Inspection on 30/04/09 for Woodleaze EMI Unit

This inspection was carried out on 30th April 2009.

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

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

Other inspections for this house

Woodleaze EMI Unit 03/05/07

Woodleaze EMI Unit 24/05/06

Woodleaze EMI Unit 05/01/06

Woodleaze EMI Unit 13/05/05

Woodleaze EMI Unit 13/10/04

Woodleaze EMI Unit 16/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Woodleaze EMI Unit Station Road Yate South Glos BS37 4AF Lead Inspector Sandra Garrett Unannounced Inspection 30th April 2009 10:00 DS0000034159.V375040.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodleaze EMI Unit Address Station Road Yate South Glos BS37 4AF 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) 01454 866043 01454 866041 jeanette.isaacs@southgloucs.gov.uk South Gloucestershire Council Mrs Susan Elizabeth Simmons-Tasker Care Home 34 Category(ies) of Dementia - over 65 years of age (34) registration, with number of places Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd May 2007 Brief Description of the Service: Condition of registration: The Home cares for people with Dementia aged over 65 years. South Gloucestershire Council operates Woodleaze and the Manager is Mrs. Sue Simmons-Tasker. The Home is registered to accommodate thirty-four older people with dementia. Two of these places are kept for short-term care. Each of the 34 single bedrooms has a washbasin and fitted wardrobes. None of the rooms have ensuite facilities. The property is arranged over two floors with shared space on the ground level, including a conservatory. Bedrooms are on both floors. There is a central courtyard pleasantly laid out with flower and plant containers and exterior furnishings. Woodleaze is a purpose-built home, built in the 1980s. It is one of 8 care homes for older people that South Gloucestershire Council own and run. The Home is close to shops, amenities and bus routes. The full fee charged for staying at the Home is £640 per week. There are extra charges for chiropodist, and hairdresser services. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority fees payable are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk http:/www.oft.gov.uk Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. All information the Care Quality Commission (the Commission) has received about the service since the last inspection was looked at. We then drew up an inspection record in preparation for the visit. This record is used to focus on and plan our work so that we concentrate on checking the most important areas. Because people with dementia aren’t always able to tell us about their lives, we use a formal way of observing people to help us understand better. We call it the: ‘Short Observational Framework for Inspection’ (SOFI). This means using a methodical and structured way of watching people living at the home. We did this for two hours in both the lounge and dining room and recorded a sample number of peoples experiences at five-minute intervals. It included looking at their wellbeing, how they related to and with other people living at the home, staff members and their environment. We also saw how other people live their lives at the home. Information from the observation is included throughout this report. We also spent time talking with the manager and members of the management team, staff and visitors. We looked at a wide range of records including care plans, assessments, complaints, staff records, health and safety and quality assurance records among others. What the service does well: People living at the home generally showed good signs of well-being, were lively and engaged with staff and activities. It was clear that staff work hard to meet peoples needs for a stimulating and enjoyable life. The staff team worked well together and showed their knowledge of each individual and their needs. Detailed pre-admission assessments make sure that the centre is the right place for people using the service and that staff are able to meet their needs. Regular staff training in safeguarding adults from abuse keeps people protected from risk of harm or abuse happening to them. Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: It was disappointing to note that the one requirement and three good practice recommendations made at the last visit had not been met. We remain concerned at the continued policy of locking peoples bedroom doors. Further, wardrobes in rooms have bolts on them to stop people putting on too many clothes. Bedrooms don’t always have nameplates or pictures that might help people find their rooms. The overall effect is that people aren’t free to use the environment as it’s designed for them i.e. as their home. Swift action needs to be taken to make sure people are free to get into their rooms at any time of the day or night. More work is needed to make sure care plans are person-centred. This means care that looks at a person’s whole life, history and needs. It recognises and values them as an individual with rights and choices, rather than just focussing on meeting basic physical care tasks. Further, care and activities records should be written in ways that show peoples enjoyment and quality of life in the home rather than just their basic care. Where people are at risk because of falls, clear risk assessments must be put in place to keep them safe. Further, staff should sign care plans to confirm that they can meet peoples individual needs. Where restraint is used for any reason staff must show that they have taken into account Deprivation of Liberty Safeguards and that such action is taken in the best interests of people being cared for. Peoples religious needs should be met wherever requested with due regard to the individual spiritual needs of each person. The manager should take action to try and make sure that religious services happen regularly at the home so that peoples spiritual needs can be properly met. Where people need help with feeding, staff must be trained in how to do this in person-centred ways that meet the person’s need for dignity, respect and to enable them to enjoy the mealtime experience. Complaints management must be improved. Few complaints were properly recorded with no clear actions taken or timescales. Complaints information wasn’t displayed. If people aren’t encouraged to raise concerns or make Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 7 complaints those concerns may not be taken seriously and could affect the care of people living at the home. Whilst the home has a ‘provisional’ certificate of its quality of care given to people, results of quality assurance surveys aren’t published openly. Further, the way surveys are done could lead to skewed results that are based on staff assumptions rather than peoples actual experiences of life in the home. