CARE HOMES FOR OLDER PEOPLE
Woodside Hall Woodside Wootton Bridge Isle Of Wight PO33 4JR Lead Inspector
Mark Sims Unannounced Inspection 14:10 6 January 2006
th 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 Woodside Hall DS0000012570.V250531.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. Woodside Hall DS0000012570.V250531.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Woodside Hall Address Woodside Wootton Bridge Isle Of Wight PO33 4JR 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) 01983 882415 01983 884578 Colville Care Limited Mrs Deirdre Lynn Shortt Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20), Physical disability (2), Terminally ill (5) of places Woodside Hall DS0000012570.V250531.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The category PD (female) relates to current resident only and will not apply when this person is no longer resident. 31st August 2005 Date of last inspection Brief Description of the Service: Woodside Hall is located at the far end of New Road and is approximately 1.5 miles from the amenities of the local town. The premises is a large period property set within its own substantial grounds, the front of which has been given over to parking and the rear which has been laid mainly to lawn. Service user accommodation is mainly single occupancy, although several multiple occupancy rooms are available for people who wish to share. The accommodation is divided between two main floors accessible via the passenger lift, although the first floor is split-level with the latter half of the floor accessible via a chairlift or stairs. Woodside Hall DS0000012570.V250531.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was undertaken unannounced and formed the second statutory inspection of the year for Woodside Hall Nursing Home. The inspection focused on those core standards not addressed at the 31st August 2005 inspection and various sources of evidence were considered in the formulation of judgements: records, observations and discussions with service users, relatives/visitor and staff/management. What the service does well:
The service experiences a very low turnover in staff, leading to a stability within the staff team that enables them to build a good understanding of each other’s strengths and weaknesses when attending or delivering care to the service users. Another positive effect of such stability is that service users and the families are able to establish and build very good relationships with the staff, as evidenced on several occasions when observing interactions between service users or their relatives and members of the staff team. These relationships and the understanding of what people like (their personal preferences), enable staff to instinctively know what a person wanted when called or quickly identify what somebody required if their communication skills were a impaired, etc. Conversations with staff showed them to be a relaxed, confident and capable group, who appreciated and understood the needs of the people they cared for and who enjoyed the relationships they had built up with service users and their relatives, as this helped generate a positive and comforting environment within which to live and work. The environment, which was not heavily focused upon during this visit, remains a plus for the home, despite problems relating to transportation and the home’s remote location. In fact it is the remoteness of the home’s location that is perhaps one of its greatest assets, as the rural countryside views across the Solent and abundant wildlife are features commented on by service users and visitors alike at every visit. Internally the premises is extremely well maintained, with the majority of the accommodation provided within single occupancy bedrooms, many of which are now en-suite. Communal areas are well appointed and as the home is only registered to accommodate a total of 20 people the lounge and dining facilities offer adequate space to relax and socialise.
