CARE HOMES FOR OLDER PEOPLE
Woodrow Retirement Home Ltd Asheldon Road Wellswood Torquay Devon TQ1 2QN Lead Inspector
Michelle Finniear Unannounced Inspection 6th December 2005 09:30 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 Woodrow Retirement Home Ltd DS0000059136.V270997.R01.S.doc Version 5.0 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. Woodrow Retirement Home Ltd DS0000059136.V270997.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Woodrow Retirement Home Ltd Address Asheldon Road Wellswood Torquay Devon TQ1 2QN 01803 213026 01803 213026 peter@woodrowtq1.fsnet.co.uk 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) Woodrow Retirement Home Ltd Mr Peter James Edwards Care Home 16 Category(ies) of Physical disability over 65 years of age (16) registration, with number of places Woodrow Retirement Home Ltd DS0000059136.V270997.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. That Peter James Edwards completes his Managers Award Date of last inspection 23/8/05 Brief Description of the Service: Woodrow care home offers accommodation with personal care to older people (60/65 ) and older people with physical disability. It is registered to provide a service for up to 16 residents both male and female. Accommodation is laid out over 2 levels with a stair lift connecting the ground and first floors. The home offers 14 single bedrooms, 12 of which have en suite facilities and 1 double en suite bedroom (which is currently being used as a single). There is also 1 communal assisted bathroom. In terms of communal space, the home has a dining room with small lounge area, a separate lounge/sun room and an attractive and accessible garden. The building itself is a large detached property located within walking distance of Wellswood village and a short bus ride from Torquay town centre with its range of shops and amenities. Woodrow Retirement Home Ltd DS0000059136.V270997.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 4.75 hours on a Tuesday in December 2005. The inspection was unannounced, which means that neither the owner nor the service users were given warning about the date or time of the inspection. To complete the inspection a tour was made of the property, 7 service users were spoken to; time was spent with the homes staff and management and various records such as care plans and medication records were inspected. What the service does well: What has improved since the last inspection?
Since the last inspection the home has been redecorated externally, repair work has happened to drains to prevent a re-occurrence of flooding, and six bedrooms have been redecorated. At the last inspection the home was required to obtain all required records prior to appointing a new staff member. Records had also to be obtained for those staff already employed. The owner confirmed that this had been done. This is to ensure service users are protected from being cared for by people who are unsuitable to work with vulnerable people. Woodrow Retirement Home Ltd DS0000059136.V270997.R01.S.doc Version 5.0 Page 6 Service user plans now provide sufficient detail as to the action that needs to be taken by staff to ensure that all aspects of the health, personal and social care needs of the service user are met. The home has started to expand upon the current quality assurance questionnaires to provide a full quality assurance and quality control system for the home, but this process has not yet been completed. Quality assurance systems are important in ensuring that service users receive a consistent and satisfactory service. A window restrictor has been fitted to a window which opens out on to a balcony. This is to ensure the service user cannot fall from the balcony. A source of training for staff in Dementia and memory loss has been identified, and training is due to be provided in the near future in this area. This will ensure staff are better prepared to work with the service users. The home has discussed the current level of service user activities provided at the home to ensure it meets their needs and wishes. What they could do better:
At the last inspection the home was required to ensure that all care staff are appropriately supervised. This has not happened. Discussion was held with the owner on this issue, and new systems have been provided for this to occur in future. Supervision is a system for performance evaluation, personal development and for supporting staff in their day-to-day tasks. It should ensure consistency in approach and practice for staff, thereby benefiting service users as well as ensuring that staff meet their full potential. Some attention was required to the medication systems at the home. The medication cupboard must be kept locked and secure at all times. Prescription only dressings must only be used for the person for whom they are prescribed and under the direct guidance of a general practitioner. The controlled drugs register must accurately reflect the medication held at the home. This is to ensure service user safety, and to ensure the medication is kept securely. The home should expand upon the current quality assurance questionnaires to provide a full quality assurance and quality control system for the home. Results of the report should be made available. This is to ensure that the home is working well to meet the needs of service users, and to ensure service users receive a consistent service. All chemicals including cleaning materials must be kept securely locked away, and Data sheets must be kept for all products in use. This is to ensure service user safety, and prevent accidental misuse.