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4 & 5 People using the 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 and/or their relatives/representatives benefit from being given information about the home when they come into it. However, this may not always be provided in ways that are accessible to people with dementia. Detailed pre-admission assessments make sure that the centre is the right place for people and that staff are able to meet their needs. Whilst people are looked after well, people with varying degrees of dementia may not get the same care as others. Further, relevant training in personcentred care and Deprivation of Liberty Safeguards is needed to make sure each person’s specialist needs are met. EVIDENCE: Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 10 The Statement of Purpose and Service users guide are comprehensive and have all the information needed to help people make a choice about coming to the home. However, information isn’t provided in ways that people with dementia can understand and is more geared to relatives/representatives. Residents meetings are held that give people opportunities to comment on what they want and need in the home, but minutes displayed were too high for people to see and were in a format that may not be able to read or see easily. We looked at assessments done before people come to the home. These were done by social workers or workers from the Mental Health team that links with the home. Assessments were detailed and included information about what had been happening before people came into the home, their needs and equalities and diversity issues such as culture and religion. The first four weeks are used as an assessment period for staff at the home to find out about peoples needs and put together a care plan. We saw a care plan that had been started and had used information from the assessment. There were also gaps where staff were still assessing the person’s needs. People living at Woodleaze have specialist needs that are to do with their dementia. These include: access to information that they can understand, care staff understanding in how their dementia affects them and giving specialist care in person-centred ways that meet their needs. Elsewhere in this report is evidence that more work needs to be done to meet peoples needs at Woodleaze. Whilst staff get training and support in working with people with dementia, the care given doesn’t always follow good practice – particularly in person-centred care. Further, giving attention to peoples rights to freedom of movement within the home rather than stopping them having such freedom will improve the quality of their lives. Although Woodleaze includes a day centre and offers respite care it doesn’t offer intermediate care for people with dementia. Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are looked after well in respect of health and personal care needs although risks to them aren’t always picked up and assessed. Whilst medication is adequately managed attention should be given to making sure all aspects of it are properly recorded. People are generally treated with dignity and respect. However, failure to help people to eat in person-centred ways doesn’t treat them with respect or meet their needs for an enjoyable mealtime experience. EVIDENCE: We case-tracked care of three people living at the home. This means looking at all records associated with the person and tracking their care by talking with both them and staff caring for them. It’s a way of thoroughly checking all the Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 12 information about a sample of people living at the home. That way we can assess whether the care given overall is adequate and meets peoples needs. We spoke with a key worker for one person whose care we tracked. A key worker is a care staff member responsible for an individual person. The worker makes sure care needs from the person’s plan are met and spends quality one to one time with her/him building a trusting relationship of care. The key worker was able to tell us about the care needs of the person that we later confirmed by looking at her/his care plan. We met the person who was lively and engaging and showed clear signs of positive well-being. Care plans cover physical, personal and healthcare needs as well as leisure, activity and emotional ones. A personal history sheet is attached that could give clues to a person’s behaviour. Diet is also included. A care staff member had picked up that one person had lost weight so a weight chart was put in place. The plan also confirmed what the key worker had said about this. Care plan updates had added more about the person’s food likes and dislikes. The person is ‘on the go’ most of the time and doesn’t like eating in the dining room with others. Finger food that is easy for her/him to eat whilst travelling is given. At each monthly review records show how a person is doing and any changes. Actions and outcomes are recorded. The main plan is also updated when changes are needed. The person had lots of risk assessments that covered medication, the locking of her/his bedroom, bathing, use of stairs and use of the garden. One person that had recently come into the home had a care plan that is being worked on. A detailed community care assessment had been provided and the home’s care plan was being put in place based on needs that had been found during the four-week trial period. The person’s assessment showed that s/he was at risk of falls and we found that s/he had had four in one week since coming to the home. However there was no risk assessment in place. Nor were the falls mentioned on the care plan. Care plans weren’t person centred. Those we saw focussed on fact and care tasks but it wasn’t clear if any of the tasks were from the person’s own choice or perspective. An example of this was in one person’s plan it stated ‘(person) gets very offended when offered help’ instead of finding out the reasons for this and what the person will accept. The plan should therefore be written from their viewpoint e.g. ‘I would like or accept help with…../when’…. Further, care plans weren’t signed by anyone: neither the person concerned, their relatives/representatives or staff. Plans should be signed by staff to confirm that the home is suitable for the person and their needs can be met. Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 13 One person has a particular type of dementia that can be affected by the environment and can lead to paranoia. The person’s needs in respect of this hadn’t been added in to the plan. Care plans are looked at monthly and a paragraph about how the person is doing and any changes were seen together with actions needed around meeting needs. One person’s records seen confirmed what the key worker had told us and showed that the keyworker knows the person well. Care records include a medical visits sheet. This is used when GPs, district nurse, chiropodist or any other health professional visits. This is good practice. From notices sent to us about events that happen to people in the home, it’s clear that staff take quick action in the event of illness, injury or anything negatively affecting people. We observed the giving of medication. The policy is for two people trained in giving medicines to do each round. One person dispenses the medicines from weekly blister packs provided by the pharmacy. The other takes it to the person, stays with them while they take whatever is prescribed then the dispensing staff member signs the medication administration sheet. The manager said this practice had reduced the risk of medication errors. We checked controlled medication (that which has to be separately stored and handled under regulation), returned medication, the medicines fridge and supplies kept in medicines cupboards. All controlled medication had been properly recorded, signed and witnessed by two people. Quantities left were all correct. The records of medication returns to the pharmacy were all properly recorded. However, there was no reason for return of medicines. We advised the manager to make sure this is added. We saw the medicines fridge. This was empty but was dirty and needed cleaning and defrosting. Further, although it had a thermometer there were no records to show the temperature was being checked daily. We noted the issue had also been picked up at a provider visit a year earlier and recommendations made including recording of fridge temperatures. We observed that people were generally treated with dignity and respect during the two days of our visit. Staff showed patience and a strong commitment to interacting with people in positive and caring ways. However, we saw from one person’s plan that s/he has difficulty eating and needs help with being fed. The person has severe communication difficulties but is able to understand some of what is being said to her/him. We witnessed a nice moment when one of the management team spoke to her/him in an endearing way and the person smiled in clear recognition of what was being said. Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 14 We saw an action plan for feeding this person although there was nothing recorded about how this should be done. During our observation of people in the dining room we saw poor care practice by a staff member in feeding the person. (We had previously observed good quality of contact by this staff member to people when doing activities in the lounge with them). The feeding process showed a lack of understanding and respect for the person and the help given was not done in a person-centred way. Further, the staff member was involved with other people on the table whilst feeding the person so didn’t give her/him full attention, then got up and left before s/he had finished the first course. Eventually another member came and took over. We also observed that the staff member gave people directive comments such as ‘go and sit down’ that also doesn’t treat them with respect or dignity. We reported our findings to the manager who took it up with the staff member concerned. Staff that have not yet had an opportunity to do their National Vocational Qualification training must have training in helping with feeding particularly in person-centred ways. Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home gives people opportunities to have a stimulating and varied life where various formal and informal activities happen regularly. However failure to record peoples enjoyment doesn’t show the quality of life they have at the home. Whilst contact with the local community is kept up, peoples spiritual and religious needs may not always be met. Greater attention to meeting those needs would help improve peoples’ quality of life. The restrictions of the environment don’t give people full choice and that choice is dependent on staff awareness and attitudes. Unsatisfactory and institutional management of meals doesn’t treat people as valuable individuals or treat them with dignity and respect. EVIDENCE: Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 16 We did part of our structured observation (this means watching peoples experiences of living in the home and noting their reactions, engagement with tasks, objects or other people) in the main lounge. This is close to the front door and staff said people enjoy being there as they can see outside and watch what goes on. A good number of people were using the lounge during the hour we spent there. People came and went or spent their time either chatting or dozing. Some were having their hair done by the hairdresser that visits the home and clearly liked this. We observed throughout the whole of the visit that people at Woodleaze are lively, animated, engaging and like to join in with activities. For part of the time we watched, they spent time having coffee and chatting. For the later part of the time staff came and did individual activities with them. These included looking at books and discussing what they saw, doing a newspaper crossword and reminiscing, particularly about Bristol as they remembered it. Staff used person-centred ways of engaging with people and showed positive caring attitudes. A bingo session was meant to have happened in the dining room on the first day of our visit. We asked why it didn’t and were told that it was because the room was being cleaned. This implies that domestic routines are treated as more important than activities with people, who then don’t benefit from the cancelled activity. We did