Inspection on 06/12/07 for Woodlarks Workshop

This inspection was carried out on 6th December 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Woodlarks Workshop 13/03/07

Woodlarks Workshop 19/05/06

Woodlarks Workshop 30/08/05

Woodlarks Workshop 04/05/05

Woodlarks Workshop 09/12/04

Woodlarks Workshop 15/06/04

Similar services:

Thorndene

Sutton Lodge Nursing Home

Wingham Court

Bethany Lodge

17 John Street

Red Oaks

Clare House Nursing Home

Broad Oak Manor Nursing Home

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

CARE HOME ADULTS 18-65 Woodlarks Workshop Lodge Hill Road Farnham Surrey GU10 3RB Lead Inspector Vera Bulbeck & Pauline Long Unannounced Inspection 6 December 2007 09:30 th Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 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 Woodlarks Workshop DS0000013841.V353938.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 Adults 18-65. 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. Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodlarks Workshop Address Lodge Hill Road Farnham Surrey GU10 3RB 01252 714041 N/A manager@woodlarks-trust.org 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) Woodlarks Workshop Trust vacant post Care Home 22 Category(ies) of Physical disability (18), Physical disability over registration, with number 65 years of age (4), Sensory impairment (1) of places Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The age/age range of the persons to be accommodated will be: 18 RESIDENTS WITHIN THE AGE RANGE OF 18 - 64 YEARS & 4 RESIDENTS 65 YEARS & OVER One service user with a sensory impairment Date of last inspection 13th March 2007 Brief Description of the Service: Woodlarks Workshop is a care home offering personal care for people with physical disabilities who are mostly below the age of 65 years. The purpose of Woodlarks Workshop is to provide opportunities for service users to develop personal and independent skills in a setting where their social and emotional needs are met in a safe and supportive environment. The sheltered workshop facility is pivotal to the daily activities for service users, and the service additionally offers respite care. Communal lounges are light and spacious and there is a dining area where meals are served in two sittings. Bedroom accommodation is in single rooms. All have a designated living area, facilities for making drinks, a private telephone and a lockable storage facility. The building is on two levels served by one passenger lift. The design of the environment is suitable to meet the specific needs of the service user group, many of whom have lived at Woodlarks for many years. There is a small gymnasium used for physiotherapy sessions and personal exercise. Woodlarks Workshop is situated in a semi rural location on the outskirts of Farnham, surrounded by well-maintained spacious grounds. Local shops and community amenities are within a short distance by car, and the home is accessible by rail, the station being located in the town. There is ample car parking facilities in the front of the building. The range of fees is from £575.00 - £650.00 per week. This does not include personal items, hairdressing and travel each resident pays £5.00 per week towards the running of the mini bus. Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit formed part of the key inspection process and took place over ten hours forty minutes commencing at 09.30am and ending at 20.10pm. Mrs V Bulbeck and Mrs P Long, Regulation Inspectors carried out the visit. A full tour of the premises was undertaken. Four care plans were sampled and the care observed for the four individuals. A number of records were sampled. The inspectors spoke with all the residents living in the home. The inspectors were also able to speak to the community nurse who was visiting the home, and all the staff on duty was spoken to during the visit. Surveys have been sent to relatives/friends, care staff, General Practitioners and Social Services Care Managers. The manager Ms Jacqueline Hayes was not available all day until 19.00 this was because she was interviewing staff with the administrator. The deputy manager was present throughout the inspection. There were sixteen residents living in the home on the day of the site visit and there was one resident living in the home on a trial basis. There were six vacancies. The inspector would like to thank the residents and staff for their co-operation and hospitality during the inspection. The service users living in the home wish to be called residents, therefore service users will be referred to as residents throughout the report. What the service does well: Resident’s views are continually sought to improve the service the home provides. The manager of the workshop stated she speaks with the residents on a daily basis and addresses issues as they arise. The inspectors spoke to all the residents; the majority of the residents were complimentary towards the home and said they enjoy living with their friends. Several residents stated they were happy and some of the staff are very nice. Residents were well dressed and several stated they enjoyed their lunch on the day of the site visit. There are two sittings for lunch, which is served in the main dining area and all the residents commented on the food being very good. The tables were nicely laid the food was plentiful and appeared appetising and nourishing and there is a choice of menu, one resident commented that she was asked what she would Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 6 like to eat. On the day of the inspection roast lamb and all the trimmings was being served and the residents clearly enjoyed their lunch. The home was