Woodside Hall DS0000012570.V250531.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: 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. Woodside Hall DS0000012570.V250531.R01.S.doc Version 5.0 Page 7 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 Woodside Hall DS0000012570.V250531.R01.S.doc Version 5.0 Page 8 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): None. No Standards were reviewed under this section of the report, as all core standards were satisfactorily reviewed at the 31st August 2005 inspection. EVIDENCE: None. Woodside Hall DS0000012570.V250531.R01.S.doc Version 5.0 Page 9 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): Standard 9. The qualified staff are responsible for ensuring that the service users’ medications are properly accounted for, accurately documented and appropriately disposed of. Some errors in these procedures were apparent. EVIDENCE: A straightforward review of the home’s approach to the management of service users’ medications revealed that some fundamental errors have crept into the qualified staff’s practice with regards to appropriate accounting and accurate record keeping for medications. On the first visit to the home the inspector noted, when checking the numbers of medications remaining in a packet, etc. against the documented numbers administered, that on several occasions the two amounts did not tally and that there were either too many or too few tablets remaining. On returning to the home and discussing this with the manager it became apparent that some of the problems are occurring at source, in as much as the pharmacy is making dispensing errors. Woodside Hall DS0000012570.V250531.R01.S.doc Version 5.0 Page 10 However, the mistakes made by the pharmacy have not been picked up by the home, as on receipt of the medicines the staff are dip sampling the medications (checking the delivery against the prescription), instead of checking each medication delivered, as recommended, against the prescription. Following the inspector’s visit on the 6th of January the manager had personally checked the next batch of medications received into the home and had picked up several discrepancies, which she had addressed with the pharmacy and which they had undertaken to remedy immediately. In addition to the medication balance issue the inspector also noticed on a couple of occasions that staff are failing to record accurately why a client might have refused or had omitted a medication. This particular issue when it arises is always bewildering, as all services and/or the medication administration records (MAR), have specific codes available for use, i.e. R = Refused or A = Asleep, etc., as is the situation at Woodside Hall. The final issue specifically involves the disposal of controlled medication, which following changes to environmental legislation now requires nursing homes to contract with an environmental agency for the collection and disposal of all waste medications (controlled and non-controlled). However, in the specific case of controlled medications homes are required to purchase specialist kits that destroy or putting beyond use the controlled substance before collection; and it was this issue that the home was noted to have failed to address, as they had not arranged to purchase the necessary equipment for the treatment of a controlled substance, opting instead to retain the medicine with their controlled drugs cabinet, the medication having not been required since October 2005. Whilst none of these issues has as yet directly impacted upon the service users, the potential, especially given the accounting concerns for service users to be detrimentally affected exist, and the management will need to take steps to ensure the concerns raised are addressed. Focusing for a moment on the service users it was established with the nurse in charge that currently no-one is self-medicating, although lockable facilities are provided within each bedroom. Whilst observing the medications being administered to service users it was pleasing to note the time taken by the staff member to ensure the service user understood the medicine(s) was for them and that they had taken the medication before moving onto the next person. Woodside Hall DS0000012570.V250531.R01.S.doc Version 5.0 Page 11 In discussion with service users it became apparent that the home’s routines ensure they receive their medications in a timely and appropriate manner, the majority of medication rounds coinciding with mealtimes and/or drinks rounds. Woodside Hall DS0000012570.V250531.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): Standards 12 & 15. People enjoy participating in the social, religious and recreational opportunities afforded them at Woodside Hall. Service users receive a choice of meals which are wholesome, appetising and well presented, which can be consumed wherever the person chooses. EVIDENCE: It had not been the inspector’s intention to review Standard 12 at this visit, as he had audited the home against this standard during the 31st of August 2005 inspection visit and found no problems. However, during this inspection both service users and their families/visitors repeatedly mentioned the efforts made by the home and the staff to ensure Christmas was a fun and enjoyable experience for everyone. One especially appreciated festivity, which was praised by everyone spoken with, was a tree decorating party, which both the service users and their relatives were invited to attend and which included a large buffet style banquet, drinks and festivities culminating in the tree decorating which again everyone was enabled to participate in, each person invited to place an ornament on the tree.
