Inspection on 25/09/06 for Woodmead

This inspection was carried out on 25th September 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Woodmead 06/01/09

Woodmead 27/06/08

Woodmead 01/02/06

Woodmead 13/06/05

Woodmead 02/12/04

Woodmead 29/09/04

Woodmead 30/01/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Woodmead 35 Portway Warminster Wiltshire BA12 8QQ Lead Inspector Roy Gregory Key Unannounced Inspection 25th September 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodmead Address 35 Portway Warminster Wiltshire BA12 8QQ 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) 01985 213477 The Orders Of St John Care Trust Mr Colin Newman Care Home 48 Category(ies) of Dementia - over 65 years of age (10), Learning registration, with number disability over 65 years of age (1), Old age, not of places falling within any other category (48), Physical disability over 65 years of age (4) Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. No more than forty eight service users with old age at any one time No more than ten service users with Dementia, over 65 years of age at any one time No more than four service users with a Physical Disability, over 65 years of age at any one time. No more than one service user with a Learning Disability , over 65 years of age at any one time. One named service user under the age of 65 years. Date of last inspection 1st February 2006 Brief Description of the Service: Woodmead was originally owned and managed by the Local Authority; it was the first purpose-built care home for elderly persons in Wiltshire, having opened in 1962, since when there have been a number of refurbishments to the building. All accommodation is in single rooms of varying sizes, none with en-suite, on the ground and first floor. The floors are linked by passenger lift. On the ground floor are a choice of sitting rooms and a dining room, which overlook an attractive enclosed garden with patio. The Orders of St John Care Trust assumed responsibility for the service in 1999. Two respite care beds are available and there is an integral day care service. The home is situated on a main road close to the centre of the market town of Warminster, with easy access to shops, parks and the community hospital. There is ample street parking and bus stops are available close to the entrance. The town also has a rail station. Weekly fee levels range between £395 (£370 for WCC block contract) and £460, according to assessed dependency. Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced visit for this inspection was made on Monday 25th September 2006 from 10:30 a.m., with a return visit on Tuesday 26th September. The registered manager, Mr Newman, was available during this period, whilst the inspector also spoke with two care leaders, the activities co-ordinator, the administrator, and members of the care, kitchen and support staff teams. During the inspection it was possible to talk privately with a visiting district nurse and with people visiting their relatives. A number of residents were spoken with, privately and in the dining room, the inspector joining different lunch sittings on consecutive days. The entire home was toured, with some individual rooms being seen. Prior to the inspection, requested information had been received from Mr Newman. Additionally, five survey forms have been received from residents, (one completed by a relative on the resident’s behalf). The inspector has spoken by telephone with a resident’s close relative since the inspection visit. During the inspection, documentation looked at included records in respect of care planning and delivery, complaints, training and recruitment, risk assessments and fire precautions records. Medication storage and records were examined. A number of instances of (non personal) care giving were observed. The judgements contained in this report have been made from evidence gathered during the inspection, which included the visit to the service and taking into account the views and experiences of people using the service. What the service does well: Questionnaires returned by residents did not contain added comments, but tick-boxes showed an overall high level of satisfaction, with no negative responses indicated. In conversations, residents spoke widely of staff respect for their privacy and making their own choices, the variety of things to do, very good catering and a clean, attractive environment. The inspector saw evidence of these features of everyday life in the home. Recently admitted residents recalled meaningful assessment visits. A relative wrote: “the overall care and attention is very good. There is no false front shown to visitors”. A visiting district nurse was very complimentary of her working relationship with the home. Care records showed prompt referrals of health concerns to GPs, specialist nurses and other professionals, along with co-operation with treatment plans. Care plans covered whole person needs and were clearly used as working documents, with residents fully involved in reviews. One resident described all care as being “on my terms – staff accept being guided to do as much as I need”. Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 6 A simple monthly newsletter, produced and distributed personally by the activities co-ordinator, kept residents in touch with activities that had taken place and that were planned. Many residents spoken to said they were regularly reminded of activities. Some efforts had been made to make activities available to those requiring a high level of support, for example there had been a trip to Longleat for seven residents, supported by seven members of staff. The manager had undertaken an extensive survey among residents to ascertain their views on a variety of aspects of the home’s services, resulting in priorities for the home’s further development. Meals shared by the inspector were of the high standard found on previous visits. A person staying for a respite period considered the meals far better than those they received as “meals on wheels” at home. A delivery of a meal to a bedroom was observed. The quality of service was equal to that in the dining room, the meal being attractive and hot. Mr Newman visits the dining room and sitting rooms every day that he is on duty and is highly regarded by residents and staff alike. He is skilled at delegation whilst being aware of the details that contribute to quality of life in the home. A relative said: “attention is always paid to observations and requests… management is very active and attentive and always includes me in consultations”. What has