clean and the majority of areas in the home were nicely decorated and furnished. The majority of residents had some items of furniture in their bedrooms, some of which they have purchased. What has improved since the last inspection? What they could do better: The management are advised to improve a number of areas in the home, and if necessary to seek the help of a care consultant. At the time of the previous site visit in August 2007 the Pharmacist Inspector made an immediate requirement regarding medication. An action plan was submitted to the Commission for Social Care Inspection regarding the work the management of woodlarks had undertaken. It was disappointing to note at the time of the inspection on 06/12/07 that the action plan referring to staff having received medication training. In fact staff had not received any medication training as stated in the action plan. It was also noted all residents who are able to self medicate to be reviewed by the G.P, this had also not been undertaken. Another area was risk assessments for residents these had not been reviewed, updated or amended as stated in the action plan of being undertaken. A number of areas relating to medication were still not being addressed. The inspector spoke with the staff on duty on the day of inspection, including two agency staff members. Staff commented communication is not very good and at times felt the management of the home does not support them. Staff also commented that a number of staff have left this was due to staff working in the home illegally. This has created a problem for the management of the home and on the day of the site visit, interviews were being undertaken for Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 7 care staff. The home is currently operating with a number of agency staff members. The fridge containing medication in the treatment room was found to be unlocked and there was cream that was out of date stored in the fridge as well as medication for a resident who had been in the home on respite care some time ago. There was some concern in respect of the health, safety and well being of the residents. This is mainly due to the staffing levels being low; according to the rota on more than one occasion there are only two staff on duty. There must be three staff on duty, particuarly at weekends when residents want to go out. It was noted on the rota that most weekends there are only two care staff on duty on either Saturday or Sunday. The inspectors were aware that the home has recently lost five members of staff who were in the country illegally and working in the home on false documentation. The kitchen needs a deep clean and the cook was advised by the inspectors to stop any staff using the kitchen as a walk through area from the grounds, and to ensure all staff when entering the kitchen, to inform staff that appropriate clothing must be worn at all times. 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. Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New admissions to the home are only admitted following a needs assessment to ensure that the home can meet the residents’ identified needs. The home does not offer intermediate care. EVIDENCE: The majority of residents living in the home have lived in the home for a number of years. However, one resident has recently been admitted to the home and the management of the home had undertaken a pre needs assessment, this is to ensure the home can meet the residents needs, this document was seen on the residents file. The deputy manager explained that full details of any potentially new persons would be undertaken before the person enters the home. The deputy manger explained the admission procedure and criteria to reflect the principles of admission and assessment appropriate to the home. This should be reflected in the homes statement of purpose. The statement of purpose was not seen at this site visit. The home does not offer intermediate care. Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents’ health, personal and social care needs are set out in an individual plan of care, in accordance with the homes philosophy. These plans are in the process of being up dated to be more person centred. Residents would like more choice and be able to make decisions on their lifestyles and to be more independent where possible. EVIDENCE: Four care plans were sampled and the inspectors were informed that the care plans are in the process of being changed to be more person centred. The front sheet of the care plan needs an admission date and there were no completed records available regarding weight charts. These records if completed accurately would benefit the residents and district nurse who is involved with residents who have medical problems. It was noted in the majority of resident’s notes health, personal and social care needs had been identified and assessed and again these are in the process of being changed. Care notes need to be more detailed to include individual’s daily routines. All the residents are able to be involved with their care plan. Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 11 The care plans should hold all the relevant information required. This includes optical, dental and health professional involvement, as well as the G.P. The care plans are kept in each individual’s bedroom, and staff have access to them. However it was noted the care plan in one residents bedroom was dated 2002 and had not been updated during that time. Care managers have undertaken reviews on all individuals, and residents have been involved with the process. A number of risk assessments need to be undertaken and some need to be updated. Staff stated that residents are supported to make decisions affecting their lives in a number of ways. However, a number of residents stated they would like to be more involved with decision-making and have more choice over their individual well-being. Holidays, menu planning and outings are mainly discussed at residents meetings, which are mainly held in the workshop. Observation by the inspector, staff are respectful to the residents. It was also noted that some individuals and staff have a good rapport. Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents have some opportunities for personal development and to take part in appropriate activities within the home and in the local community. They are supported to maintain and develop appropriate personal and family relationships. EVIDENCE: The majority of residents attend various activities in the local community and residents are able to go to concerts if requested. This week five residents went to a “Take That” concert at Wembley, and the residents who went stated they really enjoyed the evening. However, any future concerts booked need to be organised for appropriate care staff to attend with the residents. It would appear that only one member of the care staff went and this could have resulted with a problem if an emergency arose. A number of residents are able to enjoy holidays; these include on the campsite as well as trips abroad for example Cyprus and Turkey. Residents Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 13 also enjoy going swimming, skiing, canal trips and a number of other outings for example shopping and going to church. The majority of residents work in the workshop on a daily basis. Residents confirmed that they are enjoying some of the new ideas brought in by the new member of staff. Some of the work that residents have undertaken was on display and for sale; there were some very nice items on display including cushion covers. However, one resident was not so happy with the new member of staff as she is not able to knit. The member of staff stated she would try to learn to knit, to enable to help the resident when necessary with her favourite hobby. A number of residents have contact with their family. The staff stated that the families are very interested in the care of their relatives. The inspector discussed with the residents who have visitors and some of the residents are able to spend time at home with their relatives. It is recommended that any person without a relative or friend would benefit from an advocate involvement to ensure the residents have the support they need. The inspector was able to speak with all the residents living in the home. The mealtime was pleasant there are two sittings and residents clearly enjoyed their meal. The food was nutritional in content and advice is sought when required from a nutritionist. Mealtime was a very social occasion. A number of residents were excited about Christmas and some of the activities of buying and giving presents. Several commented to the inspector that the home was not able to put up any decorations just yet as the lounge and dining area were being painted before Christmas. The inspector discussed this with the manager and it was decided that the home undertakes the decoration of the lounge and dining area after Christmas so that the Christmas decorations can be displayed. Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The healthcare and support needs to be more robust to ensure the residents are being well looked after. Residents are not fully protected by the homes medication policies and procedures and lack of staff training. EVIDENCE: The inspector was informed by staff that the residents are able to choose when to go to bed and when to get up and are supported to choose their own clothes, hairstyles and other aspects of personal grooming. Residents confirmed that staff input into the care they receive is normally good. However, at the moment there are so many agency staff working in the home that do not know the residents and their individual needs. The home is in the process of employing new staff. Therefore the situation should improve. There are regular visits to the local G.P and individuals have an annual health check. The medical team as well as other professional health care people, these include the dentist, optician, chiropodist and Physiotherapist when required. A number of health professionals visit the home providing appropriate health care needs; these include the district nurse and physiotherapist. Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 15 The inspectors were able to speak with the district nurse who stated she is very satisfied with the home and the care provided to residents. However, it was stated that there could be some improvements in relation to record keeping and staffing levels. On the day of the site visit the physiotherapist visited the home to assess and treat an individual. The inspector was not able to talk with the Physiotherapist as he was in the process of treating a resident. One resident is cared for in bed the district nurse visits on a regular basis to tend to the resident. The other residents in the home go in and out of her bedroom just so that she has company. Most of the resident’s day is spent watching television. Management of the home needs to implement a plan of care to ensure the resident is not left for long periods of time. A number of risk assessments were seen, and some risk assessments need to be up dated and some need to be undertaken for each individual. The confidential notes currently in the care notes are stored appropriately in a locked facility, care plans are used as a working tool for all staff and a copy is kept in each persons bedroom. However these need to be kept up to