Woodside Hall DS0000012570.V250531.R01.S.doc Version 5.0 Page 13 The Christmas Day meal was also commented on for being both a good traditional meal and also a fun and enjoyable social occasion that was made all the more entertaining by the antics and involvement of the staff that were described as having really thrown themselves into the festive activities and Christmas spirit. Generally the meals within the home were praised with both service users and their relatives commenting on the choice of foods offered and how well the meals are prepared and served. During this visit the inspector had arrived too late to observe the main meal being served or consumed, although he was able to observe the arrangements for teatime, which largely consisted of a range of cold platters, sandwiches, etc. When questioned about the lack of a hot alternative the staff member preparing the evening meal stated that normally a hot alternative is included on the menu but as the service users regularly had a cooked breakfast and cooked main meal (fish) on Friday’s people invariably could not eat another large meal. In talking to this staff member it was establish that cooked breakfasts are offered to service users three times a week (Monday, Wednesday and Friday), as a matter of routine, although if required they could have a cooked breakfast at any time. It was also evident from scanning the food stores that adequate stocks of fresh, frozen and preserved food items are available within the home and that should patients require any alternatives to the main meal options sufficient scope was available for a choice of alternatives to be offered. Whilst talking to service users and/or their relatives/visitors within the communal areas of the home the staff were observed bringing round afternoon tea, which also included either a slice of homemade cake or biscuits. It was established through discussions with relatives that this is a regular occurrence and that cake is always available with afternoon tea should their relative or they like it, relatives are offered drinks if visiting. Woodside Hall DS0000012570.V250531.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): Standard 18. The management has taken steps to ensure that carers are appropriately equipped and skilled to promote patient safety and protect them from potential abuse. EVIDENCE: In conversation with the manager it was established that she had arranged for a senior staff member to attend the local authority training course on adult protection management and in particular the three-day course to become an adult protection instructor. The course was specifically arranged and organised by the local authority ‘adult protection team’ to equip people with the necessary skills and knowledge to train others working within the private care sector on the protection of vulnerable adults from abuse. Having completed the course, the manager is planning for the senior carer to commence adult protection training within the home, the course not only providing skills and knowledge around adult protection issues but also a training package for use with other staff. It is envisaged that the in house training should build upon and reinforce the training completed by staff during their induction training, the ‘Skills for Care’ induction units covering adult protection procedures and National Vocational Qualifications, which also considered issues around promoting the safety and wellbeing of service users.
Woodside Hall DS0000012570.V250531.R01.S.doc Version 5.0 Page 15 Conversations with service users and relatives suggest that whilst issues of abuse are of a concern in a generalised sense, there appears to be no immediate concerns with regards to people being abused, etc. within the home, this largely the result of the trust that exists between the patients, relatives and staff and the confidence in the management that any issues would be dealt with appropriately and speedily. Woodside Hall DS0000012570.V250531.R01.S.doc Version 5.0 Page 16 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): Standard 26. The home is clean, tidy and free from offensive odours. EVIDENCE: A tour of the premises demonstrated that the home was clean, tidy and free offensive odours. It also established that each bathing or toileting facility was equipped with paper towels, liquid soaps, hand wash basins and clinical/domestic waste bins. At various times during the inspection staff were noted to be wearing aprons and/or disposable gloves and these appeared to be readily and easily accessible. In conversation with care staff it was ascertained that a dedicated domestic staff team is employed to maintain the hygiene levels within the home, although specific issues of infection control and the limitation of the spread of infection around the home is shared equally between staff members. Woodside Hall DS0000012570.V250531.R01.S.doc Version 5.0 Page 17 In discussion with service users it was clear that they appreciate living within a well maintained and clean environment, a view shared by relatives, one person commenting on how when they came to look at the home it was the first they had entered that had no detectable odours. Woodside Hall DS0000012570.V250531.R01.S.doc Version 5.0 Page 18 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): Standard 28 & 29. Staff training is sufficient to ensure appropriately skilled employees who are competent in their jobs care for service users. The manager of the service should have access to staff files and details of the recruitment and selection process completed. EVIDENCE: To date 8 of the home’s 13 staff possesses a National Vocational Qualification (NVQ) at level 2 or above with a further 1 carer in the process of completing their NVQ qualification. Currently this means that 61.5 of the staff team hold an NVQ qualification, which should rise to 69 