Inspection on 27/06/08 for Woodmead

This inspection was carried out on 27th June 2008.

CSCI found this care home to be providing an Poor service.

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 25/09/06

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 09/11/2008.

CARE HOMES FOR OLDER PEOPLE Woodmead 35 Portway Warminster Wiltshire BA12 8QQ Lead Inspector Alison Duffy Key Unannounced Inspection 09:30 27th June 2008 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.V352144.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.V352144.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 01985 216456 manager.woodmead@osjctwilts.co.uk www.osjct.co.uk The Orders Of St John Care Trust Jessica Ann Young Care Home 48 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (48) of places Woodmead DS0000028300.V352144.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home providing personal care only (Code PC) to service users of either gender whose primary needs on admission to the home are within the following categories: Old Age, not falling within any other category 2. Dementia over 65 years of age - Code DE(E) - maximum of 10 places The maximum number of service users who may be accommodated is 48 25th September 2006 Date of last inspection Brief Description of the Service: Woodmead was originally opened in 1962. It is a residential care home, for up to 48 older people, 10 of whom may have a dementia. Originally managed by Wiltshire County Council, the home is now registered to the Orders of St John Care Trust. Ms Jessica Young is the registered manager. Woodmead is situated on a main road close to the centre of Warminster. It is within easy access of the shops, parks and community hospital. There is a small car park and street parking. People’s bedrooms are located on the ground and first floor. All are single rooms but they do not have en-suite facilities. A passenger lift gives easy access to the first floor. There are comfortable communal areas consisting of a choice of lounge and dining room. There is an integral day service. Staffing levels are maintained at six staff on duty during the morning and five staff during the evening. There are three waking night staff. Woodmead DS0000028300.V352144.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 0 star. This means the people who use this service experience poor quality outcomes. This key inspection took place over two days. The first day took place on the 27th June 2008 between the hours of 9.30am and 1.45pm. The second day was on the 8th July 2008, between 9.30am and 7.30pm. There were two inspectors, on the second day of the inspection. Ms Alison Stenning, locality manager was available initially. Ms Young and Ms Mudie, another locality manager, received feedback. The pharmacy inspector visited to look at the medication systems. The findings of this visit are detailed within this report. We met with people who use the service in their own rooms and within communal areas. We met with the staff members on duty. We looked at the management of peoples’ personal monies. We observed the serving of lunch and the evening meal. We looked at care-planning information, training records, staffing rosters and recruitment documentation. As part of the inspection process, we sent surveys to the home for people to complete, if they wanted to. We also sent surveys, to be distributed by the home to peoples’ relatives, their GPs and other health care professionals. The feedback received, is reported upon within this report. We sent Ms Young an Annual Quality Assurance Assessment (AQAA) to complete. This was completed in detail and returned on time. Information from the AQAA is detailed within this report. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. What the service does well: People are offered a good level of social activity provision both in the home and within the wider community. Meal provision is of a good standard and generally enjoyed by people. Woodmead DS0000028300.V352144.R01.S.doc Version 5.2 Page 6 People are clear about the ways in which they can raise any concerns. Training is given priority and ranges of subjects, other than those, which are mandatory, have been arranged. Robust recruitment procedures are in place and a high level of health and safety material is available for staff reference. Staff are committed to their roles and work hard to maintain the staffing roster. What has improved since the last inspection? What they could do better: A full investigation is needed in relation to the number and severity of falls that people are experiencing. Control measures must be applied to minimise further accidents. A review of staffing levels must be undertaken to ensure people’s individual needs are being met effectively and people are not at risk of harm. The review must take into account the layout of the building, the level of falls people are experiencing, the time of day people are being supported with their personal care routines and whether they are receiving the care they require. Other factors must include sufficient staff presence to give people