Inspection on 06/01/09 for Woodmead

This inspection was carried out on 6th January 2009.

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

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

Other inspections for this house

Woodmead 27/06/08

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 20/03/2009.

CARE HOMES FOR OLDER PEOPLE Woodmead 35 Portway Warminster Wiltshire BA12 8QQ Lead Inspector Alison Duffy Unannounced Inspection 6th January 2009 9:30 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.V373918.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.V373918.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 Vacant 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.V373918.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 27th June 2008 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. Mrs Sarah Hill is currently the acting manager. Mrs Hill is in the process of completing the process to become registered with us, as 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 seven staff on duty during the morning and five or six staff during the evening. There are four waking night staff. Woodmead DS0000028300.V373918.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate outcomes. This key inspection took place over two days. The first day took place on the 6th January 2009 between the hours of 9.30am and 4.20pm. The second day was on the 9th January 2009, between 9.30am and 12.40pm. There were two inspectors throughout the inspection. Mrs Sarah Hill, acting manager and Ms Alison Stenning, locality manager were available throughout the inspection. Mrs Hill and Ms Stenning received feedback at the end of the visit. The last key inspection of this service took place on the 28th June 2008 and the 8th July 2008. During this visit we made a judgement, based on the available evidence, that the home provided poor quality outcomes for people. We were concerned about the number of significant falls people were experiencing, insufficient staffing levels and the standard of cleanliness within the home. Within this inspection, we focused upon the concerns we previously identified and the requirements we made. We did not address each key standard, which we previously identified, as being met. Some evidence from the last inspection is used in relation to these areas, within this report. As part of this inspection, we spoke to people using the service in their own rooms and within communal areas. We spoke to staff and observed interactions between them and people using the service. We toured the accommodation and observed the serving of lunch. We looked at documentation such as care plans, daily records, staffing rosters and the accident book. After the last inspection, we sent an improvement plan to the manager to complete. This was to show us how the shortfalls we identified would be addressed. The improvement plan was completed in detail and was returned to us on time. 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: There is a clear admission procedure in place and people are fully assessed before being offered a service. Woodmead DS0000028300.V373918.R01.S.doc Version 5.2 Page 6 Meal provision is of a good standard and generally enjoyed by people. People’s rights to privacy, dignity and respect are promoted and maintained. People are encouraged to maintain important relationships and visitors are welcomed. People are clear about the ways in which they can raise any concerns. Staff training is given priority and subjects, other than those, which are mandatory, are arranged. Robust recruitment procedures are in place and a high level of health and safety material is available for staff reference. What has improved since the last inspection? What they could do better: If a care need is identified, an assessment and care plan must be put in place to direct staff on how the person’s needs are to be met. Evaluations of care plans must take into account all information in other records. The plans must be up dated as soon as changes in care are identified. There must be evidence that staff always follow the plan of care in place. While the standard of the cleanliness has improved, commodes must be cleaned in line with infection control standards. They must also be emptied promptly when used. Focus must be given to resolving the causes of the strong odours within some rooms. All jars of topical creams and lotions should be labelled with the person’s name so that they are used only for that person. Woodmead DS0000028300.V373918.R01.S.doc Version 5.2 Page 7 Systems must be in place to ensure people have satisfactory food and fluid intake. People requiring staff assistance must receive regular support in this area. Where a risk of dehydration or malnutrition is noted, food and fluid intake must be monitored and regularly evaluated. If a person is assessed as being at risk of pressure damage and is unable to move their position, there must be written evidence of changes of position in accordance with their care plan. Any form of challenging behaviour must be addressed within the person’s care plan. Clear strategies to manage these behaviours must be in place. If there is an episode of aggression, discussion must be held with the person’s care manager and/or the local safeguarding unit. This discussion will determine if a safeguarding alert should be made. 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.V373918.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.V373918.