CARE HOMES FOR OLDER PEOPLE
Woods Court Care Home Hatton Gardens Newark Nottinghamshire NG24 4BP Lead Inspector
Richard Ramsden Unannounced Inspection 22nd February 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Woods Court Care Home DS0000035542.V282814.R01.S.doc Version 5.1 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. Woods Court Care Home DS0000035542.V282814.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Woods Court Care Home Address Hatton Gardens Newark Nottinghamshire NG24 4BP 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) 01636 673548 01636 673548 Nottinghamshire County Council Miss Caroline Ann Falshaw Hobson Care Home 49 Category(ies) of Dementia (20), Dementia - over 65 years of age registration, with number (20), Old age, not falling within any other of places category (49), Physical disability (10) Woods Court Care Home DS0000035542.V282814.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. Out of the total number of beds (49), there will be 20 beds for DE 55 and over and/or DE(E Out of the total number of beds (49), 10 may be used for PD 55 and over A maximum of 5 PD 55 years and over to be accommodated outside the intermediate care unit Sevice users shall be within category OP Date of last inspection 08/09/05 Brief Description of the Service: Woods Court is a care home providing personal care and accommodation for 49 older people, 10 of which receive intermediate care. It is owned and run by Nottinghamshire County Council Social Services. The home is located within easy walking distance of Newark town centre where there are a variety of shops and facilities. The home was opened in 1988 and consists of a two-storey purpose built property, divided into five units. There is a shaft lift to assist independent access between levels. All of the bedrooms are for single occupancy, with wash hand basins. None of the rooms have ensuite facilities. The gardens are well tended and are accessible by service users. The inspector was advised that there is a secure garden area leading directly of one of the units, which has been specially designed for people who have dementia. Woods Court Care Home DS0000035542.V282814.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was completed over one day and lasted for approximately 4 hours. It included the inspection of care and other records, a discussion with three members of staff and four residents. A partial tour of the building was also completed. What the service does well:
The residents spoken with during this inspection confirmed that they are very satisfied with the services provided by the home. They stated that although the staff are very busy, they are always friendly, helpful and respectful. One person said that some of the staff are like “ family” to her. The observed interaction between staff and residents was of a very good standard. People confirmed that the food provided in the home is of a very good standard. They said that there is always plenty of food and that an alternative will always be provided if they do not want the food suggested on the menu. The meal provided on the day of this inspection appeared appetising and nutritious. The vegetables were fresh and the puddings had been prepared with sugar substitute so that the residents with diabetes could enjoy the same food as the other residents. One person said that she chooses to eat all her meals in her bedroom and that she really appreciates this flexibility. The staff training records show that a high proportion of the staff have completed NVQ training. This is good practice as it helps to ensure that staff have the appropriate training and skills to meet the assessed needs of the residents. The premises are purpose built, they are well equipped and maintain to a good standard. The residents spoken with said that they like their bedrooms and confirmed that the home is always kept clean and tidy. There are aspects of good practice highlighted in the main body of this report. Woods Court Care Home DS0000035542.V282814.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
All residents care plans must contain sufficient information and be reviewed regularly enough to ensure that staff are always aware of what assistance and support each resident requires. Residents or if appropriate their representatives should sign to confirm that they have been involved in planning and reviewing the way in which their care is provided. The registered person must ensure that risk assessments for people who manage their own medication are updated on a regular basis, to ensure that they remain safe. People must be consulted about the programme of activities arranged by the home. All residents must be informed how they can gain access to their personal records. Woods Court Care Home DS0000035542.V282814.R01.S.doc Version 5.1 Page 7 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. Woods Court Care Home DS0000035542.V282814.R01.S.doc Version 5.1 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 Woods Court Care Home DS0000035542.V282814.R01.S.doc Version 5.1 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): X None of these standards were assessed as part of this inspection. EVIDENCE: Woods Court Care Home DS0000035542.V282814.R01.S.doc Version 5.1 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. Not all of the care plans contain sufficient information and are reviewed frequently enough to ensure that staff or always aware what support and assistance each resident requires. The homes medication systems are generally well maintained but the risk assessments for the people, who administer their own medication, are not reviewed frequently enough to ensure that the system is safe. EVIDENCE: Three residents care plans were viewed as part of this inspection. One of the care plans was for a resident who receives regular respite care at the home. There was no evidence that this care plan had been reviewed or updated since 2004 when it was originally produced. It was also noted that the resident had not signed to confirm their involvement in the care planning process. The second care plan was for a resident who had been living in the home for approximately 6 months. This resident’s assessment stated that she had a diagnosis of Alzheimers disease and the poor short-term memory. The sections of the care plan on mental health needs and daily living skills had not
Woods Court Care Home DS0000035542.V282814.R01.S.doc Version 5.1 Page 11 been completed. This care plan had also not been signed by the resident or their representative. The third care plan did contain appropriate information and had been reviewed on a regular basis. However the resident had not signed it. At the last inspection the homes medication systems were checked in detail and had been, generally well maintained. Two requirements were made following the inspection to ensure the safety of the residents. The home is now recording a temperature in the room where medication is stored on a daily basis. However it was noted that the risk assessment for a resident who administers some of her own medication had not been reviewed since 2004. This risk assessment must be reviewed regularly to ensure that the residents remain safe to continue to administer their own medication. Woods Court Care Home DS0000035542.V282814.R01.S.doc Version 5.1 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): 12,14,15. The home is no longer providing sufficient activities to meet the residents social and recreational interests and needs. Generally residents are helped to exercise choice and control over their lives but the home must provide details of how they can get access to their personal records. A wholesome and appealing well-balanced diet is being provided. EVIDENCE: Since the last inspection the member of staff who was providing a comprehensive range of regular activities has retired. Although she continues to provide a service one day a week on a voluntary basis some residents stated they would like more frequent and varied activities to be provided. The senior staff stated that they are currently trying to recruit a member of staff specifically to organise and implement activities with the residents. It was noted that some activities are still being provided however there was no up-to-date information about activities circulated to the residents. Only one of the residents records viewed during this inspection contained details of their past and present social interests.