assistance, as required and the ability to spend one-to-one time with people. Staff must ensure that call bells are answered without delay. Additional domestic staff must be deployed to ensure the standard of cleanliness within the home is significantly improved upon. Peoples’ beds should be made at a reasonable time in the morning rather that being left to lunchtime. Care plans must reflect people’s individual needs and be regularly updated, as needs change. The management of specific conditions such as diabetes and sensory impairment must be clearly identified. Care plans must also be in place for the use of medicines prescribed ‘as required’ so that the prescriber’s instructions can be followed safely. Any changes to the expected pattern of use must be reported to the prescriber. Woodmead DS0000028300.V352144.R01.S.doc Version 5.2 Page 7 Control measures to minimise people’s risk of developing a pressure sore must reflect the actual level of the identified risk. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Woodmead DS0000028300.V352144.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.V352144.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are assessed before being offered a service, so are assured that their needs will be met. EVIDENCE: Within the AQAA we saw that a robust assessment process is followed before a person is considered suitable for the home. We saw that Ms Young or a senior carer would visit the person in his or her own environment. An assessment of need would be completed. A copy of the placing authority’s assessment would also be gained, if applicable. People are encouraged to visit the home, before making a decision to move in. We saw from surveys that people received sufficient information about the home, before their admission. One person wrote ‘I knew the home as I attended day care.’ Another person said ‘ I was happy to move in. I had a friend who lived here for two years.’ Further comments were ‘I had my name Woodmead DS0000028300.V352144.R01.S.doc Version 5.2 Page 10 down for a long time before a vacancy became available’ and ‘my daughter gained all information from Colin Newman – that time being the manager here. She had been granted an interview with him. I was very lucky. A spare room was available here. Given the information she required – it was then passed to me.’ We looked at the assessment documentation of six people. The assessment format contained information about people’s basic care needs. One assessment did not detail the person’s previous history or social interests. Another described a health care condition yet there was no evidence of how this was portrayed within the person’s life. One assessment stated ‘vision impaired – requires full guidance and orientation.’ We advised greater clarity to such statements. Each person had a nutritional, tissue viability and falls assessment in place. One assessment was not signed or dated. Woodmead does not provide intermediate care, so standard 6 is not applicable to this service. Woodmead DS0000028300.V352144.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans do not fully reflect people’s needs. People are at risk through insufficient control measures, to minimise the risk of falling. Not all people are receiving the care they need. People are protected by the home’s procedures for the safe administration of medicines, however the use of medicines prescribed ‘as required’ must be more closely monitored. EVIDENCE: We looked at a sample of care plans. We saw that they contained details of people’s basic needs yet not all had been updated, as needs changed. One care plan stated ‘one carer to assist XX with washing, dressing and undressing morning and night. Mobilises with a stick and one carer.’ Within the person’s daily records we saw that the person needed two staff due to a deterioration of health. The person told us they were fully reliant on staff for all tasks, including their mobility. The management of some health care conditions were not always detailed within care plans. One plan identified that the person had very poor sight. It Woodmead DS0000028300.V352144.R01.S.doc Version 5.2 Page 12 stated, under the heading communication, ‘will need full guidance due to poor eyesight (to and from bedroom, toilet, dining room.)’ Other areas of support were not identified. Another care plan detailed the person had diabetes. The amount of insulin administered and the parameters of the person’s blood sugar levels, to ensure wellbeing were not stated. There was no evidence of the support the person needed if unwell due to their diabetes or who was monitoring their condition. We saw that one person used equipment to assist their breathing. Within the care plan, we saw that it was documented ‘to ensure XX is assisted to use his/her nebuliser, 4 times a day, as instructed by Warminster Hospital.’ We advised clearer guidance to be recorded in the care plan. We saw that some recordings including the way documentation was ordered were unclear. For example, one person had been prescribed eyewash. Within one care plan, it stated the person was to receive assistance as required. However, later documentation stated ‘staff not to use same pad on both eyes.’ We saw that the control measures to minimise the risk of developing a pressure sore were the same for each person. One plan stated ‘pressure areas to be checked 2 x daily and record any changes in daily report sheets.’ There was no evidence of how this was to be achieved in practice, when the person managed their personal care independently. Some people told us they were fully satisfied with the care they received. Two people wanted more baths, yet were concerned that the staff were always busy. We saw that one person was still in their nightwear at 10.45am. They said they were cold. They told us ‘staff said they would be back to me but they don’t come.’ She said she rang her call bell. She told us ‘the member of staff said ‘I’ve only got one pair of hands.’’ The person felt that they had just been left. The impact of staffing levels on the quality of care received is addressed later within this report. Each person had a record detailing any healthcare intervention. This included the GP, district nurse, chiropodist and optician. Within a survey, one health care professional told us ‘they always seek help if not sure. Where diabetes is concerned, will seek advice and help.’ Another health care professional said ‘diabetes, need more input on occasions with blood glucose monitoring.’ A further comment was ‘they have residents with complex medical needs where care not always met.’ We spoke with a district nurse who was visiting. They said that staff seek advice speedily and then follow instructions clearly. Over the last few months, there has been a very high level of falls within the home. Eight falls have resulted in fractured bones. We saw one person, fall during the inspection. There was evidence of falls within all care documentation we looked at. Prior to this inspection, we asked for an investigation into the number of falls, which had taken place. Ms Young Woodmead DS0000028300.V352144.R01.S.doc Version 5.2 Page 13 completed this. Further falls continued. We said the organisation must investigate the potentials reason for such a high level of falls. Each person had a falls risk assessment. We saw that one of these was not accurate. The assessment identified a low risk of falling yet the person had had a number of falls. Their physical condition gave an added risk. A GP had highlighted that one particular person must not use the stairs independently. Within the care plan it was stated ‘staff to be aware that XX will walk downstairs. Encourage XX to use lift. Explained to XX the risk of him/her walking without his/her frame.’ We did not see how this instruction was to be applied in practice. The person had been referred to the falls clinic yet an outcome of the appointment was not evident. We saw that the stated control measures were insufficiently robust to minimise any further accidents. Staff had recorded any injuries, marks or bruises, which had been noted on people. We said staff needed to clarify their recording within documentation. This should include the specific size, colour and location of the bruise or wound. Our Pharmacist Inspector looked at arrangements for the handling of medicines. Storage arrangements on both areas of the home were appropriate. However, with the introduction of new legislation, the controlled drug cupboard in the main house must be more securely attached to the wall. The cupboard used in the annexe must be changed or the drugs kept in the main house. The temperature of the storage room in the main house should be monitored, as it may exceed safe levels in warmer weather. Medication administration records were completed accurately. Records of medicines received into the home and returned for disposal were kept. Staff are trained in the safe administration of medicines. Senior staff regularly check their competency. A comprehensive medication policy and procedure is available to all staff. The staff spoken to showed a good understanding of these procedures. One person who was prescribed a medicine ‘as required,’ had no care plan for the safe use of this medicine. Records showed that it had been given regularly for some time. The prescriber must review this and an appropriate care plan must be put in place. We found two incidences where the instructions for eye ointments were not being followed accurately. People told us their privacy and dignity were maintained. They said staff were polite, friendly and respectful. We saw that staff knocked on people’s doors and waited to be asked in, before entering. Personal care was undertaken in private. People said they could spend time in their room and not be disturbed. Within surveys, a health care professional told us ‘all staff treat patients in a very kind and respectful manner.’ One health care professional raised staffing levels, as an issue, which negatively affected people’s dignity. They said ‘residents ring bell and need to wait for quite some time until bell is answered. This causes problems with dignity, where some residents are unable to get to the toilet/commode in time.’ Woodmead DS0000028300.V352144.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are offered social activity provision both inside the home and within the wider community. People are able to follow their preferred routines and receive visitors as they wish. Meal provision is of a good standard and generally enjoyed by people. EVIDENCE: There is an activities coordinator who works 20 hours a week. They spoke of their role with enthusiasm. They said a weekly activity plan is developed. This is flexible and changed according to people’s wishes. A theme, such as a country, is taken each month. Events and food sampling are arranged in relation to the theme. The activity plan and photographs of events are displayed around the home. Trips out are regularly arranged. The activities coordinator said they had just had a staff and visitors football match. They had also been to the beach and to Trowbridge Country Park. A holiday is planned for later in the year. There are regular residents meetings to enable people to share their views about the home. The activities coordinator told us that meeting everyone’s needs is a challenge. She said she is responsible for all group activities. The care staff are responsible more for individual time with people. However, with existing staffing levels, time for this is minimal. With Woodmead DS0000028300.V352144.R01.S.doc Version 5.2 Page 15 more time available, it was agreed that more social activity provision could be undertaken. People told us they have a choice as to whether they wish to participate in the activities and the outings. One person told us ‘I like the activities especially Bingo.’ Another said ‘I hate bingo, but I did enjoy the trip to Bournemouth. I was very pleased with the Harry Ramsden’s lunch.’ Some people said they enjoyed sitting in the lounges and watching television. One person added, “It’s so boring here, I am bored to death”. Another person expressed how much they had enjoyed the recent musical entertainment. A member of staff told us ‘we are able to accompany the people who live here on trips, such as to Swanage.’ Another staff member said ‘we take people to the pub to play skittles in the evening.’ The activities coordinator told us that a recent series of music therapy sessions had been positive. It had helped some people with communication difficulties to express themselves. We were told that arts and crafts, including card making was also popular. People told us that they could have visitors at any time. They could entertain in their own room or in the communal areas. One person told us s/he enjoys having a telephone in their room so they can speak to their daughter abroad. A visitor told us that they were always made to feel welcome, whenever they visited. People told us they were able to follow their preferred routines such as getting up and going to bed. People said they could eat where they wanted to and spend time, independently in their room. One person said ‘staff bring me up to bed at 6.00pm. I am ready by then. I get up about 8.00am and have my breakfast brought up to me so that I can read in bed.’ Another person said ‘I hate going to bed, I choose to stay up late.’ The chef told us they work to a five week rotating menu. We saw that the menu contained a good selection of food. A cooked breakfast is offered every day along with cereals, porridge, toast and marmalade or jam. There is a choice of two main meals at lunchtime. One of these is a vegetarian option. There are two main puddings and a dessert trolley to choose from. One person was offered second helpings of the pudding, which they accepted. There is a choice of a cooked option, sandwiches or bread and butter for tea. Homemade cakes are offered, along with yogurt and a dessert of fresh or tinned fruit. The chef told us that many people choose to have their breakfast in their bedrooms. At lunchtime the majority of people eat in the dining room. We saw people eating at lunchtime and again at teatime. People saw people chatting to each other and appearing to enjoy the social interaction. The mealtimes were relaxed. Staff did not rush people and ensured that they understood the choices on offer. Woodmead DS0000028300.V352144.R01.S.doc Version 5.2 Page 16 Within a survey, one person said ‘we usually have three cooked meals daily. Light breakfast and cereals, fruit etc depending if a full staff is available. A cooked lunch or salad and a lightly cooked tea. Tea, coffee and biscuits between meals (usually choice of two menus for lunch.)’ The majority of people spoke highly of the meals provided. They said the meals were always served hot and the food was tasty. People said ‘the food is very good,’ ‘it’s basic food, nothing special,’ ‘the food is very good, nice and hot’ and ‘the cook is excellent.’ Woodmead DS0000028300.V352144.