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: At the last inspection we saw that a robust assessment process is followed before a person is considered suitable for the home. We saw that the person would be visited in his or her own environment. An assessment of need would be completed. A copy of the placing authority’s assessment would be gained, if applicable. We saw that people were encouraged to visit the home, before making a decision to move in. As the assessment process was judged to be satisfactory at the last inspection, we looked at the assessment documentation of just one person. The assessment gave clear information, which was used to create the person’s care Woodmead DS0000028300.V373918.R01.S.doc Version 5.2 Page 10 plan. The assessment reflected what the person told us about their individual needs. Two carers told us that senior carers assess people before they are offered a place at the home. They said many people often start with having day care, then respite care. They said this often leads to permanent care at the home. Staff told us that if people are admitted to hospital, the manager always assesses them to ensure they are fit to return home. Two people now living at Woodmead told us that they were assessed before moving in. They said they chose the home, based on knowing it through previous experience. Woodmead does not provide intermediate care, so standard 6 is not applicable to this service. Woodmead DS0000028300.V373918.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 adequate. This judgement has been made using available evidence including a visit to this service. Greater clarity and less duplication within care plans would ensure staff have better information about people’s individual needs. Clearer systems are required to ensure some people are not at risk of dehydration and malnutrition. Medication is generally well managed. People’s rights to privacy and respect are maintained. EVIDENCE: At the last inspection, we made a requirement that all care plans must fully reflect people’s needs and how they are to be met. We also made a requirement that the care plan must be updated to reflect the person’s changing needs. We saw that both requirements had been addressed in part. Within one care plan we saw clear recording regarding the management of a colostomy. However, the daily records showed that the person was resistant in the assistance needed to manage it. This was not identified within the care plan or its review. Dietary needs were identified and ‘review likes and dislikes’ was stated. We advised that the preferences of the person be stated in order Woodmead DS0000028300.V373918.R01.S.doc Version 5.2 Page 12 to do this. There was a list of likely reactions to foods in relation to the person’s colostomy. We advised that this list be made specific to the person’s own experiences of food. There was a care plan regarding continence. This stated ‘toilet on a regular basis.’ We advised greater clarity to this statement to enable clearer support. Information about the person’s mobility was clear and matched what we saw. Daily records demonstrated that the person sometimes resisted assistance with personal care. This was not stated within the care plan and there were no guidelines as to how to manage such behaviours. The care plan stated ‘clothing to be stain free.’ We advised that measures to enable this were reviewed, as clothing hanging on the back of the door and chair within the person’s room, showed that the goal was not being achieved. We saw that one person presented at times, with complex behaviours. The behaviours were not reflected in the person’s care plan. A behaviour chart was in place yet this had not been completed for each incident that had occurred. There were many references regarding physical violence towards staff. There were some references of verbal aggression towards other people using the service. There was no risk assessment in place regarding this. We saw a care plan regarding the person’s short-term memory loss. However, this contained little detail and did not direct the person’s care. We saw that attempts had been made to contact the Community Psychiatric Nurse. One care plan was very individualised regarding personal care routines. The information highlighted the person’s religious practice and their need for privacy. Another showed good detail about the support the person needed with aspects such as dressing and undressing. The records showed that they had a history of pressure ulcers. The care plan stated the need to change the person’s sitting position ‘on a regular basis.’ ‘Three hourly’ was stated yet this had been crossed out. We saw that the person was sat in the lounge for the afternoon. There was no evidence within documentation to show whether the person could change their position at night or whether they needed assistance. There was no record of when the person’s position had been changed to minimise the risk of pressure damage. The care plan stated that the person should only be in a wheelchair for moving around home. It stated they should be in an armchair at all other times, including meals. We saw that the person was sitting in a wheelchair, throughout the lunchtime period. Within care plans we saw that there was some duplication of topics. One person had three care plans about eating. One of these detailed the need for liquidised food yet the chef told us that all meals for this person were to be soft or minced. There was a food and fluid chart in place although it was not clear if the chart had been fully completed. If the information was accurate, the person was at risk of dehydration. The amount of fluids had not been totalled on a daily basis. There was no evidence that the charts had been used in the evaluation of the person’s care plan. We saw that the person had a full glass of juice and a jug in front them in the morning. The contents of the glass Woodmead DS0000028300.V373918.R01.S.doc Version 5.2 Page 13 and jug remained the same later in the afternoon. We saw this situation with another person who was in bed due to being unwell. The person told us that they were unable to manage the glass independently. They said they found it difficult to reach. They told us ‘I don’t want to spill it, as it’s a bit full.’ Within another plan, there were two care plans about continence. The plans were adequate although from the odours in the person’s room, there appeared to be more of an issue than highlighted within documentation. It was stated ‘take him/her to the toilet ‘regular.’’ As similarly stated above, we advised clarity to this statement. The care plan stated ‘empty commode at 6:30am’ yet this was completed at 10:30am on the day of inspection. Nutritional assessments were evident within care plans. We saw that one person had been identified as high risk. The care plan stated ‘staff to monitor for signs of malnutrition and dehydration.’ We advised clarity to this statement, as it was not clear what the signs of these conditions were. Records showed that the person had lost weight. There were no written strategies in the care plan, as to how this was being managed. The person told us that they had kidney failure and needed to drink large amounts. This was detailed on a hospital discharge summary but not on the person’s care plan. As with some other people, the fluids available to this person were not readily consumed. We saw that another assessment showed that the person was at risk of malnutrition. They had seen a dietician who confirmed their weight was acceptable, as long as they were eating and had snacks in between meals. On the day of the inspection, the person did not eat their lunch. An alternative was offered yet also refused. There was no evidence that regular snacks had been offered. One member of staff told us that one person administered their own insulin. This was not stated on the person’s care plan. There was a record of the person’s daily blood sugar levels. However, there was no evaluation as to whether these were satisfactory for the person. There was no evidence of the parameters of the person’s blood sugar levels to ensure their wellbeing. The care plan stated ‘diabetic and to keep blood sugar levels stable.’ It was not clear how this was to be achieved. We advised that the person’s awareness of factors such as a diabetic diet including carbohydrates and sugars, be stated. We met with a district nurse who regularly attends the home. She said that she was happy with the care provided. She confirmed that staff do what they are asked to do. She said the staff are very good at contacting the team with any issues straight away. Within documentation there was evidence that people had access to health care services, as required. We saw staff undertake two medication rounds. These were performed correctly and in accordance with procedures. Records were fully completed. Another member of staff had signed all handwritten instructions on the Woodmead DS0000028300.V373918.R01.S.doc Version 5.2 Page 14 medication administration record (MAR). Mrs Hill told us that once the new hairdressing salon had been completed, the old salon would be upgraded to store all medication. There would be no medication held in the annexe. We looked at the controlled drugs and the systems in place. The medication was correct and balanced with the records. At the last inspection, we made a requirement to ensure that the controlled drugs cupboard complied with current legislation. Mrs Hill told us this had been addressed through the cupboard being more securely fitted to the wall. Records of the temperatures of the medication room and the refrigerator were maintained. The room temperature was just within the highest acceptable level. We saw that a member of staff countersigned any hand written medication instruction. Within a variable dose of medication, staff did not always identify whether one or two tablets had been administered. We saw that one person was prescribed pain relief patches. The MAR stated that these needed to be changed every four days, yet the care plan gave a timescale of three days. We advised clarity and the use of body maps to demonstrate the positioning of the patches, when changed. Within one care plan, a goal to minimise pain was stated. The intervention was ‘staff to offer and administer pain relief, as prescribed.’ The medication administration record showed that the person was prescribed pain relief four times a day. However, they usually refused this. We advised the care plan be reviewed in relation to the information within the medication administration record. Another person was prescribed a specific medication for anxiety yet there was no evidence for why the medication was needed or its effects. We said that this should be detailed within the person’s care plan. There was no evidence to suggest that people’s rights to privacy, dignity and respect were not adhered to and promoted. We saw staff speak respectfully to people and engage in conversations. All personal care was provided in private. We saw that staff knocked on people’s doors and waited to be asked in before entering. Woodmead DS0000028300.V373918.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. 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 yet systems to ensure people have a satisfactory intake should be considered. EVIDENCE: People told us that they are able to make choices about their daily routines and how they spend their day. Specific comments included ‘it’s up to me when I get up,’ ‘there are no rules, you can have meals in your room’ and ‘they bring my meals in my room, which is what I want. I can get up and go to bed when I want.’ Staff told us that varied activities were available for people to join in with if they wanted to. There were photographs around the home, which demonstrated social events that had taken place. People we spoke to shared varying comments about the activities provided. One person said ‘they do do activities but I don’t go down. I like my crosswords to keep my brain going.’ Another person said ‘I like crafts and bingo.’ One person told us that they continue to attend the home’s day centre. They said ‘I go to the day centre Woodmead DS0000028300.V373918.R01.S.doc Version 5.2 Page 16 every day, which is wonderful. We do bingo and quizzes and have a chat.’ Another person said ‘not enough activities organised, you are ok if you go to the day centre but at weekends it is dull, we sit about, we should be active, organised.’ One person told us ‘it’s difficult when there aren’t people you can converse with. You can’t really hold proper, intelligent conversations with people here.’ People spoke positively of the meals provided. We saw that people were offered a choice of meal at lunchtime. All meals were served according to people’s individual needs. The chef told us that no liquidised meals are currently prepared. Within one care plan we saw that a person needed assistance to eat due to holding food in their mouth and not swallowing. The person did not receive this assistance. We saw that another person had three different carers assisting them to eat their lunch at different times. Two carers stood up to assist the person and one carer sat down. One person was assisted to the table yet they were not given their meal immediately. On three occasions they were given assistance to return to the table. The person began to eat someone else’s lunch in the lounge. We brought this to the staff’s attention and the person was given their own meal. Within the person’s care plan, it stated that they should be offered their lunch in their own room in order to reduce anxiety. After lunch, we saw the person take food from a plate, which someone else had finished with. Staff did not see this as a sign that the person could still be hungry. They said this was sometimes ‘usual behaviour.’ There was no evidence in the person’s care plan that their food intake was being monitored to ensure an adequate intake. Woodmead DS0000028300.V373918.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. Systems are in place to safeguard people from abuse yet any challenging behaviours portrayed by people, must be referred to the local safeguarding procedures. EVIDENCE: People told us that they would tell the manager, a member of staff or their family, if they were unhappy about something. All appeared clear that they would raise issues, as required. We saw that a record of formal complaints is maintained. One letter to a complainant stated, will respond ‘in due course.’ We advised that a specific date be stipulated in accordance with the home’s complaint policy and procedure. At the last inspection, we saw that staff regularly received training in safeguarding vulnerable people. They were aware of the local adult protection reporting procedures, ‘No Secrets in Wiltshire and Swindon.’ During this inspection, we saw that one person’s behaviour alarmed others. They poked a carer very hard in their back with their finger and alleged that the member of staff had slapped them. We observed that this was not so. The incident was not reported upon within the person’s daily records. Within the records there was evidence that the person had been verbally abusive to other Woodmead DS0000028300.V373918.R01.S.doc Version 5.2 Page 18 people within the home. They had been physically aggressive towards staff. There was no evidence that a safeguarding referral had been made. We advised this to be undertaken. As stated earlier in this report, strategies to manage such behaviours must be in place. One person told us ‘some agency staff can be bullies, I’ve told the manager so that they know.’ There was no evidence within the complaint log about this. Within feedback, Mrs Hill told us that she was not aware of the comment. She said she would monitor agency use. Woodmead DS0000028300.V373918.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 adequate. This judgement has been made using available evidence including a visit to this service. The standard of cleanliness within the home is much improved yet ensuring clean commodes and reducing odours, require further attention. EVIDENCE: At the last inspection, while some areas had been refurbished, the standard of cleanliness was poor. Some carpets were stained and in need of replacement. There were strong odours. Many rooms had not been vacuumed and some people’s furniture was dusty. Some items such as over-bed tables and commodes required a thorough clean. We made three requirements in this area. This involved ensuring the deployment of additional staff, to ensure a clean and hygienic environment. Also, that measures were taken to remove the strong odours and maintain waste paper bins in the toilets, in line with infection control guidance. Woodmead DS0000028300.V373918.R01.S.doc Version 5.2 Page 20 The standard of cleanliness was much improved during this inspection although some aspects, as stated below required further attention. As identified within the staffing section of this report, there is now a full compliment of housekeeping staff and new cleaning schedules have been implemented. One person told us that they had had their room decorated and a new carpet had been fitted. They said they were able to choose the wallpaper and the colour of the carpet. They told us that they wanted a new light. Mrs Hill told us that this was in the process of being arranged. All toilets and bathrooms were cleaned to a good standard. We saw that the chairs in the bathrooms, which were difficult to keep clean, had been replaced. All waste paper bins in the bathrooms and toilets now had liners. Staff told us that there is a refurbishment programme to replace wash hand basins & vanity units in people’s bedrooms. We saw that this work had almost been completed on the first floor. One person, who was admitted shortly after the last inspection told us ‘by the time I came here most of the carpets had been changed and the home was clean.’ Within one room there was a very strong odour. Although the bed had been freshly made, it remained odorous. We saw that there were two used continence pads in the room at 3.30pm. The bin had ‘please empty daily’ on it. We said the continent pads should be immediately removed and not left within the room. There were two other rooms, which had a very strong odour. Within one, the carpet was stained. There was a brown stain on the wall. We pulled back the bed and saw red staining on the under sheet & duvet cover. At 11.30am we asked staff to change the bedding. This was undertaken yet the stain was still visible on the duvet cover. The mattress and its cover were also stained. We saw on another mattress that the plastic covering was torn and did not provide a barrier. We saw that fourteen commodes were in need of a thorough clean. Three had not been emptied and contained urine. One person said that they only use their commode at night. This meant at 10:40am, that the commode not been emptied from the night. Some commodes had brown marks over the seat and some were unclean on the underside. Some were of a wooden frame. These were scratched, worn and difficult to keep clean. At the last inspection, by lunchtime, many beds had not been made. Housekeepers told us that they are now responsible for making the beds. We saw on this occasion, that the majority of beds had been made by the middle of the morning. Within three rooms, we saw some topical creams, which were not named. We advised that all such creams identified the individual owner to minimise the Woodmead DS0000028300.V373918.R01.S.doc Version 5.2 Page 21 risk of cross infection. Staff told us that they had good access to disposable protective clothing such as aprons and gloves. We saw that there was a complaint regarding the cleanliness of the environment in the complaints book. We advised that although the standard of cleanliness had improved from the last inspection, aspects as identified above, required further monitoring. The laundry was very clean with two washing machines with a sluice wash programme. There were clear systems in place, which complied with the prevention of spreading infection when laundering items. Alginate bags were used for very soiled items. We saw that non-infected soiled linen was being sorted in the laundry, which could be a potential risk to cross-infection. We recommended that laundry be sorted at source using colour-coded bags to avoid re-sorting in the laundry. Woodmead DS0000028300.V373918.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. The increase in staffing hours has enabled people to be more supported and not at risk of harm through insufficient staffing levels. Staff training is of a good standard. People are protected by a robust recruitment procedure. EVIDENCE: At the last inspection, people using the service, staff and visitors told us that the home was very short staffed. We saw that staff presence was limited and the time staff took to answer call bells was poor. During this inspection, the staffing situation had improved. Mrs Hill told us that an additional member of staff had been allocated to the lounge area during the day. An additional member of waking night staff had been deployed. A head of care position had been introduced. Mrs Hill told us that there is now a full compliment of housekeeping staff and a head housekeeper has been appointed. A carer told us, ‘things are so much better. The additional person in the lounge has made all the difference. We are not rushing around now and can give people more time. It’s much less rushed and we can get to people more quickly when they call. I can’t explain the difference it’s made.’ Other comments were ‘staffing has improved. It’s a Godsend’ and ‘better staffing now, can nearly always get to a resident when they ring the bell within 3 minutes.’ Woodmead DS0000028300.V373918.R01.S.doc Version 5.2 Page 23 We saw that there was a staff presence within all areas of the home. Call bells were not ringing constantly, as at the last inspection. One person told us ‘if I ring the bell for help, depends on the time of day how quickly they come. Usually very good at coming and seeing what has happened.’ Another person said ‘they generally come quite quickly.’ One person however said ‘90 of the problems here are due to understaffing.’ They continued to say ‘unnecessary use of agency staff and they are still using a lot, about four or five times a week. They are grossly understaffed here. There is usually enough staff at night. It’s 7 to 8am, the crucial time when there are not enough staff, as everyone wants them. Evenings aren’t too bad. I like to go to bed at 9pm and if I have to wait 10 minutes, it’s unusual. It is dangerous from 7 to 8am. I take risks because I know I won’t get a carer. Sometimes you wait 10 minutes. I’m frightened I might fall but there are times when I can’t wait.’ The housekeeping staff also told us that things had improved significantly. They said there is now an overlap of housekeepers during the day with someone covering a new afternoon shift. One housekeeper told us ‘it was unfortunate last time. We are now fully staffed and have clear cleaning schedules, so it’s working well.’ Another housekeeper said ‘we have designated areas. There is a lot to do but it is ‘do able.’ People were very complimentary about the staff. Specific comments included ‘they are lovely. They will do everything they can for you,’ ‘they are all very good’ and ‘the staff are all excellent. They all try very hard but the downfall is that there is not enough of them.’ We saw that staff interacted well with people. We saw one member of staff acknowledge people individually when arriving for duty. Another staff member said ‘you’re welcome’ after supporting a person. At the last inspection, we judged staff training provision and staff recruitment to be of a good standard. We therefore did not assess these areas on this occasion. One carer told us that they received training on a regular basis. They said they had completed manual handling, first aid, health and safety, control of substances hazardous to health and dementia. They had also completed training in pressure area care, diabetes care, continence care and the new care-planning format. The member of staff told us that some training had been in house through videos and general discussion. Other sessions had involved an external facilitator. Within a person’s daily records we saw that a stoma nurse had shown staff what to do when managing a colostomy. There were no records to demonstrate this training session. There was also no evidence to demonstrate that staff had been specifically trained in testing a person’s blood sugar level. Mrs Hill located certificates showing that some staff had attended diabetic training. However, we said evidence to demonstrate competence in the actual procedure of blood sugar testing, is required. Woodmead DS0000028300.V373918.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 good. This judgement has been made using available evidence including a visit to this service. Many of the aspects identified at the last inspection have been addressed enabling people’s health and welfare to be promoted rather than being at risk of harm. EVIDENCE: Since the last inspection, a new manager has been appointed to the home. Mrs Hill was appointed acting manager in November 2008. Mrs Hill was previously a registered manager in another care home, within the organisation. Mrs Hill told us that she is currently in the process of completing her application to become the registered manager. Mrs Hill told us that she has spent time working with the staff team to address issues, identified at the last inspection. She said the staff work hard and are committed to providing a good standard of care to people. Mrs Hill said she expects recent recruitment and the Woodmead DS0000028300.V373918.R01.S.doc Version 5.2 Page 25 allocation of additional care staffing hours, to enable staff to undertake their roles more effectively. People using the service were aware of a new manager. One person said ‘I think the manager is very good.’ Another said ‘new manager very nice. She’s very pleasant.’ One person told us that they wanted their scooter. They said they told the manager, who got it for them. At the last inspection, we saw that not all incidents, which affected the wellbeing of a person, had been reported to us under regulation 37. We made a requirement to ensure this practice. We have been informed of some incidents, such as falls. However, Ms Stenning spoke of the conclusion of a safeguarding issue that we had not been notified of. At the last inspection, we saw that the home had a quality assurance system, which was used within all of the homes in the organisation. While the system was being implemented, we were concerned that particular issues, such as the cleanliness of the home, had not been identified and addressed. Mrs Hill told us that the outcome of the last inspection was unfortunate and mainly due to the consequence of staffing shortages. She said areas had been addressed and there would not be a reoccurrence of events. Ms Stenning told us that checks are now in place so that any such issues are addressed within the monthly visits of senior managers, as part of regulation 26. At the last inspection, we saw that a number of people had placed small amounts of their personal monies, for the home to hold safely. These systems were satisfactorily managed so we did not look at this area, on this occasion. At the last inspection, we were concerned, as people had had a high number of falls. Eight people had suffered a fracture. Despite the high level of serious injuries occurring, an investigation into the possible causes had not been undertaken. We made a requirement to address this. In response, Ms Stenning completed an investigation. This addressed possible key themes such as the time of day, specific areas of the building or particular people. As stated earlier in this report, most falls appeared to have taken place during the night. In response, an additional member of night staff has been deployed. During this inspection, we saw a staff presence at all times. As stated earlier in this report, staff told us that the staffing situation was much improved. They said the additional member of staff deployed to the lounge area had been invaluable. It enabled people to be supported with their mobility if required, rather than mobilising in a possible unsafe manner on their own. We saw within the accident book that the number of falls had reduced. Mrs Hill told us one person who was at risk of falling had moved to a downstairs room. The risk of falling on the stairs therefore, had been significantly minimised. Mrs Hill told us that when rooms become vacant, other people at risk of falling would be offered a downstairs room. Mrs Hill told us that some people who had fallen Woodmead DS0000028300.V373918.R01.S.doc Version 5.2 Page 26 had been referred to the falls clinic. Some had had medication reviews and their eyes tested. Falls risk assessments had been reviewed. We advised that after a fall, there should be evidence of a 24 and 48 hour follow up assessment. This would identify any injury, which was not apparent at the time of the fall. Woodmead DS0000028300.V373918.