CARE HOMES FOR OLDER PEOPLE
Woodthorpe View Care Home 53 Woodthorpe Drive Woodthorpe, Arnold Nottingham NG5 4GY Lead Inspector
Jayne Hilton Unannounced Inspection 15th June 2007 12:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 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.V338941.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th April 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 armchairs, 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 en- suite facilities. The bedrooms are well decorated and furnished 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 15/6/07 that the current fees are between £290 and £340, depending on the assessed level of dependency of individuals. Service users pay for any hairdressing and chiropody in addition to the fee. Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This inspection took place over five and a half daytime hours and was conducted unannounced. The main method of inspection used was called ‘case tracking.’ This involves selecting two residents and looking at the quality of the care they receive by talking to them, examining their care files and discussing how support is offered to them by staff members. Four residents, four members of staff, the registered provider/ manager were spoken with as part of this inspection, documents were read and medication inspected to form an opinion about the quality of the care provided to residents. Prior to completing this visit the inspector assessed the homes previous inspection reports, the service history including complaints and adult protection referrals. The registered provider had submitted an annual quality assurance assessment, but the Commission only received this for Social Care Inspection, the day before the inspection. A review of the registration certificate and service categories was also undertaken with the registered provider. What the service does well:
Residents live in a comfortable, clean and generally safe and well-maintained environment; they are supported and protected by trained staff and the homes recruitment practices. Residents are confident that their complaints will be taken seriously and acted upon.
Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 Page 6 Resident’s needs are fully assessed and their needs are met by the home. The lifestyle experienced in the home by residents, matches their expectations and preferences and recreational interests. Equality and diversity is promoted in the home and service users are helped to exercise control over their lives. The health and personal needs of residents are met and their privacy and dignity respected. What has improved since the last inspection? What they could do better:
Although residents appear to be consulted about the quality of the service, there are no records of quality monitoring in place. Improvements are needed to the systems for health and safety to ensure service users are fully protected from harm. The Registered Provider has demonstrated a commitment to this. Requirements are set in relation to the above. Thirteen good practice recommendations are also made. Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs are fully assessed and their needs are met by the home. The home does not provide an intermediate care 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. Much progress has been made in the development of assessment documentation and the home is using a pre-assessment document and the Roper Logan and Tierney Model for activities of living. Information is collated in relation to a history of falls. Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 Page 10 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. 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. Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal needs of residents are met and their privacy and dignity respected. EVIDENCE: Care plans are in place and staff have information they need to meet the individual needs. Risk assessment tools were also in place for tissue viability, manual handling, continence, infection control and nutrition, although the nutritional assessments were not completed. The nutritional needs of residents were however recorded. Daily records were in place and were observed to be neat, signed and generally holistic. Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 Page 12 There were two residents with pressure areas and the Registered Provider/Manager reported a good relationship with the District Nurse Teams when needed. One resident had recently developed a pressure area, and although there was information within the care plan about this, the tissue viability assessment had not been changed as stated not to be at risk of pressure areas. Also where residents are identified to be at risk of developing pressure areas a care plan needs to be implemented for how the care of this is to be managed and include what pressure relieving equipment is provided. Diabetes care appears well managed. Residents spoken with confirmed that their personal and healthcare needs were met by the home and reported that staff get prompt attention from a GP should they need it. Medication was assessed to be stored securely and administered safely. Residents confirmed that the privacy and dignity was respected and that staff knocked prior to entering rooms. Residents confirmed that they were spoken to kindly and staff, were observed interacting with service users appropriately. Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The lifestyle experienced in the home by residents matches their expectations and preferences and recreational interests. Equality and diversity is promoted in the home and service users are helped to exercise control over their lives. EVIDENCE: There was evidence that activities were provided, the manager, staff and residents confirmed this. The new assessment documentation includes a section for recreational needs, 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 activities. 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 this and that they had access to telephone
Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 Page 14 facilities and personal mail is distributed upon delivery. Any assistance with reading and letter writing is provided. No visitors were present during the inspection. 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. Residents 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. Residents informed the inspector that they could have alternative meal options if they didn’t like what was on the menu. The actual 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 residents be explored. Service users reported that the food was satisfactory and plentiful. The Nutritional needs of service users, appears well managed and 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 appear nutritious and varied. Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives may be assured complaints will be listened to, taken seriously and acted upon and that they are protected from abuse. 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. There have been no complaints made to the home since the last inspection. Residents spoken with were confident complaints would be listened to and acted upon. There was now evidence that staff at the home have had training in Adult Protection. Staff confirmed that they were aware to report poor practice and that abuse was covered within their NVQ training also. Care Plans contain a copy of the homes policy for adult protection and a whistle blowing policy is also in place. The policies and procedures in place should however be updated to ensure they contain the correct information about referral
Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 Page 16 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. There have been no issues referred under Safeguarding Adults Protocols. Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable, clean and generally safe and well maintained environment. EVIDENCE: Woodthorpe View offers a well- maintained, clean and comfortable environment for those who reside at the home. Resident’s rooms examined, were well equipped, clean and residents said they comfortable. A passenger lift provides access to the first floor. Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 Page 18 Resident’s rooms were lockable and most 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]. One service user did not have a lockable facility as new furniture had been purchased .The provider agreed to take action on rectify this at promptly. Radiators in the home were thermostatically controlled and most were covered or of the low surface type. Laundry facilities are generally satisfactory and personal protective clothing and gloves seen to be in supply and used around the home. It is recommended that paper towels be used around the home for infection control. A bathroom has recently been refurbished and a walk in bath has been fitted. The bathroom door was being adjusted and a privacy lock not yet fitted. The provider confirmed this would be dealt with promptly. Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported and protected by trained staff and the homes recruitment practices. EVIDENCE: A Duty rota was observed to be in place and was adequate to meet the needs of the twenty-one users are in residence. A sample of three staff personal files was examined and found to be satisfactory in relation to recruitment practices. The personal files of staff were well organised, training and development information is being progressed and developed. All staff have undertaken training in fire safety and infection control, health and safety, first aid, manual handling and food hygiene. The manager reported that an outside consultant is currently devising an induction programme. A number of staff has enrolled to undertake NVQ 3 training; 70 of staff have achieved NVQ 2
Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 Page 20 Training should be provided in epilepsy management and a refresher on diabetes management. Training for completing nutritional screening tools should be accessed also. Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although residents appear to be consulted about the quality of the service, there are no records of quality monitoring in place. Improvements are needed to the systems for health and safety to ensure service users are fully protected from harm. EVIDENCE: 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.
Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 Page 22 The registered person had made a commitment that this would be addressed at the previous inspection however this has not been achieved. Quality assurance monitoring is also undertaken verbally with no records of surveys being undertaken; despite the homes Statement of Purpose stating that surveys will be undertaken at least annually. Although the manager and staff confirmed that when visitors have asked to see the inspection report, this has been facilitated, it is recommended that information be posted in the home and within the service user guide which informs everyone how they can access a copy of previous inspection reports, including Internet access. The home does not handle any of the resident’s personal monies. The registered provider has recently employed the services of a health and safety consultant who has made several recommendations to the home for improvement. The registered provider is developing an action plan to address the issues raised. The registered provider must seek the advice of the Environmental Health Officer in respect of water outlet temperature testing and prevention of legionella, as no records were available. A fire risk assessment is in place The registered provider reported that work to the electrical wiring circuits had been completed and that a certificate would be issued in the near future and that a copy will be forwarded to the Commission for Social Care Inspection when received. 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. Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 Page 23 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 Page 24 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 OP33 Regulation 24 [2] Requirement Documented systems must be in place for Quality Monitoring. This will ensure that residents are appropriately consulted, that the quality of services provided to them are reviewed and that the Registered Providers Obligations under Regulation 24[2] are complied with. The Registered Provider has made a commitment to ensure that this is put into place promptly, however if this regulation is found to be in further breech at future inspections Enforcement Action will be commenced. Previous Timescales 13/06/06 NOT MET Timescale for action 15/08/07 2. OP38 23[5] The Registered Person must consult with the Environmental Health Officer in relation to ensure that systems are in place for the prevention of legionella
DS0000008767.V338941.R01.S.doc 15/09/07 Woodthorpe View Care Home Version 5.2 Page 25 and water outlet temperatures are monitored. The outcome of this consultation must be forwarded to the Commission For Social Care Inspection by the timescale set. 3 OP38 13[4][5] The Registered Person must 15/08/07 ensure that the action plan is implemented promptly in response to the outcome of the recent Health and Safety Audit to ensure the health welfare and safety of residents and staff is maintained at all times. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3 4. 5. Refer to Standard OP8 OP15 OP18 OP18 OP19 Good Practice Recommendations Ensure care plans and risk assessments are promptly updated/implemented where residents need change. Explore ways to offer more meal choices on the menu Ensure the policies and procedures for Safeguarding Adults are brought up to date in line with the agreed referral protocols for Nottinghamshire. 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. Training should be provided in epilepsy and refresher training on diabetes. Training should also be accessed in using and completing nutritional screening tools. 6. OP30 Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 Page 26 7. 8 9. 10. 11. 12 13. OP31 OP31 OP33 OP33 OP33 OP36 OP38 Staff meetings should be documented and minutes kept. Information must be provided which informs everyone how he or she can access a copy of the most recent inspection report on the home. Service user surveys should be set up and cover activities and meal options initially An annual development plan should be devised for the home. It is recommended that the Registered Provider/Manager use the Regulation 26 format to audit the homes services. Staff supervision sessions must be fully documented Paper hand towels should be provided in the home in respect of prevention of cross infection. Woodthorpe View Care Home DS0000008767.V338941.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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