Woodrow Retirement Home Ltd DS0000059136.V270997.R01.S.doc Version 5.0 Page 7 Wedges must not be used to prop open fire doors. If hold open devices are required the advice of the fire authority must be sought concerning approved devices. This is to protect service users and staff in the case of a fire. The home should provide training for staff in Dementia and memory loss as part of a complete training and development programme. This is so that staff can meet service users needs. The home should examine the current level of service user activities provided at the home to ensure it meets the needs and wishes of all service users. 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. Woodrow Retirement Home Ltd DS0000059136.V270997.R01.S.doc Version 5.0 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 Woodrow Retirement Home Ltd DS0000059136.V270997.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion. EVIDENCE: The core standards were not assessed on this occasion, but were seen at the last inspection in August 2005, when they were satisfactorily met. For information on the homes compliance with these standards please refer to the report of the 23/8/05. Discussion was held on the admission process followed with a recent admission, and this was confirmed in conversation with the service user themselves. The home does not cater for intermediate care, which means they do not provide a specialist programme of intensive rehabilitation to enable service users to return to their own homes. Woodrow Retirement Home Ltd DS0000059136.V270997.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9, 10 Plans of each service users care needs are available. Service users rights to privacy and dignity are maintained. The medication cupboard was not always secured properly, and there were some problems with the medication accounting and use. EVIDENCE: Each service user has an individualised plan of care, incorporating assessments of risk where applicable. These plans are kept in each service users room and are updated daily by staff carrying out the care. Five plans were seen and in two cases these were discussed with the service users concerned who confirmed that the care tasks recorded within them had indeed been carried out. Care plans are important in ensuring that the service users needs are met in a consistent fashion and in the way in which they would like their care to be delivered. The medication systems examined were generally satisfactory, although medication is stored in a large metal cupboard that was observed to be unlocked for much of the inspection. The home uses a monitored dosage system, which means that medication sent to the home is prepared by the
Woodrow Retirement Home Ltd DS0000059136.V270997.R01.S.doc Version 5.0 Page 11 pharmacist in a series of individual cassettes. This makes it easier to see if medication has been administered and reduces the risk of errors. Some prescription only or specialist dressings were in a box for emergency use. These dressings must only be used for the service user for whom they are prescribed, to prevent any risks to the service user concerned. In addition the controlled drug record did not indicate the correct current balance held. The home owner was to investigate this and amend the records accordingly. Arrangements for care ensure that service users rights to their privacy and dignity are respected. During the inspection it was seen that care is delivered in private, which included care given by visiting district nurses. The hairdresser was also at the home and service users hair was being set in the service users own room. Rooms have private toilets and baths or showers, which means that service users hygiene needs can be met in their own rooms wherever possible. Some service users have their own telephone lines installed to their rooms, so that they can make calls in private. No service users share a room. Woodrow Retirement Home Ltd DS0000059136.V270997.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Service users can follow their preferred lifestyles wherever possible. Dietary needs of service users are well catered for with a balanced and varied selection of food available. EVIDENCE: The home has a menu planner offering home cooked food that is varied and nutritious. On the day of the inspection service users were being served fruit juice as a starter, fish, which could be served either breaded or in sauce, tartare sauce, peas, carrots and broccoli with sauté or creamed potatoes. Dessert was a honey and almond flan or ice cream with chocolate sauce, followed if wished by cheese and biscuits and tea or coffee. Service users spoken to confirmed that the food was very good. Discussion was held with service users concerning how they were able to spend their time. Service users at the home vary considerably in their abilities, from those who are quite frail and would need considerable support to go out, to another who drives a car and on the day of the inspection was going out to a local out of town store to buy something for a bridge party they were hosting. In general service users stated that the home did not disable them from following their chosen lifestyles, but that any problems were related to their health and physical condition. Visitors are welcomed to the home at any
Woodrow Retirement Home Ltd DS0000059136.V270997.R01.S.doc Version 5.0 Page 13 time, and could be seen coming and going throughout the day. One service user regularly has friends to visit, and has an active social life outside of the home. Since the last inspection the home owner has held discussions with the service users about the nature of activities provided at the home. Additional activities have been slow to get off the ground, and it is the owners opinion that service users mostly have enjoyed going out on a 1:1 supported basis rather than participating in organised group activities. Other choices in daily life are supported wherever possible. This includes for example choices in when service users wish to get up and go to bed. One service user confirmed that meals would be kept back for them if they were out somewhere when the main meals were being served. Service users have access to their care plans which are kept in their rooms, and handle their own finances for as long as they wish to with the support of family and friends where needed. Woodrow Retirement Home Ltd DS0000059136.V270997.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The home has a good understanding of the principles and practice of the Protection of Vulnerable Adults. EVIDENCE: No complaints have been received since the last inspection, however an incident of concern did occur in relation to a member of staff. The concerns were reported to the Police and it is understood that a criminal prosecution followed. The member of staff was immediately suspended and dismissed from the home and has been provisionally placed on the national list of people unsuitable to work with vulnerable adults. The home demonstrated through their actions a commitment to protect the people in their care, and demonstrated a good working knowledge of the Protection of Vulnerable Adults legislation and practice. The other core standard was not assessed on this occasion, but was seen at the last inspection in August 2005, when it was satisfactorily met. For full information on the homes compliance with these standards please refer to the report of the 23/8/05. Woodrow Retirement Home Ltd DS0000059136.V270997.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 Woodrow provides a comfortable living environment, offering service users an attractive and homely place to live. EVIDENCE: Woodrow is a period property, situated in a residential area of Wellswood, within a reasonable distance of local facilities and services and set within attractive gardens. There some are parking facilities at the home and nearby free on street parking. Rooms vary in size and shape from those well in excess of the minimum standard, providing lounge, bedroom and ensuite areas, to other rooms which fall just below the current minimum size. Many rooms have period features, such as fireplaces and large bay windows. The home is on two main floors with a mezzanine floor to the rear and a purpose built extension on the ground floor. All areas of the home seen on this