date. In one residents bedroom the care plan was dated 2002. The system for medication administration was seen and was undertaken by staff that had received medication training. However, there were a number of errors in respect of medication administration. One resident had not had her patch changed for several days and certainly not within the prescribed time by the doctor. Another resident went to the doctors and was given an antibiotic the medicine was not collected from the chemist for 5 days, causing the resident unnecessary suffering. The Medication Administration Record (MAR) sheets were seen for the four individuals who were case tracked and it was noted that there were gaps on the recording records. Sample signatures of all staff that administer medication were held with the MAR sheets for ease of reference. All staff must complete medication training as a priority and should not be administering medication until qualified to do so. There are several residents who are able to self medicate. Management of the home must ensure appropriate risk assessments are in place to ensure medication is taken as directed and staff need to ensure there are no adverse errors made. Residents are responsible for their own medication and once medication arrives in the home it is the responsibility of the residents. There were a number of drugs that need to be returned to the pharmacist which were stored in a box on the floor of the medication cupboard. These should be returned as soon as possible and not stored for any length of time. Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. All staff have received training in protecting vulnerable people and are aware of the procedures and practices, to ensure that residents are safeguarded, as far as reasonably possible, from harm or abuse. However, the shortfalls in the lack of training and continued medication errors put residents at risk of harm and abuse. EVIDENCE: The inspectors spoke with all the residents on the day of the inspection and all were complimentary about the home and some said they would not want to live anywhere else. There are regular residents meetings with the manager of the workshop and the management of the home have regular monthly meetings and residents are invited to attend. The home has received five complaints and records indicated all have been addressed appropriately. The Commission for Social Care Inspection has received several complaints and as a result one complaint was referred to the safe guarding team. The outcome has not been resolved and is currently under investigation. The Commission looked at part of the complaint at the time of a site visit in August 2007. The link inspector for the home and the Pharmacist Inspector undertook the visit. As a result of the visit a serious concern letter was issued for the medication errors to be addressed. The home produced an action plan indicating all the areas identified by the pharmacist inspector had been addressed. Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 17 However, on the day of the inspection 06/12/07 it was noted that the same mistakes were being undertaken by the staff and the staff were reported in the action plan to have received medication training. This was not the case and it was clear the same errors continue to happen. This is a cause for concern and was addressed on the day of the visit with the manager, to ensure only qualified staff are able to administer medication and no member of staff should administer medication until they have received further training. This has an impact on the safety and well being of the residents. Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Further improvements are required to ensure residents live in a safe well maintained home. The majority of the areas in the home were reasonably clean and hygienic. Staff need to be more supportive towards residents who are aiming to move towards independent living. EVIDENCE: The home had greatly improved and was clean and most of the bedrooms were personalised. The majority of the residents keep their bedrooms clean and tidy and some residents need more support from staff. Until recently there was a key worker system in operation. However, there are only five permanent staff employed and currently the situation has deteriorated regarding staff input with the residents. For example there are items left on the floor in one residents bedroom that could be a potential hazard, and staff need to clear these items to ensure an accident does not occur. In another residents bedroom a full urine bag had been left in a bowl next to the bed. Carpets in some areas of the home and one residents bedroom needs to be replaced, some carpets are badly stained and need to be cleaned. In another Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 19 residents bedroom the bed was without a headboard, and a wooden washbasin surround was chipped and needs replacing. Doors need to be renumbered since being decorated, to ensure in the event of a fire the fire officers would be given the correct information regarding the location of the bedrooms. The toilets and bathroom doors have hanging signs on stating if engaged or vacant. These need replacing with appropriate locks as on the day of inspection nearly every toilet or bathroom indicated they were in use. This was not always the case the signs had not been changed. One of the locks on the toilet door was broken and needed replacing. The maintenance person was informed and he stated he would fit a new lock the same day. The inspector checked the maintenance book and noted that it was not being used. The record of work needs to be logged and kept up to date, to enable any work needing attention is recorded so