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 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Woodmead DS0000028300.V373918.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement Timescale for action 30/03/09 2 OP7 15(2)(b) 3 OP8 12(1)(a) 4 OP8 12(1)(a) 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. This was identified at the last inspection and has been addressed in part. Further clarity and information is needed in some areas. The registered person must 09/01/09 ensure all care plans are updated as needs change. This was identified at the last inspection and has been addressed in part. The registered person must 09/01/09 ensure that people have a satisfactory food and fluid intake. All records of food and fluid intake must always be completed in full and the information used to assist in the evaluation of the person’s care plan. The registered person must 09/01/09 ensure that control measures in DS0000028300.V373918.R01.S.doc Version 5.2 Woodmead Page 29 5 OP9 13(2) 6 OP26 16(2)(k) 7 OP26 13(3) 8 OP26 13(3) 9 OP26 13(3) 10 OP26 13(3) relation to people’s risk of developing a pressure sore, are specifically linked to the level of risk identified. This was identified at the last inspection and has been partly addressed yet there must be evidence of whether the person requires support to change their position and when this is undertaken. 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 be followed safely. Any changes to the expected pattern of use must be reported to the prescriber. This was identified at the last inspection and has been addressed in part yet information about all ‘as required’ medication needs to be fully documented within care plans. The registered person must ensure that measures are taken to remove the strong odours within the identified rooms. This was identified at the last inspection and has been addressed in part yet there remain some rooms with a strong odour. The registered person must ensure that all commodes are clean on all surfaces and be promptly emptied after use. The registered person must ensure that the commode chairs are in a good state of repair and be fully wipeable. The registered person must ensure that used continence pads are promptly removed and not left in people’s rooms. The registered person must DS0000028300.V373918.R01.S.doc 28/02/09 28/02/09 09/01/09 28/02/09 09/01/09 09/01/09 Page 30 Woodmead Version 5.2 11 OP30 18(1)(c) (i) ensure that beds are always made up with clean linen. The registered person must ensure that staff who complete blood sugar testing have had specific training and their competency has been assessed and evidenced by a qualified health care professional. 28/02/09 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 6 7 Refer to Standard OP7 OP7 OP9 OP9 OP9 OP9 OP15 Good Practice Recommendations A new care plan should not be drawn up relating to a need already identified. The existing care plans should be updated. Care plans should use precise, measurable terms and wording such as ‘regularly’, ‘normal limits’ and ‘stable’ should be avoided. Where a person is on a fluid chart, their intake should be totalled and evaluated every 24 hours. If a person is prescribed a drug on an ‘as required’ basis, the MAR chart should only be completed when the person actually takes the drug. If a person is self-medicating or partially self-medicating this should be documented and a risk assessment should be in place. If a person is prescribed a variable dose of a medicine, the MAR chart should always document how much the person has taken. Staff should always sit with a person when assisting them to eat, so that they can engage with them and ensure that they are swallowing safely. Arrangements should be made to ensure that only one member of staff supports the person during a mealtime. The letter to a complainant should state precisely when the person could expect a reply, in accordance with the home’s procedures. In order to ensure that sanitary items such as commode buckets can be fully cleaned, a washer disinfector should DS0000028300.V373918.R01.S.doc Version 5.2 Page 31 8 9 OP16 OP26 Woodmead 10 11 12 13 OP26 OP30 OP35 OP38 be provided. Appropriate laundry bags should be provided so that laundry can be separated at source, not in the laundry. A record should be made of all training related to roles and specific tasks and of any cascaded training. Receipts should reflect the transactions made with people’s money, held for safekeeping. This was identified at the last inspection but not addressed on this occasion. After a fall there should be a 24 and 28 follow up assessment to identify any injuries previously undetected. Woodmead DS0000028300.V373918.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West 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. 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