Woods Court Care Home DS0000035542.V282814.R01.S.doc Version 5.1 Page 13 Residents are given the opportunity to manage their own financial affairs wherever possible. The literature supplied the prospective residents informs them that the home will provide written procedures identifying how they can contact external advocates and gain access to their personal records. The home did have literature detailing how to contact advocates but not how they could gain access to their personal records. The lunch provided for the residents on the day of this inspection appeared wholesome and nutritious. The inspector was advised that fresh vegetables are provided every day. (This is good practice). All of the homemade puddings are produced using artificial sweeteners so that the residents who have diabetes can eat the same diet as everyone else. (This is good practice). The residents spoken with were all full of praise for the food provided by the home. They confirmed that there is always plenty of food available and that an alternative will be provided if they do not want the food suggested on the menu. Residents stated that they could eat their meals in their bedrooms if they wish to. One person said that they choose to eat all of their meals in their bedroom. They said that they really appreciate this flexibility. Woods Court Care Home DS0000035542.V282814.R01.S.doc Version 5.1 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): X None of these standards were assessed as part of this inspection but all of the key standards were found to be acceptable at the previous inspection completed in September 2005. EVIDENCE: Woods Court Care Home DS0000035542.V282814.R01.S.doc Version 5.1 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): 19,26. The home has been maintained to a good standard and a lock has been fitted to the new laundry door to ensure that the resident’s health and safety is not put at risk. EVIDENCE: The inspector had been made aware that there had been some building work completed at the home. A second lounge has been created to provide additional communal space for the residents who have dementia. A lounge for people who wish to smoke as also been created and the laundry area has been extended. The lounge areas were being decorated at the time of the inspection and the inspector advised the senior staff that these rooms must not be used by residents until appropriate to call bells had been fitted. These alterations have improved and increased the amount of communal areas available to the residents.
Woods Court Care Home DS0000035542.V282814.R01.S.doc Version 5.1 Page 16 The senior staff was reminded that a copy of the Building Regulations Certificate and the Planning Permission for the laundry extension must be forwarded to the commission for social care inspection. Woods Court Care Home DS0000035542.V282814.R01.S.doc Version 5.1 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): 27,30. With the exception of social activities sufficient staff are provided to meet the assessed needs of the current residents. Staff are trained and competent to do their jobs. EVIDENCE: The staff rotas for the week of this inspection were assessed. The minimum required staffing levels were being provided. However the home has several staff vacancies and part-time staff are having to work additional hours to ensure that the shifts are adequately covered. The residents spoken with stated that although the staff always seemed very busy they do feel that they are “well looked after” and that the staff are always friendly respectful and helpful. The residents did say that they are missing the staff who previously organised the activities within the home, even though she continues to work one day a week on a voluntary basis. The staff training records show that staff are receiving appropriate training. 63 of the staff have completed NVQ level 2 or above and four additional members of staff were completing her training at the time of this inspection. (This is good practice).
Woods Court Care Home DS0000035542.V282814.R01.S.doc Version 5.1 Page 18 The member of staff spoken with during the inspection confirmed that she had completed a TOPS induction course and that she was currently completing her NVQ level 2 in care. Woods Court Care Home DS0000035542.V282814.R01.S.doc Version 5.1 Page 19 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. The home is run in the best interests of the residents. Resident’s financial interests are safeguarded. EVIDENCE: Since the last inspection the manager has given stakeholders in the community e.g. GP’s Chiropodists District Nurses etc, an opportunity to comment on how the home is achieving its goals for the service users. The information received has been made publicly available. (This is good practice). The residents personal finances administered by the home and the records of items handed in for safekeeping, were checked at random and had been well maintained. Woods Court Care Home DS0000035542.V282814.R01.S.doc Version 5.1 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X X Woods Court Care Home DS0000035542.V282814.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? 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 Requirement It is required that documentary evidence shows that residents and where appropriate their relatives, are involved in the production & review of care plans. (Timescale of 01/11/05 not complied with.) It is required that the risk assessments for residents who wish to administer their own medication are reviewed on a regular basis. (Timescale of 08/09/05 not complied with. It is required that the registered person consults with residents about a programme of activities to be arranged by the care home & provide suitable facilities for social & recreational purposes. It is required that the Registered Person ensures that all residents are made aware of how they can gain access to their personal records. Timescale for action 22/02/06 2. OP9 12 22/02/06 3. OP12 16 (3) 03/03/06 4. OP14 15 03/03/06 Woods Court Care Home DS0000035542.V282814.R01.S.doc Version 5.1 Page 22 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 7 Good Practice Recommendations It is recommended that the personal history section of the care plans are always completed so that staff are aware of residents lifestyle and interests prior to there admission to the home. (This recommendation is outstanding from the last inspection). Woods Court Care Home DS0000035542.V282814.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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