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are aware of how to make a complaint. Adult protection systems are in place to safeguard people from abuse yet people are not protected from harm due to inadequate intervention, to minimise the occurrence of falls. EVIDENCE: People told us they would tell the manager, a member of staff or their family, if they were unhappy. One person said she had complained about a member of staff. They said ‘she has left now’. A relative told us they had been given a copy of the complaints procedure. They said if there had ever been a need to raise a concern, it had always been dealt with promptly and efficiently. A record of formal complaints is maintained. The records are clear and identify any investigations, outcomes and responses to the complainant. We saw that the organisation completed an audit of complaints for 2007. There is a copy of the Statement of Purpose by the front door, which is available for visitors. The document contains a copy of the complaints procedure. Within surveys, the majority of people told us they knew how to make a complaint. Two people did not know. Of these people, one person said ‘I don’t know because I am happy.’ Other comments included ‘if only a minor matter I try to consult my helper (very helpful and understanding lady.) If serious, tell a staff member. If very serious or upsetting I would try to consult Jessica [the manager] (if she is available.)’ Woodmead DS0000028300.V352144.R01.S.doc Version 5.2 Page 18 During the inspection, we asked three members of staff, a hypothetical question about abuse. They told us about the local adult protection reporting procedures, ‘No Secrets in Wiltshire and Swindon.’ They said they had had training on abuse awareness. One member of staff told us that the local safeguarding unit had provided the training. They said they had also covered abuse awareness within their National Vocational Qualification (NVQ.) Ms Young was aware of the local adult protection procedures. She told us she would have no hesitation in contacting the safeguarding unit, for advice and to make a safeguarding referral. There was evidence that Ms Young had used the procedures appropriately. At present, two incidents are being investigated under the safeguarding process. As stated within this report, people have had a high number of falls. While we acknowledge that staff are aware of adult protection reporting procedures, the number of falls, which have occurred, gives evidence that people are not protected. Woodmead DS0000028300.V352144.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People do not benefit from a comfortable, well-maintained environment, as the standard of cleanliness needs significant improvement. EVIDENCE: Peoples’ bedrooms are located on the ground and first floor. There is also an annex, which contains people’s bedrooms and a bathroom. The annex is separated from the main part of the home, by a corridor and the day centre lounge. There is a passenger lift to the first floor. There is a large lounge, a smoking lounge and a lounge adjoining the dining room. All areas are comfortable and furnished to a good standard. New carpets have been fitted to the corridors. Peoples’ bedroom’s varied in size. All were lockable. People told us they were able to furnish their rooms with their own belongings. Woodmead DS0000028300.V352144.R01.S.doc Version 5.2 Page 20 Within the AQAA, it states ‘the front entrance and lounges have been redecorated, recarpeted and curtains replaced. Both stairwells have also been redecorated and recarpeted and curtains replaced. The vinyl flooring to the kitchen corridor has been replaced. Several bedrooms have had upgraded vanity units. The care office has been relocated and redecorated. A downstairs toilet facility has been refurbished. 6 bedrooms have had new bedroom furniture.’ We saw that some rooms would benefit from redecoration. Some carpets were stained and in need of replacement. Two rooms contained very strong odours. Many rooms had not been vacuumed and there was debris over the floor. Some people’s furniture was dusty and items such as over-bed tables and commodes required a thorough clean. One room contained an armchair, which had food debris down the side. The television remote control was dirty with sticky particles. The bedside cabinet showed evidence of where a drink had been spilled. There were wheelchairs and a standing hoist in the corridor. These were dusty and had debris over them. On the second day of the inspection, at 12noon, many beds had not been made. This caused some people anxiety. Some toilets/bathrooms were without waste paper bins. Some bins did not have liners and had brown particles inside. Within one toilet there were pictures in a pile on the floor. A wet floor sign had fallen over, presenting a trip hazard. Within the bathrooms, we saw chairs similar to those in the dining room. They could not be easily cleaned. We advised these be replaced with a design, which could be easily wiped, to minimise the risk of infection. We saw that there was only one domestic on duty. They were aiming to undertake priority tasks such as cleaning toilets and hand washbasins. They were also making beds and emptying waste paper bins. Staff told us they were very short staffed. One member of staff said ‘we can see that standards are slipping, but everyone is doing their best.’ The staff in the kitchen told us they were currently experiencing some difficulties with staff shortages. This has resulted in the chef, cook and kitchen assistant having to take on extra duties and work some extra shifts. They were concerned that this could result in other main cleaning tasks (such as the large oven) not being cleaned, as they would like it to be done. The laundry room was clean, ordered and well managed. We spoke to the laundry assistant who works 30 hours a week. They were clear about their role and the procedures they were expected to follow. Within a survey, one health care professional said ‘the smell of urine is strong and would be much nicer if there was a pleasant odour on arrival at the front door.’ A relative also commented ‘its lovely here but the smell of urine is very off putting.’ Woodmead DS0000028300.V352144.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels are insufficient to meet people’s needs and place people at risk of harm. People are protected by a robust recruitment procedure. EVIDENCE: We saw that staffing levels were maintained generally at six staff on duty in the morning. There were five in the evening. There were three waking night staff. These levels supported 48 people over two floors and the unit, which although was integral to the home, was separated from the main areas. Staff, visitors and people who use the service told us that the home was very short staffed. One person told us ‘you must expect to wait if you want anything, as they are never able to come straight away.’ Another person said ‘they will get to you when they can.’ We asked about needing to go to the toilet urgently. The person said ‘I’m not meant to, but I would try to get to the commode myself. What else can you do?’ At 10.45am, we saw one person sitting in their room, in their nightwear. They said they were cold. They told us they had rung their bell after breakfast and had been told to wait. At 10.48am, a member of staff offered the person support to get dressed. As stated earlier in this report, two people told us that they would like a bath more often. They said this was difficult due to the staff being busy. Woodmead DS0000028300.V352144.R01.S.doc Version 5.2 Page 22 We saw that one person struggled with opening a toilet door. There were no staff in the vicinity to offer support. Another person fell in the same area. We saw that one person remained seated at the dining room table, all afternoon. They were not asked or supported to go to the toilet. Social interaction was minimal. We saw that staff were busy in other parts of the building. As highlighted within the environment section of this report, the standard of the cleanliness and beds not being made before 12 noon, indicated insufficient staff. Staff told us they did not have enough time to spend with people. One person who uses the service said ‘I would be privileged to talk about my life with staff, but they’ve not got time to talk to me.’ Staff said they did not have the time to assist with activities. One member of staff said ‘personal care routines take up the whole morning. We also do the drinks trolley and there are always bells ringing. We don’t have time to do activities.’ Other comments included ‘we are rushed and don’t stop all shift,’ ‘we only really have time to sit and chat with people when they have a bath or we deliver personal care’ and ‘attending to the call bells in the annex can be particularly hard between 8 – 8.20am, as everyone is fairly dependant over there. Sometimes there can be 4 bells going off at the same time.’ Within surveys, four staff said there are usually enough staff to meet the individual needs of people. Two staff said there were sometimes enough. One member of staff said there were never enough staff on duty. Specific comments included ‘provide more care staff’ and ‘allow more time to spend with the residents on a more individual basis.’ One member of staff wrote ‘please can you get us more staff?’ A health care professional said ‘feel that there needs to be more carers at busy times of the day. It can be difficult to find carers to help at times. Perhaps residents with more complex health care needs need to be carefully assessed and in appropriate placements.’ One person told us ‘under certain adverse conditions it is (at that time) impossible to relate the full details as you would wish as there are many interruptions (some being unwarranted.) If it is vital, the carer involved will of course ‘hear you out.’ Sometimes several calls are received at the same timenot only from the residents (front and side bell doors) plus telephones may ring.’ We rang the call bell on three different occasions. It took staff between five and ten minutes to answer the bells. On two occasions staff could not locate, which call bell was ringing. We said this had major implications to the safety of people and needed to be addressed without delay. Ms Stenning said call bell response times had been identified and discussed within a staff meeting. We said the impact of staffing levels must be investigated, as a contributory factor of the time staff take, to answer call bells. Woodmead DS0000028300.V352144.R01.S.doc Version 5.2 Page 23 We looked at the recruitment documentation of the three most recently employed members of staff. The files contained the required information. There was a photograph, an application form and two written references. Each staff member had been checked against the Protection of Vulnerable Adults register before commencing employment. This ensured they were suitable to work with vulnerable people. Within surveys, all seven staff told us that their recruitment procedure was robust. Staff have access to a range of training opportunities. 77.5 of staff have National Vocational Qualification (NVQ) level 2. There is a record of training each member of staff had completed. A training matrix was not in place. It was therefore not easy to see if staff were up to date with subjects such as first aid, manual handling and infection control. Ms Young told us that all training records were in the process of being processed onto the computer. She said this would enable any gaps in training provision to be identified. Staff were positive about the training they received. One member of staff said ‘I have completed all my mandatory training. I am a manual-handling trainer. I have also completed abuse awareness, with the VA [vulnerable adults team] team, basic food hygiene, health and safety, palliative care, nutrition and diabetes.’ Another member of staff said ‘if we want specific training, the Trust will organise it for us. We had the hearing and vision team come to give a talk, which was really good.’ One member of staff told us about a lengthy course they had undertaken at a local hospice. While acknowledging that staff training provision was of a good standard, there was evidence for us to make a judgement that people are not in safe hands. As previously stated, insufficient staffing levels, poor response times to call bells and the high number of falls within the home, are factors affecting people’s wellbeing. Woodmead DS0000028300.V352144.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The manager has the skills and experience to fulfil her role. However, there is inadequate recognition from the organisation, that staffing levels are insufficient to meet people’s needs and are placing people at harm. The high occurrence of falls has not been sufficiently addressed, placing people at risk of further injury. EVIDENCE: Within the AQAA, Ms Young told us ‘I have achieved NVQ Level 4 in Care and the Registered Managers Award. I have been in a Home Manager role for over 2 years. With the assistance of the training manager for the trust I am able to maintain my own knowledge and skills by attending regular training sessions.’ Ms Young told us that she aimed to provide an open, positive approach, which promoted the inclusion of everyone. Woodmead DS0000028300.V352144.R01.S.doc Version 5.2 Page 25 Within surveys, one person told us ‘our manager – Miss Jessica Young – a very forthright and busy lady. Having the pleasure of knowing Jessica’s capabilities is a great bonus. Her administration and thoughtfulness is a great credit to the entire concept of caring and the nursing profession.’ A member of staff told us ‘we have an open door policy here from the management.’ The home has a quality assurance system that is used within all of the homes within the organisation. The system consists of various audits and questionnaires. The organisation’s quality assurance officer did an internal audit in April 2008. There were six non-conformances. These included COSHH safety data (Control of Substances Hazardous to Health) not corresponding with products and food temperatures, not being taken when agency staff were on duty. Ms Young told us that these aspects had been addressed. Senior managers visited the home on a monthly basis, as part of regulation 26. Records were in place to demonstrate the areas of discussion that took place. We saw that there had been two medication errors. We were not informed of these under regulation 37. We saw that the coroner had asked for a statement of falls following a person’s death. We advised Ms Young that we should have been informed of these occurrences. While we acknowledge that a formal quality assurance system is in place, we were concerned that particular issues, such as the cleanliness of the home, had not been identified and addressed. This is reflected in our judgement, when scoring against the outcome statement of standard 33. A number of people have placed small amounts of their personal monies, for the home to hold safely. We looked at the systems for managing this. The cash amounts we checked, corresponded with the balance sheets. Two members of staff had signed all transactions. We looked at some receipts. We saw that some of the receipts did not tally with the date or amount of the stated expenditure. My Young said she would look into this. The administrator and Ms Young had regularly audited the systems. The administrator told us, representatives from the organisation also completed regular audits. The