Inspection on 23/07/08 for Woodtown House Nursing Home

This inspection was carried out on 23rd July 2008.

CSCI found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Woodtown House Nursing Home 03/02/10

Woodtown House Nursing Home 24/07/07

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

CARE HOME ADULTS 18-65 Woodtown House Nursing Home Woodtown House Alverdiscott Road East-the-water Bideford Devon EX39 4PP Lead Inspector Susan Taylor Unannounced Inspection 23rd July 2008 18:40 Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 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 Woodtown House Nursing Home DS0000068667.V365066.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 Adults 18-65. 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. Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodtown House Nursing Home Address 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) Woodtown House Alverdiscott Road East-the-water Bideford Devon EX39 4PP 01237 470889 01237 472634 info@woodtownhouse.co.uk Ludmilia.iyavoo@deepdenecare.org Deepdene Care Ltd Manager post vacant Care Home 28 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (28) of places Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing- Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Mental disorder, excluding learning disability or dementia- Code MD The maximum number of service users who can be accommodated is 28. 24th July 2007 Date of last inspection Brief Description of the Service: Woodtown House is registered to provide 24-hour nursing care to 28 service users with a past or present mental illness. The team of staff also have specialist experience caring for people with Huntingdon’s Chorea. The home is a large detached Georgian house standing in it’s own grounds. Although in a rural setting the home is within a few minutes drive of Bideford and Torrington. A 15-seater minibus is provided for transport. There is a large garden with plenty of seating and areas of cultivation for vegetables and plants. There are bedrooms on the ground and first floors. Seven have ensuite facilities and are suitable for disabled people. There is no lift. There is a rehabilitation flat situated on the second floor, for service users who are working towards greater independence. There are a number of different communal rooms - smoking and non-smoking. In July 2008, the fees for the home ranged between £600 £1200 per week. Additional charges are made for hairdressing (dependent upon individual requirements), toiletries and newspapers (dependent upon individual requirements). Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is Two stars. This means the people who use this service experience Good quality outcomes. The inspection of Woodtown House was done under the Inspecting for better lives arrangements. We were at the home with people for 13 hours over three days on 23rd, 25th & 28th July 2008. The purpose for the inspection was to look at key standards covering: choice of home; individual needs and choices; lifestyle; personal and healthcare support; concerns, complaints and protection; environment; staffing and conduct and management of the home. We looked at records, policies and procedures in the office. A tour of the home took place. We tracked the care outcomes for three people, all with different needs. We also spoke to people alone in private, with their key workers and in groups about their experiences living at the home. We sent surveys to all of the people living in the home and received 18 back. Additionally, 4 staff returned surveys. The comments of people that did fill in the surveys are in the report. Information was also received from this service before the inspection, as asked for by the Commission for Social Care Inspection. This was in the form of an Annual Quality Assurance Assessment (referred to in the inspection report as an AQAA). The completed assessment provided us with important information that helped us to focus what we did. As at July 2008, the fees ranged between were £ 600 and £ 1200 per week for personal care. Extra charges are made for chiropody, hairdressing, newspapers and magazines and toiletries and these vary. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk http:/www.oft.gov.uk People living at Woodtown House tell us that they feel “safe” and that the service had “very much improved of late”. Staff we spoke to told us that they enjoy working at the home and that the manager is very “supportive” and has offered them “opportunities to do training”. Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Regular reviews are now taking place with people. These are recorded and show that the team know what needs a person has. Staff time is put aside so that people have more support to go out an about. Transport has also been re-organised. This ensures that people have more choice about what they do and are able to have new experiences and learn new skills. People are confident that policies and procedures are followed so that their safety is a priority when tablets are given to them A lot of staff has left over the last year. However, people tell us that this has improved in the last couple of months. Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 7 Some bedrooms and a lounge were brightly decorated after talking to people living in the home. What they could do better: Risk assessments need to be detailed (to include assessment of falls, tissue viability, behavioural and psychological issues) up to date and looked at regularly. Risks should be managed positively to help people lead the life they want. Any limitations on freedom, choice or facilities must always be in the person’s best interests and agreed with them and/or their advocates. People must be better protected from the risk of infection. Ensure that all of the staff through training is aware of current best practice. Additionally, use the Department of Health guide ‘Essential Steps’ to look at the current situation and write a plan of how to improve on this. People must be better protected from the risk of fire. Ensure that fire drills, practices and training are done at suitable intervals with staff and people living in the home. Pre-employment checks must be obtained before new staff is allowed to work in the home to ensure that people living there are protected. People should be confident that agreed extra care is provided and a record kept so that authorities that pay for it are able to see how it is delivered. People who are at risk of falls should be assessed to ensure that steps are taken, where possible, to minimise these. Alterations should be made to improve the access to bedrooms off the main lounge so that people who do not smoke have a choice as to whether they enter the designated smoking area. This should also improve the air quality for people living in those bedrooms. People will be confident that the manager has appropriate qualifications, experience and competency to run the home once an application for registration has been made and is processed by the Commission. People should be given more frequent opportunities to comment about the quality of their life, accommodation and service. Specifically, in an annual survey. Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 8 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. Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 Quality in this outcome area is good People living in the home are confident that their needs are known and regularly reviewed with them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 66 of people living in the home responding in a survey felt that they had not received enough information prior to moving in the home. Information sent to the Commission verified that Deepdene care has updated the service users guide and statement of purpose, which are given to all new people moving into the home. We spoke to people that had moved into the home in 2008 and they told us that they had been given a booklet about the home, which “explained everything” about life at Woodtown House. Information sent to the Commission tells us that three local authorities – Devon, Cornwall and Somerset – place people at Woodtown House. We looked at care files for three people, one of which moved into the home in 2008. A care management assessment of needs had been obtained for the three people whose needs we tracked. At the last inspection Deepdene had instigated a comprehensive assessment process that is person centred and we saw evidence of this in the three files we examined. The files contained detailed Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 11 information about each person that had been used to develop a plan of care with the individual. Additionally, the assessment was risk based and looked at an individual’s behaviour, physical health including continence, mental health, ability to budget, occupational therapy, and ability to manage their own medicines. Staff told us that the system was easier to follow and were clear about when reviews needed to take place with the individual’s concerned. This demonstrates that the assessment process has improved since the last inspection. We tracked the needs of three people, of which one person’s placing authority had agreed to fund extra care for the individual for 3 hours per day to ensure ‘adequate levels of supervision’ with the intention of enabling the person to be escorted 1:1 on outings and other social events. We examined daily records and duty rosters and found it difficult to quantify how this person’s extra care needs were being met. We did establish that the person had an individual programme of activities and had done some of these over the course of the previous 3 months. We discussed this with the manager who was unable to provide any further evidence to quantify how the person’s extra care needs were being met. A recommendation is made in respect of rostering. Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is good People are involved in planning their care and quality of life at Woodtown House. Effective management of risks needs to be consistent so that the safety of people is promoted; whilst at the same time encourages people to be as independent as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at three care files. Nurses are employed as key workers, who have overall responsibility for managing the care for individuals. Needs and risks that had been identified at admission were nearly always reflected in care plans. Reviews had taken place regularly with the individual’s concerned. Care plans seen were detailed with the needs of each person and it was evident that wherever possible the individual had been fully involved in the process. Care delivered to the individuals whose records had been inspected was observed as being good. For example, we looked at the file of a person Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 13 with cognitive impairment. A behavioural plan had been developed to help the individual control their cigarette intake within reasonable limits, as the person was unable to remember when they last had one. We observed this being put into effect with the individual in a positive way that respected their dignity. We spoke in private to someone with a schizoaffective disorder recovering from substance addiction. They showed us their own copy of the ‘service users guide’ in their room. This, they told us, “gives a good picture of the home”. They went on to tell us that they “love living” at Woodtown House and saw it as their “salvation”. The person described how they coped with their illness, in particular hearing voices, and told us that the manager and staff were “all very supportive”. We looked at the individual’s care file and read assessment information, including risk assessments, about the person that had been obtained from other professionals involved in supporting them. A care plan had been written using this and other observations made by the care team at the home had been recorded. This corresponded with what the person had told us about their goals and their experiences living at Woodtown House. Daily records were full and gave a clear picture of the person’s progress since their admission to the home. We spoke in private to another person that had lived at the home for a long time who said “I feel emotionally safe at Woodtown House”. We looked at this person’s care file and saw comprehensive assessment information on file. The individual told us that regular reviews were held with them to give them an opportunity to reflect on their progress and received feedback about all aspects of their behaviour. From the lengthy conversation we had, the individual had experienced good care and a quality of life that had enriched