note during the observation both in the lounge and in the dining room that people who were more withdrawn got less attention from staff. An example of this was that one person who said very little yet clearly showed s/he liked one to one attention, was left alone much of the time. When s/he tried to get attention staff did very little to engage with her/him. This led her/him to becoming withdrawn again. Where people are less able to join in or are passive or withdrawn, effort should be made to make sure they get the same attention as others so that they’re not left out. The activities records showed a good range of activities. These included: Games and exercises, Manicures and visits from the hairdresser Sing-along and dancing, Gardening in the courtyard, Bingo, Visits from the Pets as Therapy volunteer with her dog, Watching football or films on the big screen in the dining room, Trips out in the mini-bus and: Reminiscence sessions. We also saw care staff taking out people they are key workers to. One person went out to a local coffee shop with her key worker. Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 17 Occasions such as Valentines Day and Easter Day were also celebrated with events such as parties, Easter bonnet parade and buffet teas. Activities are also discussed at residents meetings. We looked at minutes of the most recent meetings. At the April 10th meeting people had come up with lots of ideas for activities and outings. These included: Going out to the pub, A day at the races, More singing and fish and chip suppers, A day out at Bristol Zoo (and more outings in general) and: More exercise. From the AQAA the manager had stated: ‘Staff are continuing to incorporate activities into the daily running of the home. These include planned activities and ad-hoc events which have benefited all that attend’. However we noted there was nothing much for people to do independently of staff. There were no rummage boxes filled with things people might like to look at, touch, wear or talk about. As they can’t get into their rooms freely, the lack of things to do for themselves could lead to boredom and frustration (Please see more about this in Standards 19 – 26). Activities records didn’t include much about whether people enjoyed the various ones listed. The date and list of people attending was all that was written in most records. We did see ‘all enjoyed’ in one record. However this isn’t enough and could be regarded as the staff member’s view of peoples enjoyment rather than how they enjoyed actually taking part. We chatted to one person who told us she would like to go to Church more. We were able to find out from her that she used to go with her relative and that services were sometimes held in the home. We also saw from the residents meeting minutes that another person had said she would like to go to Church more and all at the meeting agreed with this. We talked to the manager who said that they don’t have any minister of religion coming to the home any more to take services. She wasn’t clear about why this was. She said she would also talk to the person’s relative about why she isn’t taken to Church more often. We advised the manager she should contact the diocesan office to find out if another minister can visit the home. The manager told us that at Christmas children from the local nursery and junior school come in to sing carols. A Welsh choir used to come and the manager said she would find out if they will come again. Whilst people have freedom of movement and choice in the communal areas of the home, locking of bedrooms restricts this freedom. We saw that people are able to choose if and when they want to get up in the mornings, when to go to bed, what to wear, what to do and if they want to go out. Choice is offered at Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 18 mealtimes and we saw people being asked what type of squash they wanted, meals were shown to them to choose from and they can sit wherever they like. However, when we moved into the dining room to carry on with our observation we saw that tables were completely bare. People sat chatting, but cutlery, salt and pepper were only brought to them once they were given their meal. No tablecloths or table decorations are used. The overall effect is institutional and doesn’t show people are valued as adults or treated with respect or dignity. The meal choice for the day was put up on a whiteboard. This wasn’t easy to read and may not be accessible for people with dementia to see. Further, a piece of craftwork that showed calendar dates, days, weather and times was also displayed on the wall. Whilst this was colourful and attractive, the date was wrong, as was the weather description. This could confuse people with dementia more. People were offered two choices of main course and were shown a plate of each. People were able to get up and move around or leave the room. A number of people don’t like to eat in the dining room and meals were taken to them. We looked at menus. These showed a hot choice each day and salad as the alternative. While we were observing however we saw that people were offered two hot choices. It wasn’t clear whether this happens every day or was a ‘oneoff’ event. The dessert is only one choice each day. We sampled lunch with people on the second day of our visit. The meal of fish goujons and chips was hot and tasty and people clearly enjoyed it. Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lack of proper attention to recording complaints fails to meet peoples needs for action to be taken over them. Arrangements for protecting people living at the home doesn’t always make sure that they are protected from risk or deprivation of their liberty as far as possible. Regular staff training in safeguarding adults from abuse keeps people protected from risk of harm or abuse happening to them. EVIDENCE: We looked at the home’s AQAA when planning the inspection. This stated that: ‘Woodleaze accesses the Departments procedure for complaints, compliments, suggestions and Freedom of Information. This is discussed and information provided on admission to the home and during reviews. Families and carers are also provided with this information. We have an open door policy and take time to listen to and resolve any concerns raised by the service user or family/carers. Internal complaints book available to record any informal issues that can be dealt with immediately to ensure the complaint does