CARE HOME ADULTS 18-65
Woodley House Care Home Woodley Street Ruddington Nottingham NG11 6EP Lead Inspector
Joanna Carrington Key Unannounced Inspection 30th October 2006 10:00 Woodley House Care Home DS0000008768.V314852.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 Woodley House Care Home DS0000008768.V314852.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. Woodley House Care Home DS0000008768.V314852.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Woodley House Care Home Address Woodley Street Ruddington Nottingham NG11 6EP 0115 9848069 0115 9456020 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) Mr Brian McKean Miss Rachael Louise Stevenson Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Woodley House Care Home DS0000008768.V314852.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16th January 2006 Brief Description of the Service: Woodley House is an adapted period property that sits in its own grounds close to the centre of the village of Ruddington, which has a range of shops, churches and public houses. The accommodation is registered to accept up to thirteen service users with a learning disability and offers personal care and support. The accommodation comprises both single and double rooms and spans over three floors without a vertical lift so any potential service users would have to be fully mobile. There are a number of communal facilities and these are used flexibly. There are secluded gardens and car parking to the front and side of the building. The fees for living at the home at the time of the inspection range from £307 to £1024. These are fees agreed with different local authorities and are dependent on the needs of individual service users. Woodley House Care Home DS0000008768.V314852.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over eight hours on 30th October 2006. This was the home’s key inspection for this financial / inspection year. The main method of inspection was called ‘case tracking’ which meant selecting three service users and tracking the care and support they receive through checking their records, observation of care practice and discussion with them, where possible and with staff. Due to the limited communication and understanding of the majority of people living at the home the inspector only spoke with two service users. Staff records were looked at and a partial tour of the premises also took place in order to assess environmental standards. The manager was not available on the day of the inspection but the deputy manager was available throughout for discussion and feedback. Altogether four staff members were spoken with. What the service does well: What has improved since the last inspection?
The lounge and dining room and some bedrooms have been redecorated since the last inspection. Daily records are being used more effectively, showing what individuals’ have been up to, monitoring health and support given. As recommended in the last report, new staff are accessing Learning Disability Award Framework (LDAF) induction training, which enables staff to have a greater understanding of issues and needs of people with a learning disability. Woodley House Care Home DS0000008768.V314852.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Woodley House Care Home DS0000008768.V314852.R01.S.doc Version 5.2 Page 7 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 Woodley House Care Home DS0000008768.V314852.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5 Quality for this outcome area is good. The admissions procedure is good in ensuring the home is suitable in meeting prospective service users needs. This judgement has been made using available evidence including a visit to the service. EVIDENCE: A copy of the Statement of Purpose and Service User Guide were seen and contain important information about the home, so that prospective service users and other relevant people can find out about the service and what it provides. There are Terms and Conditions, which are signed by service users or their representatives and include what services are and are not included in the fees. All of the service users that live at the home have been there for a very long time therefore there was no assessment information prior to their admissions available. The admissions policy and procedure states clearly that enough information must be collected about prospective service users before offering them a place. There was evidence seen for one service user case tracked that they are receiving support from the Community Learning Disability Team and part of this has included a review of the placement and whether it remains suitable in meeting their needs. Evidence indicates that the appropriate health and social care professionals are involved in service users care, to ensure their needs continue to be met in the home.
Woodley House Care Home DS0000008768.V314852.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality for this outcome area is adequate. There are adequate arrangements for planning how needs and choices are met. Care plans are not being kept under regular review, which does not ensure changes in needs are identified and there is lack of evidence of service user involvement. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The care plans seen cover all aspects of health, personal and social care needs and there have been some improvements to the use of daily records, providing information on individuals’ experiences and support received. Staff spoken with were asked how they support service users with different elements of their care, for example, meeting personal care needs and managing behaviour that challenges. What was said did reflect what is recorded in care plans. Service users spoken with know who their key workers are but do not seem familiar with their care plans. Some staff spoken with did, however talk about involving service users in care planning but this is not documented. This also applies when relatives / representatives are consulted. Woodley House Care Home DS0000008768.V314852.R01.S.doc Version 5.2 Page 10 Evidence on care plans indicates that they have not been reviewed for over six months, which means some information will be out of date. This was the case for one service user case tracked. Recommendations from a dietician had been recorded in daily notes but the care plan has not been amended. One care plan seen had been written in a way that suggested the service user is made to get up a 5am. “All staff should follow routine”…”[the service user] is to get up at 5am” From discussion with staff and because this care plan was not read in isolation it is known that the care plan does not actually mean this. Nevertheless, when new staff reads this there is potential they may take this literally. A recommendation to review language used in records is made in this report. Service users spoken with confirmed they are able to make choices in their day-to-day lives. Service users can choose when they wish to spend time alone or with others and what activities they would like to participate in. Staff gave good examples of when and how service users are enabled to make decisions, for example, with meals and activities. Speech and Language therapists have been involved in setting up ‘person-centred’ plans identifying how individuals communicate and express different feelings. Risk assessments are used to identify dangers and how these can be minimised so that service users can participate in their chosen activities safely, such as visiting country parks, going out into the community and accessing the kitchen. There are also necessary risk assessments for moving and handling, eating and drinking and for service users with mental health difficulties. Woodley House Care Home DS0000008768.V314852.