that the maintenance person can see what needs to be done. The record needs to be signed when the maintenance person has completed the work. The book must be accessible at all times for the maintenance person. The fire door in the small lounge on the lower floor needs attention; there is a big gap in the door where the two doors meet. The ceiling also needs attention in the quiet room as the roof has leaked and caused damage to the ceiling tiles, these need to be replaced the maintenance person stated. Fluorescent lights have been removed from a resident’s bedroom some time ago and a new light fitted. The ceiling needs to be painted where the previous fittings were. A light in the laundry was not working and needs replacing. The kitchen needs to be deep cleaned; the cook had already identified this. It was also noted the wooden ramps outside the fire doors are extremely slippery and dangerous and need attention. There have been two lifts working in the home until recently; one lift has been put out of order. The inspectors were informed the lift would cost £15.000 to repair. Therefore it has been decided the lift is old and not worth spending the money on. The lift that is currently in use, which is the newer lift, is more efficient and accessible. The inspector would advise the management of the home to check with the company who services the lift, on the position of the controls inside the lift. Once a resident in a wheelchair gets into the lift the controls are behind the wheelchair. The resident would need to enter the lift backwards to be able to use the controls when using the lift from the lower floor. Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels and staff training need to improve to enable staff to provide the care and attention residents need. This is to ensure the residents are treated with respect and dignity at all times and their individual needs are being met. EVIDENCE: The staffing levels need to improve and there should be three care staff on duty every morning shift form 8am until 14.30 with the present number of residents living in the home. The rota indicates that on a number of occasions there are only two staff on duty. This would have an impact on the residents care needs and being able to go out when required with a member of staff. A number of staff and residents confirmed that on many occasions there are only two care staff on duty. The home has lost five members of staff recently due to immigration issues. This has had a big impact on the staffing levels in the home and has resulted in the management of the home employing a number of agency staff to provide the care to the residents. On the day of the inspection at the time of arrival of the inspectors the manager was interviewing staff all day until 7pm. Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 21 The inspectors were informed that in January the Surrey Care Association are to undertake a skills analysis on staff training. It was noted that staff need to undertake a number of training courses as well as updates to training. All staff and residents received equality and diversity training some time ago and this proved to be very beneficial to all. Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management in the home is in the process of change. The newly appointed manager has made a number of changes and needs to continue in this area. Unfortunately it has been a very difficult time for the manager particuarly regarding the staffing problems. With careful planning and skill there is no reason why the home cannot function to a good standard. EVIDENCE: The manager has decided to wait for a time before going through the registration process. However, she is qualified and skilled to meet the challenges the home presents. The manager needs to ensure the staff have the training required and should take responsibility for the home to operate a safe environment for residents to live in. All areas in the home that require attention need to be addressed as a matter of priority. This includes the safe administration of medication. Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 23 A number of records were seen these include fire records, whilst it was noted that weekly checks are undertaken on the fire alarm system and there are regular fire drills it was also noted that the fire risk assessment was out of date being 03.06/05 and the certificate for the emergency lighting system was dated 09/03/01. There is also a need to implement an emergency contingency plan in the event of an emergency the fire service would have up to date information of where residents should be taken if unable to go back into the home. These areas have been discussed previously and serious consideration should be undertaken to ensure the home is safe at all times of the day and night. The Responsible Individual produces a monthly report, this report needs to be expanded to include areas that have been checked and information should be included in the report of the findings of the Regulation 26 visit. The provider is able to delegate this role to a responsible qualified person who is not employed in the home if necessary. The staff informed the inspectors that the handover book is no longer used during the day and only night staff completed the records. However, there was very little information written in the handover book to indicate this was being followed. Handovers are a good way to communicate with all staff and if this practice has been decided to be withdrawn another practice needs to be in place to enable staff to be aware of what is happening in the home with regards to residents and their well being. The inspector was informed that some weeks ago two residents were booked