improved since the last inspection? What they could do better: No requirements have been set at this inspection. There are recommendations for improving practice. The good level of every day communication between home management and residents could be enhanced by an additional notice board upstairs, and by ensuring “low level” complaints dealt with quickly are still recorded within the complaints log. This would enable the manager to have Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 7 an overview of all matters of dissatisfaction, and thus to recognise any pattern or learning points that could help inform plans for improvement. Another communication issue, which might assist some residents to live as independently as possible, is to consider whether some signs would be helpful. For example, in long corridors where all doors look the same, toilet doors could be better identified, or the direction to the lift or garden may not be obvious. In toilets, there is good provision of soap and paper towel dispensers, but these will be unfamiliar items to some residents and might benefit from friendly labelling. Now that activities provision, co-ordinated by a dedicated worker, is embedded in the home, it is appropriate to make time to evaluate what this means in practice for individuals, especially those who are less interested in or able to join group activities. As mentioned in the previous inspection report, the activities co-ordinator post allocation of 20 hours per week is slight for the task in hand, so ways of supporting the role need to be considered. 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. Woodmead DS0000028300.V311456.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 Woodmead DS0000028300.V311456.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 & 5 (key standard 6 does not apply to Woodmead) Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Admissions to the home are preceded by full assessments of need and provision of good information to prospective residents. EVIDENCE: Records showed that when a prospective resident is referred to Woodmead, Mr Newman or one of the care leaders visits them and collects detailed information about their current needs, wishes and abilities. The Trust requires use of a range of assessment tools, including commencement of a “long-term needs assessment” that is used to commence the care planning process, if the person is admitted. The inspector recommends that forms should be endorsed with details of where assessment visits took place, and from whom information has been gathered, since sometimes it is other professionals, or family members, who have given substantial information or opinions. One assessment made it plain that the prospective resident was very involved in the process, with phrases like “X thinks that…”. Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 10 Mr Newman said he was now being particularly attentive to any indications of behavioural issues that would have to worked with, out of concern for the wellbeing of the existing resident group. For example, he had recently assessed a referred person as unsuitable to be admitted, because the records of their behaviour pattern in their existing placement were at odds with how their needs had been presented through other channels. In addition to the home’s assessments, examples were seen of needs assessments by mental health and social workers. During the inspection visit, a mental health worker was being shown around the home, to enable him better to understand the resources offered. At the time of inspection, two residents currently in hospital were subject of ongoing liaison, with a view to assessment for re-admission to the home at a later stage if at all possible. A person coming to the end of a period of respite care at the home described having been already familiar with the home by virtue of day care attendance. They had found the transition to temporary residence quite easy. This was a common pattern. Another resident had commenced their stay on a respite basis, but was now on the point of deciding to stay permanently, with support from their care manager and home staff. A third who was interviewed said they had accepted a place at Woodmead because they were desperate to bring a long hospital stay to an end; a preferred placement in their home town was not available. They considered information provided about the home had been accurate; recalled an assessment visit by Mr Newman; and described staff attention to helping them settle into the home. Mr Newman confirmed the person’s longer-term arrangements continued to be discussed with them and their family, as a move to the Trust’s home in the preferred town remained possible. Meanwhile, family members considered the home to be meeting needs to a high standard, in line with the initial assessment. A visitor, contacted by telephone, confirmed that although their relative had been unable to visit Woodmead prior to admission, members of their family had done so and had received help and information through the admission process. All residents received documented reviews of their placements after the first month of residence. Woodmead DS0000028300.V311456.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 - 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Individual care plans receive regular review and direct care across a spectrum of need. There is prompt awareness of and response to health needs, including excellent liaison with health professionals and emergency services. Systems and practice in handling medications are good. The approach to the care task is based on respect for diversity and privacy. EVIDENCE: Care plans were in place for all residents and showed evidence of regular review. Where a respite resident had had a previous stay in the home, their care plan had been updated on the later admission. Care staff were seen to use the care plans as working documents, seeking information from them and adding objective entries as necessary. A resident was to be asked by their key worker about possible changes to their care plan, following their attendance at hospital due to a fall. Prominent in their care plan was the hospital guidance on monitoring after a head injury, whilst a carer had already noted a loss of confidence as a factor to take into account in providing care. Care plans included emotional and social needs as well as health and personal care Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 12 matters. Where there had been a decision that an individual’s awareness of an aspect of care planning might be