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality for this outcome area is good. The rights and responsibilities of service users are respected and upheld, including the right to maintain and form relationships and to be a part of the local community. Service users are offered a healthy diet and enjoy their mealtimes. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Staff were observed during the inspection interacting with service users in a respectful manner and staff spoken with were able to identify best practice that respects the dignity and privacy of service users and promotes their independence and skills. For example, a staff member was observed spending meaningful time with a service user baking a cake. Service users access various formal day care services, whilst care staff of Woodley House supports others. Records viewed included weekly timetables, which showed a variety of activities, that suit individuals’ preferences and interests, both indoors and in the community. Service users spoken with said they enjoy going out to the pub and shopping with their key worker. Daily
Woodley House Care Home DS0000008768.V314852.R01.S.doc Version 5.2 Page 12 records indicate that service users have regular contact with relatives, either they visit the home or service users go out with them. Staff and service users commented on the success of the Halloween party last weekend, which friends and relatives came along to. Menu records show that service users are offered varied and nutritiously balanced meals and there is always an alternative made available including healthier options. On the day of the inspection service users were observed enjoying their evening meal of beef stew, potatoes and vegetables. Woodley House Care Home DS0000008768.V314852.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality for this outcome area is adequate. Residents are looked after well in respect of their health and personal care needs. Medicine management fails to protect the safety of service users. This judgement has been made using available evidence including a visit to the service. EVIDENCE: There are personal hygiene plans and daily routines, which provide specific information on how individual service users are supported with washing and dressing and there are information sheets titled “things important to [the service user]” which includes individuals’ preferences. There was evidence on all three care files seen that relevant healthcare professionals such as community nurses, clinical psychologists and psychiatrists are involved in the support of service users, when appropriate. Service users spoken with confirmed that when they are feeling ill staff arrange an appointment and assist them to see a doctor. There are records, which indicate that service users have regular health care checks and attend dentist and opticians etc. It is of concern that this is the third consecutive inspection where issues have been identified with medicine management. Woodley House Care Home DS0000008768.V314852.R01.S.doc Version 5.2 Page 14 The deputy manager explained that paracetamol is given to service users as a ‘homely remedy,’ which means it is not prescribed by the doctor. The home does not have its own policy for when it is appropriate to administer homely remedies. For boxed medication that was audited, what has been signed as given on the Medication Administration Records (MAR) does not tally with the quantities of medication remaining in their boxes. Auditing whether or not boxed medicines are being administered correctly is not always achievable because not all quantities of drugs are accounted for in the home. This includes Schedule 3 controlled drugs, which although are not subject to tighter storage requirements, are still powerful drugs. For one type of medicine that comes in large boxes staff are cutting around the blisters and putting the blistered tablets in a compliance aid (cassette). This is known as secondary dispensing which The Royal Pharmaceutical Society discourage. There are two different strengths of these tablets, both of which are being put in the one cassette. Once the blistered tablets are cut round and put in the cassette there is no way of determining which strength each tablet is. This is unsafe practice because the service user is at risk from being given the wrong dose. The deputy manager agreed to stop this practice immediately. Woodley House Care Home DS0000008768.V314852.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s):
22 and 23 Quality in this outcome area is good. The Complaints Procedure ensures the concerns of service users are listened to and acted on. The local Safeguarding Adults procedures are not always being followed, which does not help ensure service users are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure, which is included in the Service User Guide and a simpler version is displayed to encourage service users to pass on any concerns they may have. A service user spoken with confirmed that if he was unhappy about something he would tell the manager or a staff member. Complaints records were seen and showed that there have been no complaints made since the last inspection. All service users’ case tracked has a care plan for assistance with their finances. Both service users spoken with confirmed that they spend money and can have access to it when they want to. Staff spoken with were given a couple of scenarios and asked how they would respond in these situations. All staff spoken with demonstrated an understanding of their responsibilities to alert the manager of any disclosure or suspicion of abuse, in line with Safeguarding Adults and whistle blowing policies and procedures. An incident in which a service user pushed another service user has been recorded, but not reported to Social Services and the Adult Protection Unit, in line with the local Safeguarding Adults procedures. It is not the sole decision of the manager as to what action should be taken or what strategies are put in place to protect all service users in the home. Social Services must be consulted on this.