not have to become more formal unless stated by Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 20 the service user or family members’. The manager went on to state: compliments and comments are logged and actioned immediately with clear outcomes. However this was not the case when we looked at the complaints file. The complaints procedure wasn’t displayed at all. We saw an older version of the leaflet dated 2005. There are two files for complaints. In the more formal one no complaints had been recorded since 2003. The file did however, include compliments and letters of thanks for care given. However, the manager also keeps a book of concerns or complaints. This isn’t confidential and could breach peoples privacy and dignity. Four complaints from either people living at the home or their relatives were recorded. These were about meals, cleanliness of rooms, not being able to go out and not having the right clothes. No timescale for investigation, clear actions taken or outcomes for people were recorded. We discussed all with the manager who immediately put in place the new South Gloucestershire booklet (dated April 2009) ‘Your Experience Counts: Tell us what you think’. This includes information about the complaints procedure, how to contact the authority, our new name and address details with email address, a sheet to fill in to make a complaint and information about the principles on which services and service delivery to people in South Gloucestershire are based. The booklet is also available in different languages and formats on request. The manager said she would display this in the foyer of the home and draw visitors’ attention to it. However, we also saw from a team manager’s monitoring visit report, that a complaint about finance had been received by the manager and forwarded to the finance department. The manager was unable to find any record of the complaint although she said she had written a letter about it. She later contacted the finance department for a copy of her letter, that we saw. We discussed the possibility of ‘gate keeping’ complaints with the manager. This means that the manager or management team could decide what is a valid or important concern or complaint to record, rather than dealing with each one as important to the well-being of people living at the home. The manager must keep a file of each concern or complaint that shows investigation, actions taken and outcome for the person complaining and keep this available for inspection at any time. This will show that staff at the home are open to any concern raised and also to showing how those concerns are dealt with. We did see in the AQAA that plans for improvement in the next 12 months are to: ‘continue with encouraging an openess for all service users, staff members and carers relating to daily life and care provision.At Woodleaze we will encourage all service users and families to approach any staff members with Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 21 suggestions, concerns or complaints and ensure they are all acknowledged and listened to and an appropriate response and action provided’. We saw that staff continue to get regular training in safeguarding adults from abuse. Staff told us that they have such training and were confident that they would be able to recognise signs of abuse happening. Training records showed dates of initial training e.g. 2005 for seven staff, and dates booked for them to have refresher training in either May or June ’09. Where training had been done the date was recorded. New staff get an introduction to safeguarding during their induction. While we were in the dining room we did witness a disagreement between two people over possession of a dining chair. This became a physical issue and could have led to abuse. We contacted staff to separate the two. One of the management team came and used positive distracting methods to break up the disagreement. This was done in a cheery and person-centred way and is good practice. We looked at an ‘action plan’ called ‘Tender Loving Care’ for a person during a recent bout of ill health. The action plan was detailed and covered everything that needed to be done for the person’s well-being and comfort. It covered personal care, GP involvement, regular checks by any staff member, checking food taken and skin care among other actions. We noted that the person had use of bedrails in place to stop her/him from falling. We discussed this with the manager who was unaware of consents needed and use of bedrails with reference to the new Deprivation of Liberty Safeguards (DOLS). These state: ‘The Mental Capacity Act DOLS will protect people who cant make decisions about care or treatment, who need to be cared for in a restrictive way. For example some people who have dementia, a mental health problem or severe learning difficulties. The manager was unaware of the responsibilities on staff. A risk assessment was in place but there was no evidence that use of bedrails had been discussed with or consent got from the person’s relatives/representatives. We gave the manager a copy of information relating to DOLS. Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24 & 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical environment doesn’t always meet the specialist needs of people living at the home. Further, a lack of respect for peoples rights, choices and liberty could lead to people with dementia being highly disadvantaged. Failure to give people space in which to lock valuables away doesn’t make sure they are protected from risk. Satisfactory, proper cleaning and hygiene makes sure people are protected from risk of infection as far as possible. EVIDENCE: Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 23 Woodleaze is a purpose built home arranged over two floors. It is accessible to disabled people including visitors. All toilets and bathrooms have accessible equipment including grab rails and special baths. None of the bedrooms have en-suite facilities but each has a washbasin. Lounges and a conservatory are situated on the ground floor and were well used at our visit. The décor is homely and in good order. However, the overall homeliness of the communal area on the ground floor is spoiled by metal shutters in place at the foot of the staircase. The shutters are kept locked and give a real institutional feel to the otherwise welcoming and open space where people like to sit. A plan should be made to remove the shutters