disconcerting for them, this was documented. Responses from residents’ relatives showed they felt included in decisionmaking and sharing of information. Care records showed plentiful liaison with health professionals, including specialist nurses and physiotherapists. The inspector was able to talk to a district nurse, who visited the home twice every week. She said she had never had any concerns about the standards of care in the home, and had always seen the staff as very committed to meeting residents’ needs. She had given staff advice about assessment of pressure area risk, and was accustomed to seeing them take pro-active steps to avoid the incidence of pressure damage, which was accordingly rare. Home staff were quick to refer any emergent problems to district nursing staff, who were provided with their own storage facility. Their working notes were kept in the care office, where home staff could make ready reference to them if necessary. Notifications of incidents in the home show that emergency services are quickly obtained if such a need is apparent, and carers’ records of incidents were objective. Examples were seen of use of a “transfer to hospital” form, which provided for an effective exchange of information. It was clear that the senior team maintain ongoing awareness of the wellbeing of residents in hospital, including by way of visits. Some excellent examples of care interactions between staff and residents were seen during the inspection visit. Residents identified no concerns about lack of respect and confirmed all personal care and support is provided in the bedroom or bathroom. One described all care as being “on my terms – staff accept being guided to do as much as I need”. Responses to the call bell were said to be prompt. The inspector saw that in the dining room, carers were alert to the presenting wellbeing and appetite of residents, engaging with residents about concerns then or afterwards as appropriate, and passing on information to the care leaders for further action. Night staff records also showed examples of responses to individual residents’ needs. Where residents self-administered medicines, or were subject of prescriptions for “as needed” medications, care plans for these eventualities had been put in place in line with a recommendation from the previous inspection. Medication administration records for all case-tracked individuals were clear, including a hand-written chart for a person staying as a temporary resident. A medication error notified earlier in the year was discussed with the care leader, who had shared details at the time with the pharmacist inspector. The incident had been thought through in detail to identify how the error had come about, and how a similar situation could be better handled in the future. There was ongoing dialogue with a GP practice to seek to resolve a prescribing matter that was leading to waste. All medication changes were tracked in “doctors’ notes” so that they were readily recognised at staff handovers. Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 13 Care leaders had received external accredited medications training. The care leader with particular responsibility for medication use in the home showed evidence of delivery of internal training and updating records of competency of care staff involved in administration. A disagreement between a resident and carer about timing of the taking of a particular medicine was seen to be handled professionally by the carer, resulting in safe storage of the medicine until an agreed time of administration. Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 - 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home has developed regular activities provision that links with residents’ individual interests and capabilities, including provision for religious observance, although opportunities for residents to participate can be limited by staff availability. Within daily life, residents are able to exercise many choices. Community and family contacts are encouraged. Meals are of good quality. EVIDENCE: The inspector discussed activities provision with the activities co-ordinator. There were records of various activities offered regularly, providing for mental, social and physical stimulation. A number of trips out were arranged through the year, the residents’ meeting having agreed on a standard £10 charge to help meet the costs of these. A group of seven residents, all of whom had been identified as needing one-to-one support, had been enabled to go on an outing to Longleat with seven members of staff. Other one-to-one provision had been made, for example individuals had been helped to go into town or just into the home’s gardens. However, such opportunities were limited by staff availability, and there were comments from residents and relatives that people who generally chose to spend a lot of time in their rooms, or people with mobility or Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 15 hearing difficulties, did not appear to benefit as much from activities provision as those who were natural joiners. A comment in a survey form was: “access to fresh air or a short trip out is difficult for X who has to use a wheelchair – the garden or the town are important”. (See also the report on staffing issues at Page 21 below). Several residents commented on the availability of ‘church services’ within the home, and assistance given to those who wished to attend. Residents and the activities co-ordinator greatly appreciated the support of those staff who were able to lend support outside their working hours, and the day care organiser worked regularly with the co-ordinator to provide some activities tailored to the needs of those with dementia. When the home had been reliant on agency staff cover during the summer of 2006, the relative lack of staff who knew the residents well, and had time to engage in social care as part of daily duties, had impacted on what the co-ordinator could arrange. So, as at the previous inspection, the inspector recognised that the role of activities co-ordinator was benefiting the resident group as a whole, but considered the hours allocated by the Trust to the role to be insufficient to the needs of a home of this size. The co-ordinator was finding, and demonstrating, that recording of activities (another demand on her time) enabled her to identify trends and shortfalls. There were social needs care plans for all residents, which would benefit from allocated time spent on evaluation now that experience has been gained in identifying and providing for social needs in a more systematic