in 2006 when the additional staff member completes her course. As repeatedly reported throughout the body of the report the service users and their relatives hold the staff in high regard and consider them to be kind, caring and dedicated people who deliver a consistently high quality of care. In discussion with the manager it became apparent that she appreciates the efforts and drive shown by the staff team to constantly improve their skills and knowledge; and that she respects the decision of some staff not to undertake NVQ courses, as they feel the timing is not right for them career wise. Woodside Hall DS0000012570.V250531.R01.S.doc Version 5.0 Page 19 At the last inspection undertaken on the 31st August 2005, the home was required to: ‘make available for inspection those records required for inspection purposes’, namely the staff recruitment files. It was also recommended that this be achieved by: ‘The manager discussing with the directors the issue of accessing information required for inspection purposes in their absence’. However, on reviewing the company’s response to this requirement it was established that no action has been taken and that despite the timescale set for compliance no contact had been made with the Commission to renegotiate the timescale. Woodside Hall DS0000012570.V250531.R01.S.doc Version 5.0 Page 20 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): Standards 31, 33 & 35. The home is well run by a manager who is appropriately skilled and qualified. The interests of the service users are safeguarded by the home’s quality auditing process. The home’s approach to supporting service users manage their finances enables people to be self sufficient and/or able to purchase items as they wish. EVIDENCE: The manager is a skilled and competent leader who possess both a managerial qualification, ‘The Registered Managers Award’, and relevant professional nursing qualification ‘Registered Nurse’. In conversation with the service users and their families it was established that the manager, as with all of her staff, is considered approachable, supportive
Woodside Hall DS0000012570.V250531.R01.S.doc Version 5.0 Page 21 and caring, and people who have the best interest of the service users at heart. Quality management is presently handled by the home’s manager in association with the company’s director of nursing, with an annual service user satisfaction surveys used to gather information about people’s opinions of how the service is meeting their needs (the questionnaires circulated every April), environmental assessments, the review and revision of records and record keeping practices and the updating and monitoring of policy and procedure for the home. In conversation with the service users, only one of the people asked could clearly recall completing or participating in the company’s quality assurance process, although given the frailty of some clients this was not an unexpected finding. However, all of the service users or their relatives were familiar with the manager and director of nursing and confirmed that they often spend time in the home meeting with people and taking an interest in their feelings regards the service and its performance. As for the staff they were less familiar with the process of quality assessment and would appear not to have too many formal opportunities to contribute to the process, as team meetings only occur once or twice a year (normally twice), a time when feedback from the questionnaires could be shared. However, staff are afforded the opportunity to discuss issues at handover, a daily occurrence between shifts, which is an informal communication tool that enables immediate issues to be discussed. As a company with several directors the home should receive regular visits from one of the directors, in accordance with Regulation 26 of the Care Homes Regulations. However, records held by the Commission indicate that these visits are either not taking place or copies of the reports to be produced are not being appropriately sent on to the Commission, an issue which requires attention, as this is the second consecutive inspection where the issue has been raised. The company historically prefer not to become involved in the direct management of service users’ finances, offering instead to support people through the provision of a tick system, the home purchasing all items required by a service user and billing or invoicing them at the end of the month. One service user presently manages their own financial affairs, with several other service users supported by their families or representatives, although the majority opt to use the system highlighted above. Woodside Hall DS0000012570.V250531.R01.S.doc Version 5.0 Page 22 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 X 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X 3 STAFFING Standard No Score 27 X 28 3 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X X Woodside Hall DS0000012570.V250531.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation Requirement Timescale for action 13/02/06 2 OP29 3 OP33 Regulation The manager must ensure that 13 action is taken to address the medication errors highlighted in the body of this report. Regulation This requirement remains 17 unaddressed from the 31 August 2005 inspection: Records required for inspection purposes must be accessible, including all staff recruitment records. Regulation This requirement remains 26 unaddressed from the 31 August 2005 inspection: The company must undertake Regulation 26 visits and forward copies of the visit reports to the Commission. 13/02/06 13/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Woodside Hall DS0000012570.V250531.R01.S.doc Version 5.0 Page 24 Woodside Hall DS0000012570.V250531.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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