and replace them with doors that could be painted out in the same way that other doors are. Some bedrooms had been redecorated and were made homely by use of ornaments and personal photographs. Some rooms looked tired, faded and bare. Very few carpets were seen anywhere, that added to the bareness. However, staff showed us some newly refurbished rooms that had new wardrobes and vanity units in a light coloured wood. These made a lot of difference to the overall décor of rooms. There is no activity room as the manager said there is a lack of space. However a day centre attached to the home has a room that can be used for activities when not in use by people during the day. Attention has been given to making the communal parts of the home suitable for people with dementia. This included painting toilet doors in a bright primary colour with pictures on so that people can easily find them. Corridors had been painted and doors to cupboards, sluices or areas that might be dangerous for people to explore were ‘painted out’ in the same way as the corridors themselves so that the doors look hidden. This is good practice. However, a policy of locking all bedroom doors during the day has been in place for a number of years. It wasn’t clear why this was still happening following discussion and requirements made at the last two inspections. The manager and staff said that the reason for locking doors is that some people may go into other people’s rooms and take items that don’t belong to them. At the last inspection it was a requirement that the home re-assess this policy. This hadn’t been done. It’s our view that the manager and staff may not be confident in being able to deal with people having free access to what is after all their home. Training should therefore be provided to help staff gain confidence in doing person-centred activities with people that may stop them from going into other rooms. Staff confirmed to us that bedrooms remain locked. Some people have keys to their rooms and can use them independently. Others have to rely on staff judging when they may wish to go to their rooms. As some people have more advanced dementia and/or communication needs it wasn’t clear how staff would know when people wanted to go to their rooms e.g. to rest. Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 24 We saw a risk assessment about locking of doors. This stated ‘Staff are to lock (person’s) door after use and not leave it unattended’. The assessment went on to state that the person wouldn’t be safe in her/his room for long during the day due to her/his dementia. We met this person and judged from her behaviour that s/he may not be safe anywhere in the home rather than just in her/his room where there are familiar things from her/his past to comfort her/him. Risk assessments should be done on the basis of the risk to each person whilst in their room rather than keeping them out of it. People are further disadvantaged in the home by many of the bedroom doors having nothing on them to show that a) they are bedrooms and b) whose bedroom they are. Some doors were completely blank. Other doors did have ‘cartoon’ pictures but these weren’t particularly accessible to people with dementia and it wasn’t clear if the pictures on them were meaningful to the person whose room it was. Further, within bedrooms bolts were seen high up on some wardrobes. It was clear that they were there to stop people from opening them. Staff told us that this was to stop people putting on lots of layers of their clothing. On the other hand bedrooms didn’t have any lockable space where they could keep items of value or sentiment safely. Whilst bedrooms were pleasantly decorated and homely, the overall effect is of institutional practice that’s accepted by staff unquestioningly and is more for their benefit. One staff member told us that rooms are ‘ransacked’ by people and one room in particular seems to be targeted for this. The use of language implies a wilful trespassing of rooms when in fact it could simply be that people are unaware of whose room it is, get bored and frustrated and lack sufficient things to do to occupy them at all times. We discussed all the above with the manager. We required that a plan be made to start keeping bedroom doors unlocked permanently unless people are able to lock them independently and keep their keys. The plan should include: - Discussing the issue and the new DOL safeguards with all staff. This should lead to staff changing their way of thinking about the issue and becoming more creative about use of space, - Putting in place ‘rummage boxes’ in lounges and other areas. These are full of things that people with dementia may wish to explore, touch, look at etc. They can also be used for reminiscence activity, - Removing all bolts from wardrobe doors and giving people a space where they can lock away any items of value to them and: - Making sure all bedroom doors have names or numbers and also pictures or photographs that have meaning for each person. This will help them be able to find and recognise their own rooms. Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 25 Central to all the above is training for staff that will help reduce the ‘locked door’ culture. The home was very clean and smelled fresh and pleasant. Staff were seen working around the home making beds, cleaning rooms and washing floors. Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29 & 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from sufficient numbers of care staff to meet their needs. Further, progress with training in National Vocational Qualification in Care makes sure people are looked after properly. Whilst adequate recruitment processes make sure people living at the home are protected from risk, failure to keep staff photographs may not make sure people are protected from risk. Whilst people get good basic care, staff training in person-centred care, activities and recording would positively benefit people living in the home. EVIDENCE: Over the two days of this visit care and domestic staff were seen in good numbers. The manager said that there are six care staff on each morning and five on each afternoon and evening. We looked at rotas. These showed a struggle to cover each shift with the right number of people. Care staff numbers ranged from five some mornings and six on others and five on some afternoons and four on others. However we noted that there were enough staff on duty while we were