Woodrow Retirement Home Ltd DS0000059136.V270997.R01.S.doc Version 5.0 Page 16 visit were odour free. This means service users have an attractive environment in which to live. The home has a communal dining room and a small sun lounge/conservatory. Plans are in hand to improve this facility to provide improved lounge facilities, which will enhance the environment for service users. The environmental health officer last visited the home on 20/7/05, and made only minor recommendations. Water temperature regulators have been fitted to all outlets to which service users would have access according to the owner to protect service users from scalding and radiator covers have been provided to protect service users from coming into contact with hot surfaces. Evidence of Employers liability insurance was seen with a renewal date of May 2006. The home does not cater for service users with severe disability. An environmental assessment has been undertaken which indicates the premises are suitable for the current level of disability. Aids and adaptations include a specialist bath with hoist, raised toilet seats, grab rails and a chair lift to access the mezzanine floor level. This means service users physical care needs can be met at the home. The laundry was not seen on this inspection, however is sited in a shed to the rear of the building. The home has policies for control of infection, and training has been given to staff in this area. Woodrow Retirement Home Ltd DS0000059136.V270997.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 Woodrow has a developing programme of staff training to meet service user needs. EVIDENCE: Discussion was held with the owner and a member of staff in relation to training needs it is understood that two staff are undertaking their NVQ level 2, and another is just waiting to have the units ‘signed off’ having completed the award. One other has completed the award. NVQ’s are a system of recognising the competence and level of skill of workers. The home has 12 staff, so when all 4 complete the awards there will be a ratio of 33 with an NVQ2. The standard is 50 , so there is a current shortfall. The home is preparing to provide training in dementia care to the staff, based upon a learning pack which was discussed. This will ensure that the staff are able to meet the needs of those people accommodated with some degree of memory loss. Woodrow Retirement Home Ltd DS0000059136.V270997.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 36, 38 Staff supervision systems have not been fully implemented at the home. Attention is required to the storage of chemicals to ensure service users live in a safe environment. There are few quality assurance controls in place. EVIDENCE: Staff supervision systems have not been fully implemented at the home. Supervision is a system for performance evaluation, personal development and for supporting staff in their day-to-day tasks. It should ensure consistency in approach and practice for staff, thereby benefiting service users as well as ensuring that staff meet their full potential. Some areas of the arrangements for meeting the health safety and welfare arrangements were examined. In particular it was noticed that several cleaning products were left out in the bathroom and toilet areas. These products should
Woodrow Retirement Home Ltd DS0000059136.V270997.R01.S.doc Version 5.0 Page 19 be kept secured to avoid accidental ingestion or inappropriate use. Data sheets on all products in use must be kept at the home. Several fire doors at the home were propped open with wooden wedges. If the home or service user require the door to be held open then the advice of the fire authority should be sought in relation to approved devices. Discussion was held with the owner on service user finances. The owner supports one service user by collecting money for them and purchasing items which are receipted and records kept. All other service users manage their own finances or do so with the support of relatives or advocates. The home manager could evidence service user questionnaires which had been sent out to service users previously, which will provide a basis for a Quality assurance and quality control programme, currently not in place. Any areas raised through these questionnaires are addressed individually with service users and are not yet compiled into a final report. Woodrow Retirement Home Ltd DS0000059136.V270997.R01.S.doc Version 5.0 Page 20 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 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 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 x 17 x 18 x 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 X 28 X 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x 2 2 x 2 Woodrow Retirement Home Ltd DS0000059136.V270997.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP36 OP33 Regulation 18(2) 24 Requirement Care staff must be appropriately supervised. Previous date for completion 30/10/05. The home should expand upon the current quality assurance questionnaires to provide a full quality assurance and quality control system for the home. Results of the report should be made available. The medication cupboard must be kept locked and secure at all times. Prescription only dressings must only be used for the person for whom they are prescribed and under the direct guidance of a general practitioner. The controlled drugs register must accurately reflect the medication held at the home. All chemicals including cleaning materials must be kept securely locked away.. Data sheets must be kept for all products in use Wedges must not be used to prop open fire doors. If hold open devices are required the
DS0000059136.V270997.R01.S.doc Timescale for action 30/03/06 30/03/06 3 OP9 13 06/12/05 4 5 6 OP38 OP38 OP38 13 13 23 06/12/05 20/12/05 06/12/05 Woodrow Retirement Home Ltd Version 5.0 Page 22 advice of the fire authority must be sought concerning approved devices. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard 36 Good Practice Recommendations Care staff should receive formal supervision at least 6 times a year (Standard 36.2). Supervision should cover all aspects of practice, the philosophy of care in the home and the staffs training and career development needs (Standard 36.2). The home should provide training for staff in Dementia and memory loss as part of a complete training and development programme. The home should examine the current level of service user activities provided at the home to ensure it meets the needs and wishes of all service users. 2 3 30 12,13 Woodrow Retirement Home Ltd DS0000059136.V270997.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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