Woodley House Care Home DS0000008768.V314852.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 and 30 Quality in this outcome area is adequate. The environment on the whole is warm and comfortable for service users but there is a lack of documentation explaining when individuals’ bedrooms are sparse. Cleanliness is in need of some improvement. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been some changes to the environment since the last inspection. The lounge and dining rooms has been re-decorated. Communal areas are homely and furnishings are domestic in style. The flooring is marked badly in some areas. The deputy manager reported that quotes for new flooring are currently being obtained. The carpets in the quiet room and flooring in the dining room were observed to be in need of cleaning. The pre-inspection questionnaire states that furniture in bedrooms has been replaced. Two of the three bedrooms seen were very sparse, with limited furniture and belongings locked away. The deputy manager explained this is to do with the needs of those service users but there is no documentation of this in a relevant care plan and risk assessment. This is made a best practice recommendation in this report. Woodley House Care Home DS0000008768.V314852.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. Service users benefit from a well-supported and well-trained staff team. Recruitment practice does not fully protect service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff spoken with reported that the management team are very supportive and they are happy with the level of training they receive. New staff talked about doing the Learning Disability Award Framework (LDAF) Foundation training and the message book evidenced that four more staff have been booked to do their National Vocational Qualification Level 2. More that fifty percent of the staff team are qualified to at least this standard or are working towards it. Training records show that staff have regular updates in their mandatory training such as fire awareness, food hygiene and other courses are accessed to enable staff to meet the needs of service users for example, epilepsy awareness and managing violence and aggression. Out of the four staff files randomly selected there was no evidence of a Criminal Record Bureau (CRB) check and on the other two files the CRB check was issued after they commenced employment. This is only allowed if a POVA First check has been carried out, and there is evidence of this on their file. One staff file only contained one written reference when there should be two. Woodley House Care Home DS0000008768.V314852.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. The lack of quality monitoring that seeks the views of service users does not ensure the home is well run and in their best interests. Improvements in some practice will ensure the health and safety of service users is promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered provider conducts monthly monitoring visits to the home, and supplies copies of reports to the Commission. The pre-inspection questionnaire states that there are quality assurance questionnaires in place however no evidence was supplied during the inspection to indicate that questionnaires have been used as a method to seek the views of service users and when appropriate, their relatives / representatives. A copy of the Nottinghamshire tool ‘The Quality Tree’, which the home is signed up to was seen. It is recommended that this tool be implemented, in order to identify ways of improving and developing the service.
Woodley House Care Home DS0000008768.V314852.R01.S.doc Version 5.2 Page 19 The pre-inspection questionnaire shows that gas and electrical systems are regularly serviced and there are adequate measures in place for the control of Legionella. The daily temperature records for fridge and freezers were looked at during the inspection. In the last two weeks there have been couple of gaps of between two and three days when temperatures have not been monitored. In one service user’s bedroom the mattress was observed to be shorter that the bed frame, which means there is a significant gap at the foot of the bed. This has not been risk assessed, to ensure there is no serious risk of entrapment. This is required. Woodley House Care Home DS0000008768.V314852.R01.S.doc Version 5.2 Page 20 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 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 2 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 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 3 X 1 X X 2 X Woodley House Care Home DS0000008768.V314852.R01.S.doc Version 5.2 Page 21 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. 2. Standard YA6 YA20 Regulation 15 13(2) Requirement Timescale for action 31/12/06 Ensure care plans are kept under review. 30/11/06 Ensure there are adequate arrangements in place for the recording, handling, safekeeping and safe administration of medicines received into the home. This refers to: 1. Ensuring all medicines are administered as prescribed. (Quantities should tally with what has been signed as given) 2. Carrying over any quantities of medicines onto current Medication Administration Records, to ensure all quantities are accounted for (or return to pharmacy) 3. Not secondary dispensing medication. 4. Devising a homely remedies policy. This is the third consecutive requirement to ensure there are adequate arrangements in place for medicine management. Woodley House Care Home DS0000008768.V314852.R01.S.doc Version 5.2 Page 22 3. YA23 13, 37 4. YA34 19 5. YA39 24 6. YA42 13 Ensure all incidents where a service user assaults another service user are referred to Social Services in accordance with Local Safeguarding Adults procedures, and are notified to the Adult Protection Unit and the Commission. Ensure two written references and a Criminal Record Bureau check is returned before a staff member commences employment. Ensure there is a system in place that is implemented at regular intervals for reviewing and improving the quality of care, and includes consultation with service users are representatives. Carry out environmental risk assessments for the beds that have gaps at the end of them. 30/11/06 30/11/06 28/02/07 30/11/06 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 YA6 YA6 YA25 YA30 YA39 Good Practice Recommendations Document all consultation with service users and their relatives / representatives over the development and review of care plans. Ensure language used in care plans is clear and demonstrates best practice, rather than imply inappropriate practice. Document in a relevant care plan and risk assessment the need for keeping individual service users’ bedrooms sparse with limited furniture and personal items. Ensure all areas of the home are kept clean. Use the Nottinghamshire tool ‘The Quality Tree’ as a quality assurance system that seeks the views of service users and their relatives / representatives.
DS0000008768.V314852.R01.S.doc Version 5.2 Page 23 Woodley House Care Home 6. YA42 Ensure the recording and monitoring of fridge / freezer temperatures is kept up to date, in line with Health and Safety requirements. Woodley House Care Home DS0000008768.V314852.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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