there to enable staff to meet needs and do some sort of activity with people. The AQAA stated that there are three staff on at night to Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 27 meet peoples needs. The manager had also stated in the AQAA plans for improvement in the next twelve months : ‘To maintain consistency of care and continue to keep open lines of communication with all staff teams through open door policy and regular meetings’. The AQAA also recorded that what could be done better is to work towards achieving a a fully NVQ qualified staff team. We found that of the current staff numbers eight day staff have the qualification and seven are waiting to do it. Two night staff have it and one is doing it. Overall records show that good progress is being made with NVQ and the good practice recommendation made at the last visit about this had been adopted. We looked at staff recruitment records. These met the requirements of the National Minimum Standards Schedule relating to what needs to be kept in the home. However noticed that in some files the only photograph of a staff member was a poor photocopy e.g. from a passport. Some had no photo at all. Clear photos of each staff member must be kept in the home so that people are cared for by properly recruited and validated staff. We looked at copies of staff meeting minutes for both day and night staff. The meetings covered care of new people coming into the home and drew staff attention to the assessment period. Staff vacancies and hours and shifts were also discussed. Equalities and Diversity issues had been discussed at a full staff meeting held in November 2008 when an outside NVQ assessor had come to give a talk to staff on Equalities and Diversity in community care and housing. Booklets were given out and issues arising from it were to be discussed in supervision. This is good practice. We saw that staff had all done safeguarding adults from abuse training or were booked to do it in 2009. Staff said they had training in dementia care but we weren’t able to see what the content of this was. Nine staff were booked to do training in the Mental Capacity Act (MCA) and DOLS on 9 May ’09. All care staff except one had done first aid training and all were booked to do moving and handling and health and safety training this year. The training file was very organised with names and dates. Some but not all staff had done ‘communication in dementia’ training and a course in dealing with anger in dementia. Staff haven’t had training in person-centred care or effective care recording. Training wasn’t discussed in any of the staff meetings that we saw notes of. From all the above standards inspected it was clear to us that whilst staff work well with people in their care and try hard to meet their specialist needs, they need more training in person-centred care. Training in person-centred care recording and activities for people with dementia will help staff understand and gain confidence. This will lead to a more open environment for people. Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 28 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 35, 36,37 & 38 People using the 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 trained and experienced, failure to take note of or meet requirements and good practice recommendations doesn’t show that the home is being run in the best interests of people living there. Quality assurance checking doesn’t show that results are based on actual experiences of people with dementia. Whilst peoples cash is kept satisfactorily, more regular checks and balances would make sure they are protected from risk. More regular opportunities for staff supervision would help them think about their work and improve peoples quality of life at the home. Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 29 Whilst care recording is objective and factual attention is needed to make sure records reflect the quality of peoples lives. Satisfactory management of health and safety keeps people safe and protected from risk of harm. EVIDENCE: The manager Mrs Sue Simmons-Tasker was available on both days of the inspection. She and her management team were welcoming and open to the inspection process and gave us everything we needed to assess the quality of care given to people. The manager is trained an experienced having been a manager for a number of years. She has an open door policy and people living at the home were able to come in and out of the office if they wished. Where we found that action needed to be taken during our visit she did this quickly and took on board all our comments. However we were concerned that the requirement and three out of four good practice recommendations made at the last visit a year before, hadn’t been acted on. The manager couldn’t give us full explanations as to why this was and was unclear about issues such as Deprivation of Liberty and restraint. Further, as recorded above her management of complaints needed clear improvement. One of the good practice recommendations not adopted was that the results of quality assurance surveys should be published and made available to current and potential residents, relatives/representatives and other interested parties. We saw that a ‘provisional’ certificate of quality was displayed but the actual results of surveys weren’t. Further, the results weren’t easy to follow so it was difficult to see how the overall result was formed. We also looked at the staff survey results. Although most of these were positive, it wasn’t clear how negative comments about atmosphere, morale, the progress of the home and failure of the management team to listen to staff views, had been followed up. A representative of the registered provider visits the home to do an internal quality check each month. We looked at two of these. The latest one had been done at the end of March ’09. From this staff comments had been recorded and showed improvement in atmosphere and morale. We looked at records of how peoples satisfaction with their lives in the home were measured. The questionnaire available is filled in by staff and from answers seen it was clear that staff make judgements about quality from their own views of how people are cared for. Further, forms that are for relatives to fill in had been done by care staff. This doesn’t make it an objective measurement of quality. We found an example of this whilst case-tracking: a person’s care was scored at 9 – good for help s/he needed with eating. Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 30 However this hadn’t been our experience whilst doing our structured observation. We did a check of peoples cash held and managed at the home. All balances were correct and were written up properly. However we noted that the Administrator is responsible for checking cash but there is no check done by the manager. The provider had done an internal audit in April ‘09 and this issue had been picked up together with the need for two signatures when transactions are entered on to cash sheets. We found the same at this visit. The auditor had recorded that the matters had been raised before. We checked a random sample of staff supervision records to see if supervision was happening regularly. Of the five records looked at, two have the capacity to meet the recommended target of six times a year. One person had five sessions in the year from January ’08 to January ’09. One staff had long gaps between sessions e.g. August ’07 to February ’09. However although sessions were recorded some of these were brief – e.g. one sentence only. This doesn’t show that staff have had opportunities to discuss their work or raise concerns that will be dealt with. From looking at daily records we found a lack of person-centred recording. Staff had done record-keeping training. However, some records were very brief i.e. only ‘slept well’ recorded and almost all were factual and not about the person’s quality of life. Use of negative terms were also seen e.g. the person was ‘aggressive’ rather than her/his behaviour being challenging. More work is needed to move from a factual/medical way of writing about people to a more person-centred one. Health and safety records were properly kept and showed that regular checks of fire safety are done. Fire drills are done very often and are written up. Some were written up in good detail whilst others weren’t written up at all. The last fire drill was done at the beginning of April ’09 with fourteen staff attending. All staff are booked for fire safety training in either February or October ’09. Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 31 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 X 3 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X 1 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 2 X 3 2 2 3 Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP16 Regulation 22 (3) Requirement Any concern or complaint must be properly recorded to show investigation, actions taken and outcomes for people using the service. Complaints information must be displayed so that people are aware of their right to complain and how to do it. This will make sure that people are well cared for by a team that is open to any concerns or complaints. Where any form of restraint is used this must be clearly documented to show that the need for it has been considered and done with regard to Deprivation of Liberty Safeguards and is in the best interests of the person concerned. This will make sure peoples rights are protected and they are kept safe from harm. A plan for unlocking of bedrooms and making them accessible to people living at the home, must be done. DS0000034159.V375040.R01.S.doc Timescale for action 30/06/09 2. OP18 13 (7) 30/06/09 3. OP24 13 (7) 31/07/09 Woodleaze EMI Unit Version 5.2 Page 33 inspection in April 2008) Further restrictions within bedrooms must be removed and people given lockable spaces in which to keep any valuable items. This will make sure people aren’t deprived of their liberty and the home is run in their best interests. (Timescale not met from the last A recent, clear photograph must be kept in each staff member’s file. This will make sure people with dementia are kept safe and protected. 30/06/09 4. OP29 Sch 2 (1) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP4 Good Practice Recommendations Each bedroom door should show the name of the person whose room it is and made accessible to them so that they can find it easily. This will make sure people are able to find their own rooms and be more independent in doing so. Care plans should be written in more person-centred ways that put peoples interests and needs at the heart of them. This will make sure peoples quality of life is improved by staff that better understand their individual needs and wishes. More effort should be made to make sure people with dementia have more person-centred activities and things to occupy them. This will make sure they get a good quality of social life in the home. The manager should take action to make sure people are able to have their religious needs met both in and outside the home. DS0000034159.V375040.R01.S.doc Version 5.2 Page 34 2. OP7 3. OP12 4. OP13 Woodleaze EMI Unit This will make sure people will feel supported by being able to worship as they wish. 5. OP30 Care staff should have training in how to help people to eat from a person-centred perspective. This will make sure people have enjoyable meal time experiences and are treated with dignity and respect. Care staff should have training in person-centred activities for people with dementia and writing care records in person-centred ways. This will make sure people are cared for by staff that understand their needs and are able to record their enjoyment of life in the home. More objective ways of monitoring quality of life for people in the home should be found so that quality is measured in more person-centred ways. This will make sure the home is being run in the best interests of people living there. Supervisions should be held for each staff member at the frequency as set out in the registered provider’s policy. Further, supervision records should be recorded in enough detail to show that staff have opportunities to raise issues and think about their work. This will make sure that people are cared for by a well supported and supervised staff team. Care and activities records should be written in personcentred ways that show how people live their whole lives at the home rather than just how basic care needs are met. This will give a clearer picture of how staff care for people with dementia and are able to meet all their needs. 6. OP33 7. OP36 8. OP37 Woodleaze EMI Unit DS0000034159.V375040.R01.S.doc Version 5.2 Page 35 Care Quality Commission South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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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