way. Another aid to developing this aspect of care would be to enable a member of care staff with a special interest to develop a support role to the co-ordinator. A simple monthly newsletter produced by the activities co-ordinator kept residents in touch with activities that had taken place and that were planned. Personal distribution of this to all residents gave an opportunity to restate offers to facilitate involvement, and to ask about things individuals might like to do or to have arranged. Many residents spoken to said they were regularly reminded of activities, and they appreciated having freedom of choice. Meals shared by the inspector were of the high standard found on previous visits. A person staying for a respite period considered the meals far better than those they received as “meals on wheels” at home. At lunch there was a choice of two main meals and two sweets, backed by efficient, helpful service. In the kitchen was a record of residents’ dietary needs and preferences, and it was clear both kitchen and care staff had a good working knowledge of this information. Food satisfaction monitoring was undertaken and recorded regularly by the chef, who also said residents were unreserved in making comments direct to the kitchen. At least one fresh vegetable was included in main meal choices every day, and fresh fruit was available on the trolley service, as well as home made cakes. Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 16 A delivery of a meal to a bedroom was observed. The quality of service was equal to that in the dining room, the meal being attractive and hot. The resident had a supply of condiments in the room. Other residents said the food was always excellent, and a visitor described the food as “wonderful”, having seen their relative develop an appetite since admission, with evident benefits for their overall wellbeing. A note of caution mentioned by a visitor was that when their relative’s preferences for how they like their tea and coffee were not met, the drink they were given was simply not drunk. The inspector received drinks from the trolley service to residents and found them to be fresh and hot. Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 17 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 - 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. There is good provision for receipt of and response to complaints, providing all such matters are recorded. Staff and management understand and exercise responsibilities in respect of keeping residents safe and upholding their rights. EVIDENCE: One complaint had been recorded within the Trust complaints procedure since the previous inspection. This concerned cleaning arrangements for a bedroom, and had led to negotiation of how to deliver the service and to record that it is done. A resident spoke to the inspector about a concern they had raised, which the manager had discussed with them. Care records confirmed this discussion and its outcome, but it did not figure in the complaints record because it had been resolved within “normal” working practices. However, if all issues about perceived shortfalls in level of service were recorded in a complaint record, the manager would be in a better position to take an overview of any pattern that may emerge, which in turn could inform developmental plans or staff supervision and training. Good use has been made of local inter-agency safeguarding procedures, when necessary, resulting in shared decision-making and exchange of information in order to promote safety of individuals. Good objective recording of incidents by care staff was helpful when needed by other agencies. It was suggested that in some circumstances, it would be appropriate to ask mental health workers to provide or agree risk assessments or behaviour management strategies. Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 18 Residents are given advice and encouragement about locking bedrooms. Visitors’ entry to the home is controlled, whilst excursions from the home are subject to risk assessment. The home has experience of referring a resident to a local advocacy service, about which there is information displayed in the home. Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The environment provides for comfort, choice and safety, and is well maintained. There are good standards of hygiene around the home. Some residents may require more aids to enable independent use of all facilities. EVIDENCE: Significant progress had been made on repainting the upstairs corridors. New carpets in that area also contributed to a warmer, more homely feel than was apparent at previous inspection. Downstairs, a toilet near the dining room was in the midst of conversion to two modern toilets, which will represent a marked improvement on current provision, in line with a previous recommendation. All areas of the home, including bathrooms and toilets, showed high standards of cleanliness, although visitors have commented that some odour is present sometimes. An improvement to minimise cross infection risk would be to replace soiled light pulls. The wooden dining room floor was not presenting well, but was due to be fitted with carpet in the near future. Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 20 Given that some residents have difficulties with memory and orientation, it would be worth giving thought to signage to help identify toilets, route to the lift etc. Equally, foam soap and paper towel dispensers will be unfamiliar items to some residents and might benefit from friendly labelling. A recently admitted resident considered the lack of en suite toilets a major compromise on accepting admission to the home. Many rooms had recently been provided with new commodes. A comment in a survey form was that commodes sometimes were left over-long before being emptied. A staff response to this was that the task is integral to assistance to an individual’s morning routine. Both the kitchen and laundry had cleaning routines that were evidently effective. Sluices were clean and orderly. Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. A good level of developmental training has been maintained amongst care staff, who provide care in a way residents appreciate. However, availability of staff is sometimes compromised. Recruitment practice is good. EVIDENCE: Rotas showed the home mostly achieving five care staff on morning shifts and four on evenings. These figures were in addition to care leaders, who have a number of administrative and liaison duties during weekdays, taking them substantially away from front line tasks. On several days there was an additional 6 pm to 10 pm shift, which was reported as making a significant difference not only in terms of a less pressured response to physical care needs, but also allowing more key worker tasks one-to-one with residents, and support to activities. A care leader agreed that when care staff numbers fall to four, the resultant ratio of one to twelve residents amounts to a very stretched workforce. This had reportedly occurred too often during the summer, 2006, when a number of factors led to a temporary shortfall in staff availability. Additionally, use of agency workers (unusual for this service) for the same reasons, resulted in loss of continuity. This was noted by a frequent visitor, who found communication about their relative disrupted at that time. Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 22 A resident said an offer by a care leader to enable more access to the garden in the summer had resulted in this happening only twice, which the person saw as an example of how staff appeared under constant pressure, “an impossible job”; but there was no criticism of the quality of work, experienced as “with respect and kindness always”. This matched the observation of a newer resident that staff were always polite and efficient, but had no time to talk unless undertaking a specific task at the same time. A regular visitor said: “they’re so kind, nothing is too much trouble”. Mr Newman’s view that the home was catering to a frailer resident group than previously, having to provide more support to mobility, hygiene and orientation, confirmed the perception of some longer-term residents that the demands on staff had changed over time, with consequences for their availability. All care interactions observed by the inspector were marked by patience and sensitivity. Over half the staff had achieved NVQ in care at various levels, with others working towards this. Several staff had undertaken an accredited course in understanding dementia, whilst other recently completed training included pressure ulcer prevention, emergency aid and handling medications. The home was fully staffed for housekeepers, who considered their staffing level appropriate to the needs of the home. At weekends there was housekeeper presence until 7 pm. A dedicated worker in the laundry resulted in consistency of service to residents. Mr Newman had been able to address the difficulties earlier recruitment of staff since the regulations, to ensure residents ments. appoint replacement and additional staff to in the year, described above. Records of previous inspection showed adherence to were not put at risk by unsuitable appoint- Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents and their supporters experience an open style of management, with good channels of communication and canvassing of views. Residents’ financial interests are safeguarded, where required. Provision for health and safety is very good. Staff receive regular supervision. EVIDENCE: Mr Newman is in his last few months as manager before retirement. He is highly regarded by residents and staff alike, skilled at delegation whilst being aware of the details that contribute to quality of life in the home. A relative said through a survey form that “attention is always paid to observations and requests”, making particular mention of the availability of manager and senior staff: “management is very active and attentive and always includes me in consultations”. Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 24 One of the care leaders oversees provision for health and safety in the home, including fire safety. Documentation was really well organised. Staff and visiting professionals signed acknowledgement of risk assessments they needed to be aware of. A full record of the most recent fire drill showed this had been a simulation exercise. Health and safety arrangements were underpinned by comprehensive policy guidance from the provider Trust, and external auditing of compliance with Trust systems. A trip hazard highlighted at previous inspection had been addressed immediately. Despite the staffing difficulties during previous months, records showed that supervision of staff had been maintained, with little slippage. A care leader described the arrangements made to enable night staff to receive regular supervision. There was no change in the good systems used to assist residents with safe keeping of and access to money, where this is requested. A quality assurance survey undertaken in the home had resulted in thirty returns, which Mr Newman had analysed to help determine budget priorities in particular. The survey had shown high rates of satisfaction, with the main areas for improvement identified being décor and quality of bedroom furniture. Mr Newman confirmed an intention to feed back the findings and resulting intentions from the survey to residents and visitors, by way of an extended newsletter and residents’ meeting. Ongoing contact between residents and home management was facilitated by the good quality of working relationships that exist; for example, Mr Newman visits the dining room and sitting rooms every day. But residents’ meetings had stalled; the inspector is aware that a meeting has taken place since the inspection, but the last recorded one was in March 2006. A recently admitted resident thought there should be more regular residents’ meetings. Dissemination of information was via the monthly newsletter, and a notice board in the dining room. It was suggested that a second notice board upstairs might help residents in that area to feel more included. Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X 2 X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 3 X 4 Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP3 OP12 OP16 OP22 OP22 OP33 Good Practice Recommendations Records of assessment should show where they took place and from whom information was obtained. Set aside time to enable the Activities Co-ordinator to evaluate social needs care plans, and investigate ways to increase support to the Activities Co-ordinator. Ensure all matters of complaint are recorded in such a way as to facilitate an overview of the nature of complaints received, to assist developmental planning. Assess how environmental signage might help to meet current service user needs. Provide additional notice board(s) to ensure maximum distribution of information to residents. Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Woodmead DS0000028300.V311456.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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