to go on holiday and the residents and staff were not aware they were going on holiday. In fact no one was aware until the car arrive to take him or her to his or her destination. The inspectors were informed that the two residents had ten minutes to pack and be on their way. This practice is unacceptable and there must be some method of communication and record keeping ensuring the residents are treated with the respect and dignity they deserve. The management of the home needs to provide adequate facilities for the cook, to leave her clothes and any personal items in a safe place. On the day of the inspection it was noted that her coat and handbag were under one of the working surfaces in the kitchen. There is also a need for any visitors or members of staff entering the kitchen to be provided with protective clothing. No one should enter the kitchen without these garments. It was also noted that a member of staff came in from the garden through the kitchen storeroom and used the kitchen sink. This practice is unacceptable and action must be taken to ensure all staff are aware of the procedures for entering the kitchen without protective clothing. The clinical waste bins that were overflowing in several bathrooms needs to be emptied sooner than as arranged with a contactor for a weekly collection. This Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 24 practice needs to be addressed as a priority as some of the bins had a bad odour. The Commission has received a number of surveys from residents, relatives/ friends, care managers and health professionals. Some of the comments received from residents: • • • • Woodlarks is a good place to live Staff are not always able to understand what is being said Like living in the home with all my friends Do not like the new manager, resident stated on survey afraid may get into trouble if she mentions to anyone Some comments received from relatives/ friends • • • • • • • • Residents are worried about moving into supported living Staffing very low shortage of staff leading to a drop in standards i.e. laundry and bed making Workshop well run and residents are enjoying their days more, more interesting Woodlarks provides excellent care and support Skilful staff have been replaced with staff who have no special skills or knowledge Catering is very good Not sure of who to contact in the event of making a complaint Everything about the home is good Comments received from care managers • • There is a happy atmosphere in the home Communication could be better Comment received from a health professional • Woodlarks is highly regarded in -Farnham Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 1 X 2 X X 2 X Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 26 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 YA20 Regulation 13 Requirement So as to show that people get their medicines correctly you must: - Handle medicines as described in the guidelines ‘the Administration and Control of Medicines in Care Homes and Children’s Services’ published by the Royal Pharmaceutical Society of Great Britain. - Give people who use your service their medicines at the dose and frequency their doctor prescribed them. - Keep complete and accurate records of all medicines received into the home and given to people who use this service. (Timescale 07/08/07 not met). Timescale for action 24/12/07 2. YA20 13 So as to reduce the risks to 24/12/07 people the risk assessments for people who look after their own medicines must be reviewed and updated to include how you are supporting people in this activity. (Timescale 20/08/07 not met). All staff administering medication 04/01/08 must have further training to DS0000013841.V353938.R01.S.doc Version 5.2 Page 27 3 YA20 13 Woodlarks Workshop YA23 4 YA24 16 & 23 5 YA30 18 6 YA32 18 7 YA35 18 8 YA37 9 9 10 YA42 YA42 16 13 ensure medication procedures are undertaken at all times. The premises need to be kept in a good state of repair, this includes, the kitchen needs a deep clean, carpets badly stained, ceilings need painting, a broken lock needs replacing and a headboard is missing from a residents bed. Infection control measures need to be reviewed, and staff to ensure residents are appropriately supported to include personal hygiene. Staffing levels must be improved, to ensure adequate staff are on duty to meet the needs of the residents. All staff require updates to training and a number of staff must complete appropriate specialist training to meet the needs of the residents. Management of the home to ensure the residents are protected from harm or abuse at all times. To ensure the manager has adequate support to manage the home efficiently. All persons entering the kitchen must wear protective clothing. The fire records must improve the fire risk assessment needs updating, emergency lighting must be checked and to implement an emergency contingency plan. 04/01/08 24/12/07 06/12/07 25/01/08 24/12/07 06/12/07 24/12/07 Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 28 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. 2 3 4. 5 Refer to Standard YA2 YA23 YA23 YA39 YA42 Good Practice Recommendations Care plans need to be updated and regularly reviewed. The current vacant/engaged signs on bathroom and toilet doors need to be reviewed. The maintenance book needs to be completed to indicate work outstanding and work completed and should be dated and signed by the maintenance person. The regulation 26 visit report requires more information. Management of the home to provide appropriate facilities for the cook’s personal belongings. Woodlarks Workshop DS0000013841.V353938.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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