CARE HOMES FOR OLDER PEOPLE
Woodthorpe View Care Home 53 Woodthorpe Drive Woodthorpe, Arnold Nottingham NG5 4GY Lead Inspector
Jayne Hilton Unannounced Inspection 10th April 2006 08:00 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 Woodthorpe View Care Home DS0000008767.V288211.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. Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Woodthorpe View Care Home Address 53 Woodthorpe Drive Woodthorpe, Arnold Nottingham NG5 4GY 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) 0115 9624556 0115 9525951 Mrs Rhoda Emaline Ellis Mr Michael Ellis Mrs Rhoda Emaline Ellis Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th February 2006 Brief Description of the Service: Woodthorpe View is a large converted residential house on two storeys with a modern extension. It provides care for up to 28 older people. The home is in a residential area Nottingham and is close to local shops, park and other amenities. The home has a large sitting room with a range of comfortable arm chairs, and a dining room with small tables so that service users can sit together to eat. There is an all season conservatory leading off the dining room. This looks out on to a patio area which has seating and can be accessed via a patio door. There are twenty eight single bedrooms, twenty one of them with ensuite facilities. The bedrooms are well decorated and furinshed and service users can personalise them with their own belongings. There are bathrooms on each floor with adapted baths and shower, 4 toilets on the ground floor and 2 on the second. There is a lift between the two floors which is large enough for a wheelchair. All access within the home is level. The home has a number of pets including small dogs, a cat and birds. There is a parking area to the side of the home. The Registered Manager reported on 10/4/06 that the current fees are between £281 and £319, depending on the assessed level of dependency of individuals. Service users pay for any hairdressing and chiropody in adddition to the fee. Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Regulation Inspector Jayne Hilton carried out the unannounced inspection on 10th April 2006 for duration of five and a half hours. The focus of the inspection was to assess if compliance had been achieved for the requirements set at the previous inspection. Some of which were made as additional immediate requirements after a CSCI management review on 5th September 2005 and at the inspection carried out on 13th February 2006. All other key standards were also assessed. The methodology used included, examination of four care plans, two of which the individuals were case tracked and examination of other associated records and systems such as accident records and medication. Speaking with five staff members and the Registered Provider/Manager, a part tour of the building, observation of practices and speaking with seven service users and a relative. There had been much progress made since the previous inspection and most of the requirements set had been met or partly met within the agreed timescales. The Provider and Duty Manager now have a copy of the National Minimum Standards and Care Home Regulations 2001 for Older Peoples Services and therefore are now familiar with the expectation and ethos of these. A partly completed action plan has been received from the Registered Provider detailing the action to be taken to comply. The Registered Provider is reminded that an action plan for any immediate requirements must be responded to by return of receipt of the formal immediate requirement letter and an action plan for the requirements set with the report must be returned within 28 days of receipt of the report. What the service does well:
Those service users spoken with praised the home and reported that they were comfortable and well looked after. Certainly observations by the inspector on the day of the inspection confirmed this. Service users were well presented and appeared relaxed and contented. Service users also spoke well of the staff and of the care and food that they received. The inspector observed good rapport between staff and service users. The accommodation provided is of a good standard, clean and well decorated and presented. Service users live in a comfortable, clean and generally safe and well maintained environment.
Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 6 Adequate provision of washing, toilet and bathroom facilities are in place. Service users do have some specialist equipment to maximise independence but a review on manual handling equipment and practices is needed. Bedrooms are well equipped and personalised. The home was clean and smelled fresh throughout. Service users needs are fully assessed and feel their needs are met by the home. Further work will enhance the documentation already in place. Service users are confident that their complaints will be taken seriously and acted upon. Service users rooms were lockable and had provision of lockable facilities, [Evidence of the issue of keys or a suitable risk assessment where service users are not able to hold a key should be included within the care plan]. The temperature of the home was very warm, however the temperature of the home was varied in sitting areas to enable service users to sit where they felt most comfortable. Radiators in bedrooms were thermostatically controlled and most were covered or of the low surface type. Much progress has been made in the development of assessment documentation and the home is now using a pre-assessment document and the Roper Logan and Tierney Model for activities of living. Information is included in the assessment in relation to a history of falls. The assessment documentation includes likes and dislikes of service users and there was evidence that one relative had signed the assessment document. Risk assessment tools were also in place for tissue viability, manual handling, and continence and infection control. Care plans are in place and although they would benefit from some further development on the whole the system in place is satisfactory. Equality and Diversity is respected in the following ways: Care staff were aware of the equal opportunities policy in the home and what this meant in relation to their practice. Care plans contained information about service users religious needs, sexuality, age, disability and gender. Care practices were observed and no concerns were highlighted in this topic. The assessment and care planning documentation however need to address any race or cultural issues of service users. There are no service users currently residing in the home with ethnic or cultural needs. The overall outcomes for service users are assessed, as good. Service users scored the home between 6-8 out of ten for quality. One service user felt that the conservatory should be painted in a brighter colour such as cream; another stated that the staff had helped her eating problems. A relative praised the care provided for her relative and said that her relative had put weight on since moving to the home. She also said she is always made welcome by the staff and management when she visits. Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 7 What has improved since the last inspection?
Information is now included in the assessment in relation to a history of falls. The registered person reported that other service users and relatives did not wish to be involved in the process and written declarations have been obtained where service users or their representatives wish not to be involved. The assessment and care plan process is reviewed monthly. Care Plans now include nutritional assessments with the weight charts and care plans to monitor the nutritional needs of service users. Service users psychological needs were also noted within the communication sheets, revision and addition to the care plans would encompass this. The new assessment documentation includes a section for recreational needs but this was not completed on every care plan. Progress is therefore noted, however the development of an activities programme and documentation of who has refused participation would improve the system further. Efforts has been made to improve the recruitment standards and the immediate requirement set at the last inspection was found to be met. There was evidence that the training provision had been improved. Manual handling training has been booked and observation of practices was satisfactory. The systems in place for handling medication have been improved and are now satisfactory. The registered person is continuing to update her knowledge and skills further to current practices by attending training courses. Staff spoken with confirmed they have one to one discussions with the manager and Senior Care person and discuss their training and development needs but this is not being documented. Record keeping has improved and most of the repairs have been completed. Windows on the first floor are now fitted with restrainers. Radiator covers have been ordered for the two radiators in the main lounge that were, noted to be hot to the touch at the previous inspection. The laundry door is kept closed and locked when not in use. A smoking room for staff is provided and the door kept open during the day. This has been appropriately risk assessed and the door is kept closed when not in use. Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 8 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. Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 9 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 Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 10 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): 2,3,4, Each service user has a contract for the home which outlines the terms and conditions of the service provided. Service users needs are fully assessed and feel their needs are met by the home. Further work will enhance the documentation already in place. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service EVIDENCE: A contract was seen in those care plans examined and the registered provider has confirmed in writing to the service user that the home can meet their individual needs. Room numbers should e included on the terms and conditions document. Much progress has been made in the development of assessment documentation and the home is now using a pre-assessment document and
Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 11 the Roper Logan and Tierney Model for activities of living. Foot care although covered within the care plans had not been incorporated into the initial assessment documentation as standard 3.3. Information has been collated in relation to a history of falls. The assessment documentation includes likes and dislikes of service users and there was evidence that one relative had signed the assessment document. The registered person reported that other service users and relatives did not wish to be involved in the process, however written declarations have been obtained where service users or their representatives wish not to be involved. The assessment and care plan process is reviewed monthly, however more detailed evaluation is needed to each aspect of care. Those service users and relative spoken with praised the home and reported that they were comfortable and well looked after. Certainly observations by the inspector on the day of the inspection confirmed this. Service users were well presented and appeared relaxed and contented. Through the case-tracking process it came to light that a service user who was admitted to the home in 2003 had been admitted out of the category of registration. The Registered Person confirmed that they fully understood the legislative requirements in relation to service user categories and that this would not happen again. Because of the length of time since the service user was admitted and that the home appears to be meeting the service users needs with support from the gereo-psychiatric services no further action is to be taken. However continual monitoring and the appropriate evaluation of care plans is needed to ensure the home can continue to meet the needs of the service user. Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 12 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): 7,8.9,10 The service users health and personal needs are generally set out in a plan of care with service users healthcare needs generally met, further progress is needed to ensure that all information and care needs are fully documented. Medication management is generally satisfactory, improved documentation must be in place regarding the injection issue raised at the inspection. Service users generally felt that their privacy and dignity was respected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service EVIDENCE: Care plans are now in place and although they would benefit from some further development on the whole the system in place is satisfactory. Guidance was given in relation to ensuring that all of the service users assessed needs were written up into a care plan format. Particular gaps were noted at this inspection in relation to Epilepsy and Aggression. Care plans need to be put into place for all of the individual service users needs and which instruct staff how the needs of the individual is to be met. Evaluation of the care plans needs to be evidenced within the review process.
Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 13 Risk assessment tools were also in place for tissue viability, manual handling, continence, infection control and nutrition, although the nutritional assessments were not completed. All of the assessment tools used need to be reviewed regularly and evidenced as such. Daily records were in place and were observed to be neat, signed and generally holistic. Visits by the GP and other healthcare professionals such as the optician, dentist and chiropodist are recorded within the care plan file on separate sheets for easy reference and to provide an accessible running history of visits. There were no service users with pressure areas and the Registered Provider/Manager reported a good relationship with the District Nurse Teams when needed. Diabetes care appears well managed. It was noted that oneservice users relative had requested that NHS Chiropody treatment be accessed for the service user. There was no information in the service users care plan that this had been requested or followed through. The Registered Person should look into the issue to see if the person meets the criteria for NHS entitlements for Chiropody. Service users and a relative spoken with conformed that their personal and healthcare needs were met by the home. Good contact was reported should relatives in the home be ill. Service users reported that staff get prompt attention from a GP should they need it. Records were seen for blood tests but did not always state the reason for the blood being taken, neither was there a record of the results. The manager and staff stated that they did not always know the reason why a service user was visited by the District Nurse to take blood and that they were not always given the results. This issue needs to be addressed with the relevant medical practice and where service users require regular/routine blood tests, this should be part f the service users care plan and the record for any follow up is clear. Where blood tests are required periodically the reason should cross reference to the daily notes and a follow up record for results and any action to be taken. One service users care notes indicated that the service user was receiving a regular injection. Staff reported that they give the service user the injection and have been trained in order to carry out this task by the District Nurse. There was no record for the training, neither was there any documentation to state that staff were in agreement to performing the task or that they had been assessed as competent to do this. Evidence of this must be provided urgently to the inspector. There was no care plan in place, neither was there any information about the prescription, although a record of when and by whom the injection was given was kept. This must be implemented promptly. Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 14 Manual handling risk assessments are in place, but these were noted not to be fully completed in relation to identified risk to staff. Consultation with the Health and Safety Executive in relation to employer responsibilities is strongly advised. Medication was observed to be stored securely and administered safely. A medication round was observed and the inspector observed appropriate practice of signing the record after visibly observing the service user take the medication and was observed to check the medication record prior to administering the medication. The temperature of the room where medication is kept is now being monitored as well as the temperature of the medicine fridge was. Records for medication was seen to be satisfactory. Staff that dispense medication have had appropriate training. Photographs of service users have been placed with individual medication records and on the individual cassettes to assist with identification. A medicines policy, which includes a drug error policy, is in place, which also prompts staff of how to obtain medical advice and assistance should a drug error occur. It is recommended that this be placed in an accessible position and reminds staff to inform CSCI under Regulation 37 Service users and a relative confirmed that on the whole service users privacy and dignity was respected and that staff knocked prior to entering rooms. Service users confirmed that they were spoken to kindly and staff, were observed interacting with service users appropriately. The inspector did observe that a male resident was shaved in the conservatory lounge and this is not good practice. Personal Care tasks should be carried out in a way that always respects the service users privacy and dignity Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Service users generally find the lifestyle experienced in the home matches their expectations and preferences and recreational interests but would like more stimulation and variance in activities. Service users maintain contact with family friends and representatives. Equality and diversity is promoted in the home and service users are helped to exercise control over their lives. Service users enjoy their meals. Service users would benefit from more choice of menu items. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was evidence that activities were provided, the manager, staff and service users confirmed this. An activities book has been set up to document when activities take place and who participates. The new assessment documentation includes a section for recreational needs but this was not completed on every care plan. Progress is therefore noted, however the development of an activities programme and documentation of who has refused participation would improve the system. Activities include bingo, which seems to be popular, movement to music, jigsaws and card games. It is recommended that the registered person further develop the provision of
Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 16 activities. Some service users reported that they would like to have more provided in the way of activities and stimulation, others were limited to what they could actually participate in due to frailty or disabilities. The inspector discussed ideas of innovation in relation to meeting more service users needs in relation to their past interests and in arranging themed events that would include all service users. Visitors reported that they are made very welcome in the home and visitors were observed to come and go throughout the inspection. The service user guide informs the reader that visitors are welcome to visit at any time and to the service users convenience and that telephone facilities are provided. Service users confirmed access to telephone facilities and personal mail is distributed upon delivery. Any assistance with reading and letter writing is provided. Equality and Diversity is respected in the following ways. Care staff was aware of the equal opportunities policy in the home and what this meant in relation to their practice. Care plans contained information about service users religious needs, sexuality, age, disability and gender. Care practices were observed and no concerns highlighted in this topic. The assessment and care planning documentation however need to address any race or cultural issues of service users. There are no service users currently residing in the home with ethnic or cultural needs. Service users confirmed they can get up and go to bed when they wish and likes and dislikes are covered within the assessment and care plan process. Service users informed the inspector that they could have alternative meal options if they didn’t like what was on the menu. The menu does not offer two choices and the cook reported that as kitchen facilities are is small, this limits the amount of food preparation and cooking. It is recommended that meal options are offered within the menu and that ways of facilitating more choice to service users is explored. Service users reported that the food was satisfactory and plentiful. A relative noted that her father had put weight on in the few months of being in the home. The Nutritional needs of service users, appears well managed. Care plans contain nutritional information. Service users reported that they are provided with a cup of tea upon waking and could have a drink any time of the day and that they enjoyed their meals. Food stocks appeared ample, fresh fruit and vegetables were seen and menus are displayed in the dining room, they appear nutritious and varied. Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Service users are confident that their complaints will be taken seriously and acted upon. Further work is required to ensure service users are fully protected from abuse. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service EVIDENCE: The complaints procedure is well displayed both in the reception/entrance and in each bedroom. The Service user guide also informs the reader about how complaints will be responded to. The registered person use s a hardback book to document complaints. There have been no complaints made to the home or CSCI since the last inspection. It is recommended that a formal system be devised with a template for recording the details of the complaint and for letters and outcomes to keep with the complaints record. Service users and a relative spoken with were confident complaints would be listened to and acted upon. There was no evidence that staff at the home have had training in Adult Protection and therefore had limited knowledge in this area. Staff confirmed that they were aware to report poor practice and that abuse was covered within their NVQ training. Separate training for staff in adult protection has been accessed but not yet completed. Care Plans contain a copy of the homes policy for adult protection; A Whistle blowing policy is also in place. The
Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 18 Registered Person should ensure that she is up to date in knowledge for reporting and referring any Safeguarding Adults issues and obtain training in this respect from The Safeguarding Adults Unit. There has been no reported Safeguarding Adults issues in the home since the previous inspection. It was reported that there was no equipment in the home used for restraint such as bedrails. The home does not have a policy for use of restraint. This should be put into place. Service users reported that they felt safe. Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24,25,26 Service users live in a comfortable, clean and generally safe and well maintained environment. Some repairs and safety issues are required to meet regulation fully. Bedrooms are well equipped and personalised. Attention is required in relation to water outlet tests. The home was clean and smelled fresh throughout. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service EVIDENCE: Woodthorpe View offers a well- maintained, clean and comfortable environment for those who reside at the home. A Victorian House with a purpose built extension, car parking facilities and patio garden to the front of the home with seating. A large lounge, dining area and conservatory provide adequate communal space. 28 bedrooms have an on call system and grab rails are sited throughout. Six bedrooms have en-suite facilities with showers sixteen have WC’s. The six bedrooms without WC’s are sited close to others. Service users rooms examined were well equipped, clean and appeared
Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 20 comfortable. A passenger lift provides access to the first floor. There is no equipment to aid with manual handling and this aspect needs to be reviewed. The registered person reported that she has plans to install a new bath with a chair lift. Room sizes were not measured at this visit. Service users rooms were lockable and had provision of lockable facilities, [Evidence of the issue of keys or a suitable risk assessment where service users are not able to hold a key should be included within the care plan]. Since the last inspection windows on the first floor have been fitted with restrainers. The temperature of the home was very warm, however the temperature of the home was varied in sitting areas to enable service users to sit where they felt most comfortable. Radiators in bedrooms were thermostatically controlled and most were covered or of the low surface type. Two radiators in the main lounge were hot to the touch and chairs were placed close to them. This posed a risk to service users and the risk must be minimised by some form of cover. The manager reported that covers are on order and are to fitted imminently The home was bright and lighting of a domestic type. A sample of water temperatures were taken and found to be satisfactory. Records for these were not however available for inspection and they should be kept in the home for inspection. Laundry facilities are generally satisfactory and personal protective clothing and gloves seen to be in supply and used around the home. A bathroom was not in use and is awaiting attention from a plumber. Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29, 30 The numbers of staff meets Service users needs and NVQ training is ongoing Service users are supported by the homes safe recruitment practices. Training provision for staff is improved. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service EVIDENCE: Two care staff, one cook and one domestic were on duty alongside a duty manager and the registered person, another staff member was asked to attend duty by the manager because of the inspection, to ensure service users needs were met. A Duty rota was observed to be in place. Domestic and catering hours appear to be above the minimum levels and two staff covers nights. Currently twenty service users are in residence. The inspector did observe that at times staff took breaks, there was no staff in the lounge areas and service users were seen to require assistance during their absence. A sample of four staff personal files was examined and found to be satisfactory in relation to recruitment practices. No new staff had been employed since the last inspection. The personal files of staff were well organised, training and development information is being progressed and developed.
Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 22 A checklist on the front will enable the registered person to keep a check on the progress of documentation gathering for new staff. All staff have undertaken training in fire safety and infection control, health and safety, first aid. Manual handling and food hygiene training is booked. There was no evidence of induction and foundation training for staff, but no new staff had started since the requirement was set. The manager reported that an outside consultant is currently devising an induction programme. A number of staff has enrolled to undertake NVQ training; most are halfway through to completion. Training should be provided in epilepsy management and dealing with aggression and challenging behaviour. Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 23 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): 31,33,35,38 The registered person needs to continue to update her knowledge and skills further to current practices and the home is not run in the best interests of service users, as there is no quality monitoring in place. Service users financial interests are safeguarded. Staff supervision needs to be fully documented. Further work must be undertaken in relation to Manual Handling Operations Regulations, Water storage and safe temperatures to ensure the health, safety and welfare of service users and staff is fully promoted and protected. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service EVIDENCE: The Registered Person has attended some training sessions in house, fire safety and diabetes management, health and safety and first aid. The
Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 24 Registered Person reported that learning and updating had resulted from the compilation and development of the new care plans. The registered person is near to retirement age and therefore re-considering her future at the home. The Registered Person reported that she may consider undertaking NVQ 4 and will endeavour to attend any training in the future to update her knowledge. The manager and staff confirmed staff meetings to take place but these are not documented. There are no Quality Monitoring systems in place. This must be put into place and is required by regulation. Discussion took place about using service user and relative questionnaires and obtaining views of visiting professionals and then evaluating and feeding back the results and changing the service according to information gained. It was suggested that these be carried out on a quarterly basis and cover a topic at a time, such as food provision and menus and activities and entertainment etc. As the Registered Provider is in day-to-day control of the home as Registered Manager there is no obligation to undertake the requirements of Regulation 26, however the Provider/manager may find it useful to undertake the visit and report as part of the quality monitoring systems in the home. An annual development plan should be set up based on a systematic cycle of planning-action-review, reflecting on aims and outcomes for service users. The Registered Person should explore implementing a professionally recognised quality assurance system and organising relative/ resident meetings. Standard 35-The Registered Person reported that no monies were held on behalf of service users and that if any valuables were to be stored for safekeeping appropriate receipts and procedures would be in place. The Registered Person reported that she supervises staff regularly, staff spoken with were able to confirm this had taken place and what had been discussed, however this appears to be verbal and still not documented. The registered person has made a commitment that this will be addressed within the next few months. As progress has been noted in compliance with other requirements set within a short timescale from the previous inspection a further timescale has been agreed for supervision and appraisals to be fully documented. The accident book complies of a type with the Data Protection Act. A sample of accident records were seen and appeared to be completed appropriately Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 25 Records in relation to safe water outlet temperatures must be available for inspection at all times. Water outlet temperatures for communal areas for bathing and washing and in sinks in service rooms must be regulated to no higher than 43 degrees to prevent risk of scalding and records kept of checks/tests of these. A record was seen for the running of showerheads as a means to the prevention of legionella but no storage temperatures or evidence of any other system was provided. The Registered Manager reported that advice had been obtained from the Environmental Health Officer in relation to this, but required further guidance of what needed to be implemented. This must be actioned promptly. Health and Safety Posters were seen and completed. Staff have now been trained in safe health and safety practices and first aid. Food hygiene training is booked for 19th May 06. Although the manual handling practices that were observed appeared to be carried out in a safe and satisfactory manner, risk assessments had been partly completed in relation to mobility, transfers and assistance given to service users, the possible risk to the staff member involved in the task needs to be explored in more detail and the Registered Provider is advised to seek advice and information from The Health and Safety Executive in relation to employer responsibilities under the Manual Handling Operations Regulations. There is also no manual handling equipment in the home as the manager states that the home provides personal care only and only admits service users who are mobile. Most service users have some mobility needs and use walking frames. Training in manual handling has been arranged for staff for 24th April 2006. Manual handling skills are required to assist service users to transfer from chairs to beds and when service users suffer a fall or when they increase in frailty or become ill. It was explained that both service users and staff need to be safeguarded regarding safe manual handling practices and training and appropriate equipment should be provided. There are currently no risk assessments in place for safe working practices, however it was reported that a consultant is working on and these should be in place shortly. At the previous inspection there was no evidence of a five-year electrical circuit safety check, evidence has been provided that work has commenced and will be completed during the summer months, as the circuits will require switching off. Paper hand towels should be provided in the staff toilet. Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 26 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 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X 3 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 2 X 2 Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 27 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 OP8 Regulation 12, 13, 14, 15, 17,18 Requirement Ensure that the reason for and the details of the prescription injection for the identified service user is fully documented in the service users plan of care and on the Medication Administration Record Charts. Evidence must be provided to CSCI that those staff who are administering the injection have a, agreed to doing so, b, have received training from the District Nurse and c, that the District Nurse has assessed the staff members as competent and takes full responsibility for the staff members actions. Should the evidence not be provided by the timescale set, Staff must not be permitted to undertake the task and the District Nurse be contacted to undertake the task routinely. 2 OP9 12, 13, 14, 15, 17,18 Ensure that the reason for and 10/05/06 the details of the prescription injection for the identified service user is fully documented in the
DS0000008767.V288211.R01.S.doc Version 5.1 Page 28 Timescale for action 10/05/06 Woodthorpe View Care Home service users plan of care and on the Medication Administration Record Charts. Evidence must be provided to CSCI that those staff who are administering the injection have a, agreed to doing so, b, have received training from the District Nurse and c, that the District Nurse has assessed the staff members as competent and takes full responsibility for the staff members actions. Should the evidence not be provided by the timescale set, Staff must not be permitted to undertake the task and the District Nurse be contacted to undertake the task routinely. 3 4 5 6 7 8 OP19 OP33 OP36 OP38 OP38 OP38 16,23 24, 26 18 12, 13, 16, 23 12,1 3, 16,23 12, 13, 16, 23 Ensure the faulty bath is repaired Systems must be in place for Quality Monitoring. Staff supervision sessions must be fully documented Evidence must be provided that water outlet temperatures do not exceed 43 degrees. Evidence must be provided that systems are in place for the prevention of legionella Evidence must be provided that the Registered Person as consulted with the health and Safety Executive in relation to Manual Handling Operations Regulations, associated policies, risk assessments and the provision of equipment for safe handling practices 10/06/06 13/06/06 10/06/06 10/06/06 10/06/06 10/06/06 Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 29 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 Refer to Standard OP2 OP3 OP7 Good Practice Recommendations Ensure the room number is stated on the terms and conditions documentation Ensure a section for Foot care is included in the assessment and care plan process Ensure care plans are devised for all of the service users needs including the topics covered in St 3.3 and includes behaviour and epilepsy and all are individually evaluate d and reviewed Ensure all of the risk assessment tools used are fully completed and reviewed. Ensure details of blood tests are fully documented, part of a care plan if appropriate and are also appropriately followed up. Follow up the relative’s request for her relative to receive NHS Chiropody. Ensure service users privacy and dignity is respected regarding personal care tasks in communal areas. Formalise the activities provision and be more innovative in relation to stimulation and events. Include the assessment of service users ethnic and cultural needs. Explore ways to offer more meal choices on the menu Formalise the complaints procedure –devise a template and appropriate file Ensure a policy is in place for use of restraint and ensure staff are aware of this. Evidence should be provided in care plans that service users have been given the option of holding a key for their bedroom door and lockable facilities and if not able to do so an appropriate risk assessment should be in place. Staff should take staggered breaks, so that staff are always at hand if service users require assistance. Training should be provided in epilepsy an dealing with challenging behaviour Staff meetings should be documented and minutes kept. Service user surveys should be set up and cover activities and meal options initially
DS0000008767.V288211.R01.S.doc Version 5.1 Page 30 4 5 OP8 OP8 6 7 8 9 10 11 12 OP10 OP12 OP14 OP15 OP16 OP18 OP25 13 14 15 16 OP27 OP30 OP31 OP33 Woodthorpe View Care Home 17 18 19 OP33 OP33 OP38 An annual development plan should be devised for the home. It is recommended that the Registered Provider/Manager uses the Regulation 26 format to audit the homes services. Paper hand towels should be provided in the staff toilet. Woodthorpe View Care Home DS0000008767.V288211.R01.S.doc Version 5.1 Page 31 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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