them as a person. We observed that the person was confident and spoke openly about what worked for them and what did not work. They also told us that as they developed new skills and interests they had “taken on more responsibility” for their own life and was looking forward to moving on to a supported living service. We observed the care outcomes for a third person, who was identified as being at risk of absonding. We read a detailed personalised procedure for staff to follow in the event that the individual disappeared from the premises. Additionally, the manager told us that they they would also inform the Commission if an incident such as this occurred. In the same person’s file, the initial assessment done by the home briefly mentioned that the person also posed a significant fire risk. However, there was no risk assessment in place covering this or mention of the issue in the individual’s care plan. We discussed this with the person in charge, who looked at the care file and commented that the assessment and care plans were not up to the standard expected by Deepdene Care. They also agreed that important points identified on assessment had not been reflected in the individual’s risk assessment or care plan. We were told that further training about risk assessment and care planning was planned for qualified staff. In view of this, we agreed that the Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 14 requirement made at the last inspection should be repeated to facilitate improvement in this respect. In surveys 33 of people living in the home felt they could ‘usually make decisions about what they do each day. Comments received ranged from ‘I please myself…I tell people when I’m going out’ to ‘we have a certain amount of say in what we do…some things are dictated to us which we don’t want or like’. One person commented further with ‘sometimes you can’t always do what you want due to transport’. We explored these issues further when we met people in person and also discussed them with the person in charge. People told us that a monthly community meeting is held. Previously, one person had typed up the minutes following the meetings but had chosen to have a break from doing this. The person in charge told us that they recognised that it had been an unsettling year for people. They highlighted that as the aims and objectives of the service moved more towards rehabilitation and this coupled with problems recruiting suitably qualified staff to deliver this had resulted in some resistance to change. However, when we spoke to people at length the majority told us that they were feeling “more settled” since the new manager had started. Additionally, they said that they were being consulted more about proposed changes and felt “listened to” whenever they expressed concern and were “reassured”. The home has a policy and procedure for the management of petty cash. Monthly audits had taken place of the all the financial management systems. All of the people living in the home are being encouraged to open their own savings/bank accounts. The new manager told us that there are named key holders for the safe. We looked at records for four people. Balances tallied across records. People living in the home verified that the petty cash was accessible to them. Receipts for purchases had been obtained and balances tallied with records kept. We looked at a person’s care file and read their care plan. The person had told us that they needed a lot of support with budgetting. They told us they were well supported with this. The person’s care plan had been reviewed with the person and measures put in place to protect them from potential financial abuse. We saw correspondence on the file about this from the placing authority. The registered persons had been tasked with monitoring and managing the person’s finances with them. A clear strategy was in place that everyone understood and we observed being followed in a way that was positive for the individual concerned and promoted their dignity. Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this outcome area is good The organisation of transport and staff availability has ensured that people have better access to hobbies, outings and activities of their choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff told us that they had seen a number of improvements for people living at the home in the last year. Their comments included, “….people are informed of when things are going on i.e. outings and activities and have the opportunity to sign up for them” and “Staff spend more time talking, sitting or walking with people in the grounds to motivate them to do something other than just stagnating”. Additionally, we were told, “The clothes people are wearing are better, their appearance has improved and people look smarter”. “There was a trip to the circus recently and people are going out for meals now” Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 16 100 of people responding in a survey felt that the level of activities and outings could be improved in the home. The majority of people verified that they had choice about what they did during the day, evenings and at weekends. However their comments highlighted that there may be some limitations to this; ‘Its not always possible to do things that I wish to do due to difficulties with the system and poor organisation’; and they ‘mean well but don’t get the best out of residents’; and there are ‘no outings for some and loads for others’; and ‘not always consulted about shopping trips or going out’; and ‘sometimes you can’t always do what you want due to transport’. We spoke to several people about activities and access to transport and views were mixed. A few people believed that unfair changes had been made to the way the minibus was used and that it should be available at all times to allow them to travel into Bideford. Additionally, they told us they were expected to pay to use the minibus. The majority of people we spoke to told us that they used the minibus to go to places like the ‘Link Centre’, shopping trips and outings. None of these people had to pay for these trips. We spoke to the person in charge and asked them to clarify what the minibus is used for and what if any charges is levied to people using it. We were told Deepdene totally funds the minibus and it is used to take people to hospital