and act on what they say. They were aware of the complaints procedure and felt comfortable about taking any concerns to the manager or staff. The complaints procedure was on display in the entrance hall of the home informing people how to make a complaint. The previous inspection visit had identified that the registered manager has established a sense of openness at the home so that relatives, residents and staff can voice their concerns. Discussion with people who use the service confirmed that they feel safe in the home and feel free to express themselves. The home’s quality assurance questionnaire also encourages people to comment about the service.
Woodlands Rest Home DS0000049977.V333719.R01.S.doc Version 5.2 Page 15 Staff spoken with confirmed that they receive training in adult protection matters and staff training records provided further evidence of this. Staff spoken with demonstrated understanding of the procedures to follow if abuse is suspected. The home has copies of the local authority adult protection procedures and a whistle blowing policy. Woodlands Rest Home DS0000049977.V333719.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. Improvements have been made to ensure infection control procedures are effective. EVIDENCE: During a tour of the premises it was possible to see that the home was wellmaintained and provided suitable aids and adaptations to meet the needs of the people who live there. Handrails are in place throughout the building and radiators are covered to protect people. A new ‘walk-in’ bath has been installed and the bathroom re-decorated. New lighting has been fitted in one of the lounge areas and the kitchen has been re-painted. Woodlands Rest Home DS0000049977.V333719.R01.S.doc Version 5.2 Page 17 People who live in the home are encouraged to personalise their bedrooms to help them settle in. Those individuals spoken to were satisfied with the furniture and fittings and the general comfort of their surroundings. The grounds outside were well kept offering several areas to sit. The home was well lit, clean and tidy. People who use the service and returned questionnaires all confirmed that the home is kept fresh and clean. There are infection control procedures in place that are supported by relevant staff training. Since the last inspection the hand-washing facilities in the laundry room have been made more accessible, and there is a notice for the area to be kept clear of obstructions. Woodlands Rest Home DS0000049977.V333719.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have confidence in the staff that care for them. Staff in the home are trained, skilled and in sufficient numbers to support the people who live there. The homes’ recruitment procedures have been reviewed so as to be more robust in order to protect people. EVIDENCE: A sample two-week rota was received as part of the pre-inspection questionnaire. It stated that there are four or five staff plus the manager who work 8 – 4 pm, except weekends when there are four staff on duty during these hours. In the afternoons there are three staff working 3.30 – 10 pm with a fourth person who works 5 – 8pm. At weekends the afternoon staff cover changes to four staff plus the person working 5 – 8pm. There are two staff members on duty at night both awake. In addition there is a cook at the home seven days a week and a domestic worker employed five days a week. The staffing levels at the time of the visit were suitable to meet the needs of the people who live in the home. There is a stable team of carers, with no newly recruited staff since the last inspection. This provides good continuity of care for people who use the service. The homes staff recruitment procedure had been reviewed since the last inspection and was robust, as shown by a sample of two staff members
Woodlands Rest Home DS0000049977.V333719.R01.S.doc Version 5.2 Page 19 records, which contained all the required information including evidence of Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks, written references and employment histories. The organisation promotes an environment where staff members are expected to undertake training to develop their skills. Information provided by the registered manager in the pre inspection questionnaire stated that 10 of the 22 staff have completed or are working towards an NVQ level 2 or 3 award. A member of staff confirmed she was doing NVQ level 3 training and that she found the overall training programme to be useful, in helping staff to develop further skills to meet the needs of people who use the service. A resident remarked that ‘staff on the whole are very good’. Training recently completed included manual handling, fire safety, first aid, food hygiene, infection control, pressure care, health and safety, dementia care, medicine management, challenging behaviour and adult protection. Planned training included further courses in fire safety, moving and handling, care planning, diabetes, epilepsy and NVQ training. A new staff induction training package was in place that is linked to the core standards of NVQ training. The home received the ‘Investors in People’ Award in January 2006. Woodlands Rest Home DS0000049977.V333719.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the required qualifications and experience to run the home and works to continually improve the service. Systems are in place to ensure that the home is run in the best interests of people who use the service and that safe working practices are maintained. EVIDENCE: The registered manager has many years experience of working in care and completed an NVQ level 4 in care and the Registered Manager’s Award in 2006. Ms. Saunders was also commended in the ‘Residential Carers Award’ in December 2006 and received the organisation’s outstanding achievement award in the same year. The registered manager is supported by the Care
Woodlands Rest Home DS0000049977.V333719.R01.S.doc Version 5.2 Page 21 Services Manager and meets with other managers every three months to discuss organisational and practice issues. The home conducts a survey of the views of people who use the service and their relatives. The results of questionnaires returned for a January survey were available in the hallway and a follow up report on the findings and any action taken was due. The quality survey asks people to express their levels of satisfaction and to give comment on a wide range of matters, for example admission, reception and friendliness of staff, the atmosphere in the home and the care and attention shown by staff, privacy, call system responses, noise levels, daily routines, religious beliefs and other matters. Previous comments on noise levels had been followed up with new door closers being fitted. A further survey is planned for July 2007 and the registered manager said a survey of staff and other professionals’ views was also to be undertaken. The provider carries out a monthly audit of the service. This includes asking people who live in the home for feedback about the quality of service they are receiving. The registered manager keeps records in respect of any monies held on behalf of people who use the service. An individual record of any income and expenditure is kept, together with any receipts and a sample of these was seen. In the sample seen the amount held matched the balance recorded. Access to any monies and the records is restricted to the registered manager and the Care Services Manager, who may delegate this responsibility if necessary. Any third party who gives money signs the record to evidence that the home has received the money. The registered manager undertakes checks of the records every week and the Care Services Manager completes an audit every two months. Records were seen that demonstrated that the home promotes safe working practices, to protect people who use the service, staff and visitors. A fire safety risk assessment for the building was in place and staff had received upto-date training, instruction and drills. Certificates were available for checks, tests and servicing of domestic appliances and services such as gas and electric, as well as maintenance of the lift and hoists. A written policy for health and safety was also in place. Woodlands Rest Home DS0000049977.V333719.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Woodlands Rest Home DS0000049977.V333719.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Woodlands Rest Home DS0000049977.V333719.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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
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