organisation has a range of health and safety policies and procedures. Regular health and safety audits take place. Systems are in place to monitor issues such as hot water temperatures. Radiators have been covered to reduce the risk of scalding. We saw that equipment such as hoists and portable electrical appliances had been tested, as required. The fire risk assessment was completed in March 2006. There was no evidence of it being reviewed or updated. Ms Mudie told us that the fire risk assessments for all homes had been completed centrally within the organisation. She said they might not have reached the individual services, as yet. Woodmead DS0000028300.V352144.R01.S.doc Version 5.2 Page 26 As stated earlier in this report, people have had a high number of falls. The accident book highlighted 18 accidents in June 2008. There had been seven entries, so far in July. All except two of the accidents were falls. Ms Young had informed us about significant falls under regulation 37. Since February 2008, eight people have had falls, which have resulted in a fracture. We saw a high number of falls, recorded within people’s daily records. People have had skin tears and bruising, as a result of their accidents. We saw one person fall during the inspection. Ms Young said she had investigated the high level of falls. There was no pattern. Some people had been referred to the falls clinic. We said further investigation into the level of falls must be undertaken. Any contributory factors, such as staffing levels must be addressed accordingly. Woodmead DS0000028300.V352144.R01.S.doc Version 5.2 Page 27 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X X X X 1 STAFFING Standard No Score 27 1 28 1 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 1 Woodmead DS0000028300.V352144.R01.S.doc Version 5.2 Page 28 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. 1 Standard OP7 Regulation 15(1) Requirement The registered person must ensure care plans fully reflect people needs and how they are to be met. This must include the management of conditions such as diabetes and sensory impairment. The registered person must ensure all care plans are updated as needs change The registered person must ensure that control measures in relation to people’s risk of developing a pressure sore, are specifically linked to the level of risk identified. The registered person must ensure that all controlled drugs are stored in a cupboard, which meets the current storage regulations (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007.) The registered person must ensure that care plans are in place for the use of medicines prescribed ‘as required’ so that the prescriber’s instructions can DS0000028300.V352144.R01.S.doc Timescale for action 31/08/08 2 3 OP7 OP8 15(2)(b) 12(1)(a) 08/07/08 18/08/08 4 OP9 13(2) 01/11/08 5 OP9 13(2) 18/08/08 Woodmead Version 5.2 Page 29 6 OP26 23(2)(d) 7 OP26 16(2)(k) 8 OP26 13(3) 9 OP27 18(1)(a) 10 11 OP27 OP37 12(1)(a) 37 12 OP38 13(4)(c) be followed safely. Any changes to the expected pattern of use must be reported to the prescriber. The registered person must ensure additional staff are deployed to ensure a clean and hygienic environment is maintained. The registered person must ensure that measures are taken to remove the strong odours within the identified rooms. The registered person must ensure that the waste paper bins in the toilets are maintained in line with infection control guidance. The registered person must ensure a review of staffing levels is undertaken to ensure people’s safety and wellbeing. The registered person must ensure that peoples’ call bells are answered without delay. The registered person must ensure that CSCI is notified without delay of any incident, which affects the well being of a person. The registered person must ensure a full investigation is undertaken in relation to the numbers of falls that have taken place. Control measures must be put in place to minimise further occurrences. 08/07/08 08/07/08 08/07/08 08/07/08 08/07/08 08/07/08 31/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Woodmead Refer to Good Practice Recommendations DS0000028300.V352144.R01.S.doc Version 5.2 Page 30 1 2 3 4 5 Standard OP3 OP7 OP8 OP26 OP35 The registered person should ensure assessments are sufficiently detailed to ensure people’s individual needs are clearly identified. The registered person should assess the reasons why people are only able to have one bath a week. The registered person should ensure that staff record specific information of any marks or bruises identified on people. The registered person should ensure that the chairs in the bathrooms are replaced with those easier to keep clean. The registered person should ensure that all receipts reflect the transactions made with people’s money, held for safekeeping. Woodmead DS0000028300.V352144.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Regional Office Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Woodmead DS0000028300.V352144.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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