appointments, the Link Centre, outings and for therapeutic purposes such as learning new skills such as shopping or going to work placements. However, people are discouraged from using the minibus as a substitute for taxis for spur of the moment additional trips that they choose to go on. We were told that Deepdene holds a contract with a local taxi firm and will pay for journeys taken for therapeutic reasons only. The Commission’s view is that this is a reasonable arrangement that is made clear in the information given to people about the home. Staff in their surveys also raised concerns that the proposed activity coordinator had not been appointed. Information sent to the Commission by the provider highlights that there are shortfalls and that they are still trying to actively recruit an occupational therapist to take up this role. However, we observed some positive outcomes for people that demonstrated that there had been some improvement in the level of community inclusion for individuals. For example, a person that previously had not left the home due to a lack of confidence was observed preparing to go out to the ‘Link Centre’ with staff. The difference for the person was that their disability was accounted for. Measures such as additional staff and mobility aids had been put in place to enable the individual to experience going out for the first time. This also had a positive affect on the person’s mental state and they told us how much they were “enjoying going out and socialising with other people”. They also told us that the day before they had joined the art therapy group and had made cards. One person showed us the vegetable patch that certain people had expressed an interest in maintaining. Several varieties of vegetables had been sown and Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 17 people said they were looking forward to seeing them grow and being able to eat their own produce. There is a three-week rotating menu with two main course choices. We were shown a record demonstrating that people are asked everyday what they would like. Additionally, people had been asked for feedback about the quality and quantity of food. We joined one person in the dining room at lunchtime. The menu was clearly displayed. People said the food is “lovely”, “very nice” and “there has been a great improvement in meals”. We were also told that “everything is fresh, no frozen meals are being given”. A member of staff had taken over the role of cook and we were told that Deepdene intends to pay for additional training for this person to include NVQ levels 2 & 3 in catering. Therefore, people are satisfied with the level of choice and quality of food available and are consulted regularly about menus. Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome area is good Healthcare is delivered in a sensitive way that promotes the dignity, privacy and safety of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In a survey of people living at the home, 100 of people were satisfied with the healthcare they received. Similarly, people that we met who required assistance with personal care verified that staff did this in a way that promoted their dignity and privacy at all times. Hoists were seen being used. Training records for four permanent care staff demonstrated that they had received manual handling training. The new manager told us that an update had been booked and we were shown correspondence to verify this. We tracked the healthcare needs of four individuals. All had been registered with a local GP. Correspondence on all of the files verified that other health and social care professionals e.g. Physiotherapist, psychiatrist, social worker, Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 19 continence advisor and occupational therapist were involved in the care of these individuals. Therefore, the healthcare needs of people living in the home are well met. There is a procedure for reporting accidents. Examination of recent entries demonstrated that appropriate action had been taken at the time of the accident, and where needed had included being seen by the GP or being taken to hospital for treatment. One person had fallen three times. We looked at the individual’s care file to find out whether an assessment had been done to look at the possible reasons for this and also highlight any hazards for that person that might increase the level of risk of falls. This had not been done and we asked the manager to do this. We were told that the policy and procedure on management of medication had been reinforced following the last inspection to discourage poor practice ‘potting up’. We observed a nurse administering medication in the evening and this was done safely. A local surgery dispenses medicines for people living at the home. One of the trained staff is responsible for stock taking. We looked at records of ordered drugs and a register of controlled drugs. The system was easy to audit Medication charts had been completed appropriately. Medication had been given as prescribed. All medication was kept in a secure place. The nurse administering medication told the inspector that they are shown the procedures during induction and assessed as being competent. People living in the home felt that medicines were handled well and they said, “I am able to look after my own medicines and that gives me greater independence” and “the nurses give me my tablets, all I have to do is turn up for them”. Therefore, we have seen improvement in the safety of handling medicines, which ensures that people receive the right medication at the right time. Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good People are confident that any concerns would be dealt with appropriately and are protected by staff that are able to recognise abuse and understand their duty to report poor practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In a survey 73 of people responding verified that they know who to complain to. The complaint procedure was clearly displayed on the notice board outside the office and is clearly written and easy to understand. Information sent to us by the provider verified that 4 complaints had been received and resolved within 28 days. Records examined verified this also. People told us that there had been times over the previous twelve months when they didn’t feel listened to, although this had “very much improved of late”. The new manager was described as being “approachable” and people were confident that they were being listened to and their wishes acted upon. The provider explained that staffing constraints had required a somewhat pragmatic approach to be taken about some decisions over the last 12 months. Various examples of such decisions related to matters of health and safety and we were told that it had not always been possible to take account of people’s wishes and this had created discontent for some individual’s. However, he reassured us that that Deepdene wants to achieve a totally person centred service. Throughout the inspection, we saw positive examples (as reported in Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 21 other sections) of how this has developed since we last visited. Therefore, our view is that some of the comments expressed are the result of the process of change that can be difficult for some people to accept. Woodtown House has a clearly written adult protection procedure that makes reference to the ‘Alerter’s guide’ and the local authority led adult protection procedure. Information sent to us by the provider verified that one referral had been made to POVA (Protection of Vulnerable Adults). However, the Department of Health had decided to take no further action on this. 100 of staff responding in a survey verified that they understood adult protection procedures. Similarly, staff spoken to understood these procedures and had received training on the subject matter. We were shown correspondence that verified that further training had been booked for staff about the Mental Capacity Act and Deprivation of Liberty. The vast majority of people living in the home felt that the staff is “kind”, “very supportive” and “listen even if they can’t change things to suit me”. Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate People live in a well-maintained, comfortable and clean environment. Best practice infection control measures are not consistently followed and therefore may put to people living in the home at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection, parts of the home had been refurbished. The front lounge had moved into what had been the office, a staff rest room had been created and many bedrooms had been decorated. People said that the accommodation was “improving” and is “quite comfortable”. However, they did raise concerns about access to the front lounge, which is a non-smoking area. We were told that the old lounge had become an office and after decoration a new lounge created in what had been the office. We were told the room was locked and used as an additional meeting room for reviews and Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 23 handovers and therefore people perceived they did not have free access as they had done previously. We spoke to the provider and manager about this. It was explained that the room should not have been locked and that the lock existed from when the room was used as an office in which confidential information had to be kept secure. We were told that the lock would be disabled immediately and that people would be reminded that they could use the room whenever they wanted to. Before we left the home we observed that the lock had been disabled and people were using the lounge. Whilst touring the communal rooms, we observed that smokers use the main lounge. The ventilation is poor. Smoke had penetrated a corridor with bedrooms leading off of it leaving air quality poor in that area for people living there. The manager had downloaded good practice guidance on the matter and had identified the problem in line with legislation (Health Act 2006). As a result of this, she told us that new windows had been ordered with extra opening fanlights. Additionally, the manager agreed that access to bedrooms via the lounge was not ideal and should be looked into to resolve this. Providing an alternative route would ensure that people who do not smoke have a choice as to whether they enter the designated smoking area and would improve the air quality outside their bedrooms. A recommendation has been made about this. There is a refurbishment plan in place. A new staff room had been developed, which staff said was well used. The company has used an external health and safety consultant and we read some of the most recent reports that had been acted upon. Some general maintenance of systems such as the fire system is due in July 2008, we need to establish whether this has been done. People whose care we tracked showed us their bedrooms, all of which varied in size and outlook. All of the people who did this had a key to their bedroom and had been encouraged to personalise their space as much as possible. One person told us that new curtains had been purchased for their bedroom but had been incorrectly altered. The manager verfied that this had been sorted out and the curtains would be hung during the inspection. In a survey, 83 of people felt that the home was ‘always’ or ‘usually’ clean. Information sent to us by the provider verified that there are two domestic staff and a full time maintenance person. With regard to infection control measures, the provider has verified that an audit using the department of health guidance had not been carried out. Additionally, records highlighted that a number of staff that have not had recent training about infection control. Therefore, the team cannot be certain that best practice is being followed with regard to infection control management. And this was illustrated by the fact that we found a wooden commode being used by person living in the home, which was soiled. This presented a risk to that person because the commode could not be properly disinfected. We spoke to the manager about this, who was unaware that the commode was being used and agreed that it Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 24 would present an infection risk for the person using it. She immediately asked a member of staff to remove it. A requirement has been made about this. Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 & 35 Quality in this outcome area is adequate Recruitment practice does not adequately protect people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In a survey, people had mixed views about the care, support and availability of staff. Similarly, they raised concerns about the high turnover, their being insufficient staff and the reliability of using agency. The provider also highlighted these problems and verified that in the previous 3 months 51 nursing shifts and 155 care shifts have been covered by agency staff. Additionally, that there has been a high turnover - 5 FT and 2 PT staff. We examined duty rosters for the weeks commencing 25/5/08, 1/6/08 and 8/6/08 in addition to the week during which the inspection took place. Staffing levels were consistently at 1 registered nurse and 4 carers from 7.30 to 5pm, 1 registered nurse and 3 carers from 5pm to 9pm and 1 registered nurse and 2 carers from 9pm to 8am. In addition to this, there was a maintenance person, housekeeper, administrator, cook and two cleaners all of whom work full time. A gardener is also employed 3 days per week 9-3pm. The duty rosters Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 26 demonstrated a high level of agency cover, however the same agency staff was being used. We spoke to agency staff on duty and they verified that they had consistently worked at the home for some months. More recent duty rosters demonstrated that the situation was improving and that a number of new staff had been appointed. This was borne out in discussions with permanent staff and people living in the home. Their comments included “it’s been difficult at times, but it’s much better now as they’ve taken on more new staff”, “we are inducting a few new staff at the moment” and “we’ve tried to ensure that continuity of care is maintained by using the same agency staff until such times as we’ve been able to recruit new people” and “staffing is improving, I had been working very long days. Old staff couldn’t cope with change it not all Deepdene’s fault”. We observed that staff did not appear rushed and were attentive to people living in the home. As discussed under section 1, we tracked the needs of three people, of which one person’s placing authority had agreed to fund extra care for the individual for 3 hours per day to ensure ‘adequate levels of supervision’ with the intention of enabling the person to be escorted 1:1 on outings and other social events. We examined daily records and duty rosters and found it difficult to quantify how this person’s extra care needs were being met. We did establish that the person had an individual programme of activities and had done some of these over the course of the previous 3 months. We discussed this with the manager who was unable to provide any further evidence to quantify how the person’s extra care needs were being met. A recommendation is made in respect of this and is linked to section 1, standard 3. In a survey, staff that responded told us that re-employment checks were done. We examined 4 staff files. All of the staff had been employed since April 2008. Written references [two] had not been obtained prior to employment for one individual. Duty rosters verified that the individual had worked at the home since 10th July 2008. Deepdene received a reference, including a CRB certificate for the person on 21st July 2008. Therefore, the individual had worked in the home prior to satisfactory references having been obtained. The shortfalls were discussed with the registered manager who verified these findings and contacted Head Office immediately. Before the end of the inspection, a second reference dated 28th July 2008 obtained for the person was faxed to the manager by Head Office and was satisfactory. In light of this, we decided not to issue an immediate requirement. However, a requirement has been made with regard to the poor recruitment practice seen, which has meant that people living at Woodtown have not been adequately protected. We showed the manager the Commission’s publication ‘Safe and sound? Checking the suitability of new care staff in regulated social care services’ [available at http:/www.csci.org.uk/pdf/safe_sound_tagged.pdf] and clarified what constitutes good practice in relation to recruitment procedures. The Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 27 registered manager told us they would address the shortfalls as a priority. We were shown records, which demonstrate that Deepdene ensures that qualified nursing staffs maintain their professional registration with the Nursing, Midwifery Council. All of the staff responding in a survey had undertaken induction training. Information sent to the Commission by the provider verified that induction training is based upon ‘Skills for care’ common foundation standards. We spoke to new staff, all of whom felt “well supported” and comments like “we’re not dropped in at the deep end” and “I was given loads of information about policies and procedures, standards and know what is expected of me” established that people receive a good induction at the start of their employment. The majority of staff in a survey verified that training is funded. According to information sent to the Commission, 3 out of 11 or 27 permanent care staffs has an NVQ in Care. The percentage of staff with this has reduced since last year and is likely to be due to the turnover of staff. 2 or 18 of care staff are also in the process of working towards this also. Staff told us that the organisation is committed to developing the staff and “often offers training”. The manager demonstrated that she values the staff and is committed to developing each individual. Since starting her employment (2 weeks before the inspection) she had set up a training matrix and identified what gaps there were in people’s skills, knowledge and experience and was in the process of organising essential training to rectify this. We highlighted that in addition to core training, other specialist training should be provided about Huntingdon’s Chorea and epilepsy for example to ensure that staff have a greater awareness of the needs of people in their care. Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Commission was notified that the Registered Manager left employment in April 2008, and Deepdene put in place interim management arrangements. Since that time one of the Director’s has been managing the home. At the inspection, we met the Director and newly recruited General Manager and discussed their proposals for the management structure of the home. They propose that the General Manager will apply for registration. Additionally, the position of ‘clinical Team leader’ had been created to ensure that qualified staff are directed and supervised by a senior nurse with mental health experience and qualifications. Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 29 We spoke at length to the General Manager who has a wealth of commercial management experience including running her own residential care home some years ago. She told us that she keeps up to date by using the internet and through professional journals. Additionally, since starting her employment she had already set up “good links” with the local college. Throughout the inspection we found the manager to have a sound understanding of her role, regulations and quality management. She was clear and decisive about how shortfalls would be managed and had identified and begun to deal with these by the time the inspection commenced. Throughout the inspection we received positive praise about the new manager with comments like “she’s a breath of fresh air, always listens and does something”, “she’s getting things done that have needed to be done for ages and she’s only been here 2 weeks” and “she always makes herself available” and is “very supportive”. Additionally, the provider gave the Commission a detailed picture of the current situation in the service, in a document entitled AQAA (Annual Quality Assurance Assessment) that was explicit about what achievements have been made and how it is planning to improve the quality of the service. A number of other quality assurance initiatives were seen to be followed that focussed on outcomes in respect of handling of medicines, meals, finances and health and safety procedures in the home. The manager verified that the last quality assurance survey was done in 2006 and that people living at the home, staff and other stakeholders would be surveyed in the coming months. Comprehensive Health & Safety policies and procedures were seen. People living in the home and staff said that the procedures had been “tightened up”. Information sent to the Commission by the provider verified that the organisation continues to use an external health and safety consultant to carry out an audit and have addressing issues identified in reports. Staff spoken to verified that they had had recent moving and handling training. We were shown written confirmation demonstrating that this had been booked. People told us that they “feel safe” at Woodtown House. Electrical appliances had been checked to ensure conformity and safety. Staff on duty had First Aid qualifications. First Aid boxes were accessible to staff. We examined the fire log and established that the fire alarm system, emergency lighting and extinguishers had been regularly checked and properly maintained by an outside company. Two new staff said that the induction training had included fire procedures in the home. Accident records were examined, were well kept and demonstrated that prompt and appropriate action had been taken. A fire risk assessment and strategy in the event of fire was seen. According to records examined, nine staff had not attended fire training in the last 12 months. The home’s risk assessment requires all staff to have this. Staff made comments like “training hasn’t been happening as frequently as it should” and “I haven’t had fire training for ages”. We Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 30 discussed this matter with the manager who had developed a training matrix, which also highlighted gaps in health and safety training and concurred with other records examined. A requirement has been made about this. Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 2 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 2 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 x 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 32 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 YA9 Regulation 13(4)c Requirement The registered person must ensure that risk assessments consistently show that safety, independence and choice has been considered and is regularly reviewed with people living in the home. This requirement is repeated and the timescale extended to enable the provider to roll out training to staff. The registered person must make suitable arrangements to prevent infection, toxic conditions and the spread of infection to people living and working at the care home; to include the training of staff. The registered person must ensure that pre-employment checks are obtained before new staff is allowed to work in the home so that people living there are protected. After consultation with the fire authority, the registered person must protect people living there by ensuring that fire drills, DS0000068667.V365066.R01.S.doc Timescale for action 31/12/08 2. YA30 13(3) 31/01/09 3 YA34 19(1)b Sch 2 30/11/08 3. YA42 23(4)e 30/11/08 Woodtown House Nursing Home Version 5.2 Page 33 practices and training are provided at suitable intervals, to persons working at the care home. 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 YA3 YA9 YA24 Good Practice Recommendations People should be confident that agreed extra care is provided and a record kept so that Commissioning staff and CSCI can audit it. People who are at risk of falls should be assessed to ensure that steps are taken to minimise these. Alterations should be made to improve the access to bedrooms off the main lounge so that people who do not smoke have a choice as to whether they enter the designated smoking area and the air quality outside their bedrooms is improved. Use the Department of Health guide ‘Essential Steps’ to assess current infection control management to protect people that live in the home and staff that work there. Additionally, provide infection control training for all staff so that they are aware of current best practice. Apply for registration of the new manager to demonstrate that they have the required qualifications, experience and competency to run the home. People should be given more frequent opportunities to comment about the quality of their life, accommodation and service. Specifically, in an annual survey. 4. YA30 5. YA37 6. YA39 Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 © 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 Woodtown House Nursing Home DS0000068667.V365066.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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