Inspection on 24/07/07 for Woodtown House Nursing Home

This inspection was carried out on 24th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but 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 23/07/08

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 09/07/2008.

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 24 & 25th July 2007 09:50 th Woodtown House Nursing Home DS0000068667.V339819.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.V339819.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.V339819.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 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.V339819.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection New service 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 2007, the fees for the home ranged between £600 £1000 per week. Additional charges are made for hairdressing (dependent upon individual requirements), toiletries and newspapers (dependent upon individual requirements). Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first key inspection of Woodtown House under the ‘Inspecting for better lives’ arrangements since Deepdene Care took over the ownership of the home. During the first six months Deepdence Care had to address a number of historical issues, which has been challenging. Additionally, the home had been without the leadership of the registered manager for some months and people living at the home and the team of staff felt the impact of this. A new manager was due to start employment on 6th August 2007. The inspector was at the home with people for 14 hours. 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. Additionally, to see what developments had occurred since the change of ownership in December 2006. The inspector looked at records, policies and procedures at the office. A tour of the home took place. Surveys were sent to ten people that live at Woodtown House, twenty staff and seven health and social care professionals: 30 of the people living at the home; 40 of staff and 14 health and social care professionals responded to the survey. The comments of the people who responded are included within the report. As at July 2007, the fees ranged between £600 and £1000 per week for personal and nursing care. 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 What the service does well: The people that live at Woodtown House say that it is a friendly place to live. Before moving in they are given a lot of information, which helps them to decide whether it is the right home for them. Once they have moved in, people say that they can generally choose how they wish to spend their lives at Woodtown House. Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 6 People told us that meals are “delicious”, “very nice”, “lovely” and “tasty”. And that the menu is varied and gives them plenty of choice. A handful of people said that they cook their own meals and get support from the staff to do this. People told us that no matter what their background was they were encouraged to form friendships and maintain relationships with families and friends. Relatives told us that they are made welcome at the home. There are policies and procedures that protect vulnerable people, including dealing with complaints. People know how to make complaints and say that they can voice their concerns and feel that staff listens to them. Deepdene Care has ensured that appropriate checks are done before staff are allowed to work with the people that live at the home. Staff are encouraged to do training so that they all keep up to date and understand how to care for people that live at Woodtown House. In terms of health and safety, the majority of people told us that they feel safe at Woodtown House because Deepdene Care has “tightened up on all the checks”. What has improved since the last inspection? What they could do better: Legal requirements have been made about: The assessed needs of people must be regularly reviewed with them and documented. Risk assessments must show that safety, independence and choice has been considered and is regularly reviewed with people living in the home. Make arrangements to enable people living in the home to engage in a wider range of social educational and occupational activities. Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 7 Take steps to recruit and retain a permanent team of staff to ensure that people living in the home receive good continuity of care as is reasonable to meet their needs. Recommendations have been made about: People living in the home should be involved in planning and reviewing their care to ensure that it meets their needs. People living in the home should be confident that all of the staff that administer medication to them do this safely by following Deepdene Care’s policies and procedures. People living in the home should be full involved in planning the decoration and refurbishment of the home and know when it will take place. 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. Apply for registration of the new manager to demonstrate that they have the required qualifications, experience and competency to run the home. 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.V339819.R01.S.doc Version 5.2 Page 8 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.V339819.R01.S.doc Version 5.2 Page 9 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 Quality in this outcome area is adequate Information given to prospective residents helps them to make an informed decision about whether Woodtown House is the right home for them. The majority of assessment information examined was out of date and did not reflect the current needs of individual’s concerned. However, Deepdene Care have recognised this and have set up comprehensive assessment process that will ensure that people’s needs are well known, reviewed regularly and form the basis of person centred planning This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector read the service users guide produced by Deepdene Care, which outlines the referral and moving in procedure. 100 of people responding in a survey felt that this provided sufficient information about what to expect from the home. A person that had recently moved in said they had had a trial period to give them the opportunity to decide whether the home was the right place for them. Documentation about this person had been received by the home and was kept in their individual care file. Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 10 Three other care files were inspected. Comprehensive assessments had been completed with individual people. In discussion with key workers, the individuals concerned and examination of records it was evident that written information was out of date in three out of the four files. To illustrate this, one person’s assessment identified that nocturnal enuresis was a problem when last reviewed in December 2006. Staff at handover verified that this was no longer a problem for the individual concerned. Entries in the individual’s care diary also verified this. Another person whose assessment identified an infection was also out of date. The keyworker told the inspector that following treatment the person was now clear of infection. On examination of the incident records one person had needed treatment following an episode of choking and was seen by the GP. However, on reading the individual’s care plan and risk assessments no review had taken place and there was no mention of a choking risk. In the AQAA Deepdene Care verified that internal audits had also identified this and that a comprehensive ‘review of all current residents’ had begun. The home had, however obtained important information from the agency placing the service user at Woodtown House. Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 11 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 and 9 Quality in this outcome area is adequate The philosophy at Woodtown House is shifting more towards person centred care. The success of this will be dependent upon having a permanent stable team of staff committed to this. Care given to people is good, although supporting documentation does not always reflect what is being delivered in practice. People are enabled to make day-to-day decisions and choose how they wish to spend their lives at Woodtown House. Financial systems have been tightened to protect the interests of the most vulnerable people who need help to manage their own finances. Effective management of risks needs to be prioritised 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: Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 12 Four care files were inspected. 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. However, there was no evidence that reviews had taken place as regularly as they should have done; in particular documentation about one person who was at risk of falls and malnutrition did not have any evidence that their care had been reviewed or written strategies in place to minimise these risks. In discussion with key staff it was evident that precautionary measures were in place but these were communicated by word of mouth at handovers. This was discussed with the responsible individual after the field work part of the inspection. Other care plans seen gave sufficient detail about 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. The inspector saw that specialist equipment was being used for one individual that had been recommended after physiotherapist involvement. People living in the home told the inspector that they are encouraged to make decisions on a day-to-day basis about their lives. A monthly community meeting is held. One person likes to type up the minutes following the meetings and showed the inspector these. The person also said that themselves and other residents had recently been asked for their views about the home during a visit from the management team of Deepdene Care. Since taking over ownership of the home, Deepdene Care verified that the procedures for managing people’s money had been totally reviewed to safeguard people’s financial interests following a complaint. A new policy and procedure had been written for the management of petty cash. Similarly, we saw evidence that 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 person in charge told the inspector that only senior staff on duty are key holders for the safe. Records for four people were examined. Balances tallied across records. Staff and service users spoken to verified that the petty cash was accessible to them. Receipts for purchases had been obtained and balances tallied with records kept. On examination of the incident records one person had needed treatment following an episode of choking [24/6/07] and was seen by the GP. However, on reading the individual’s care plan and risk assessments there was no evidence to show that a review had taken place or mention of a choking risk. This was discussed with the person in charge at the time of the inspection that verified that the risk assessment would be updated to reflect this. Three other care files were inspected, two of which had a risk assessment. On one file the assessment was dated 9/12/06 and had not been reviewed since despite evidence of incidents indicating that the person was at risk of leaving the home alone and vulnerable if they did so. In the AQAA Deepdene Care verified that Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 13 internal audits had also identified this issue and that a comprehensive ‘review of all current residents’ had begun. Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 14 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 adequate Individual’s preferences are encouraged in respect of hobbies, meals and activities. However, opportunities for people to be involved in vocational training and employment support schemes are currently minimal. Since taking over the ownership of Woodtown House, Deepdene Care have identified that opportunities for people to re-integrate into community living and improve social inclusion needs further development. The success of this will be dependent upon having a permanent stable team of staff committed to this. People are encouraged to maintain family networks and relationships within the home. A good choice of appetising and well-balanced meals is available for people living at Woodtown House. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 15 100 of people that responded in a survey felt that the level of activities and outings could be improved in the home. Staff in their surveys also raised concerns that the activity co-ordinator was no longer employed at the home. People that the inspector met commented “there’s not a great deal to do” and “there’s nothing to do, I just spend time doing my [own things]”. Similarly, a visiting relative said that their relation “needs more to do”. Four care files were examined to establish what support and opportunities had been implemented for the individuals concerned. On person’s care plan included daily one to one time to support the individual either going out or other activities. Additionally, correspondence with the individual’s care manager outlined a breakdown of weekly fees that included an additional three hours per day of personal care and support. Staff spoken to verify that the aim of this was to keep the person concerned engaged in a period of activity every day to improve overall behaviour and concentration levels for that individual. The inspector examined a record of activities for June to July 2007 [one month] that had been kept in relation to this individual – a total of 10 activities on different days were listed falling short of the care planned. For the same period, a total of 63 shifts (nursing and support workers) had been covered by agency staff. Staff and the responsible individual felt that this had impacted on their ability to develop opportunities for people living in the home. In the AQAA, the provider recognised that there are shortfalls and that day to day living for people at the home is very much routinised. The organisation aims to promote positive community inclusion for people living at the home and has written in the AQAA that a ‘community support team’ is being developed from within the staff team to facilitate this. The responsible individual told the inspector that a rigorous recruitment drive was also underway to attract skilled and motivated staff to fill vacancies. The ‘action and improvement framework’ for the home outlines plans to refurbish the resident’s kitchen so that it is accessible for everyone and provides a rehabilitation resource. Community meeting minutes were seen, which demonstrated that people living in the home had been involved in discussions about the change in focus. One person told the inspector that the home had a new mini bus on trial loan. Arts and crafts sessions had still taken place on Thursday afternoons and the artwork was displayed in the dining room. A four-week rolling menu was inspected, which demonstrated that alternatives are made available at every meal. The inspector joined a group of people for lunch, which was appetising and served in a relaxed and unhurried manner. People commented that lunch was “delicious”, “very nice”, “lovely” and “tasty”. A record of meals provided demonstrated that meals are varied. The lunchtime menu was displayed in the dining room and there was a vegetarian alternative. Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 16 Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 17 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 Care is delivered to service users in a sensitive way that promotes their dignity and privacy. The team works in partnership with other professionals to ensure that the healthcare needs of service users are met. Procedures ensure that medication is stored and recorded in a manner that protects service users by ensuring that they are given the right medication, at the right time. However, staff responsible for administering medication need to be made aware of best practice outlined in the procedure to avoid putting people at risk of being given the wrong medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Cultural, religious and ethnical needs had been clearly identified in the four care files that were examined. In a survey of people living at the home, 100 of people were satisfied with the healthcare they received. Similarly, people that the inspector met who required assistance with personal care verified that staff did this in a way that promoted their dignity and privacy at all times. Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 18 Hoists were seen being used. The inspector examined training records for four permanent care staff. Certificates seen demonstrated that staff had received manual handling training, which covered the safe operation of hoists. The inspector 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, continence advisor and occupational therapist were involved in the care of these individuals. There is a procedure for reporting accidents. Examination of three 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. The inspector observed a nurse administering morning medication. Medication was ‘potted up’ enmasse in unlabelled pots on a tray then taken around the home and administered as prescribed for people. The inspector highlighted that this was not best practice to the nurse concerned due to the risk of being distracted and potential administration errors being made. However, the nurse concerned felt that given environmental constraints and number of people requiring medication in the morning it was the only way to manage this effectively. The policy and procedure on management of medication clearly stated that medication should be administered as dispensed to each individual then a record made of it as opposed to ‘potting up’. This matter was discussed with the acting manager and responsible individual who told the inspector that it would be addressed with the individual practitioner concerned. A local surgery dispenses medicines for people living at the home. One of the trained staff is responsible for stock taking. Records of ordered drugs and a register of controlled drugs were seen. The system was easy to audit Medication charts had been completed appropriately. The inspector saw that medication was administered 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. The inspector tracked medication administered to four people. Controlled medication that was being administered by one person was recorded as being ‘self medicated’ on the MAR chart. The individual showed the inspector the lockable cabinet in their bedroom that was being used to store their medicines in. A risk assessment and care plan seen in the same individual’s care file made reference to the fact that the person was self medicating and a strategy for minimising risks was highlighted within the documents. Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 19 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 Deepdene Care has responded swiftly and appropriately to protect vulnerable adults by making referrals to POVA, instigating extra training for staff and assisting with investigations. Additionally, complaints have been handled in such as way as to ensure that people are protected and able to voice their concerns. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In a survey 66 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. In the AQAA, the provider verified that 5 complaints had been received and resolved within 28 days. Records examined verified this also. 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. In the AQAA the provider has verified that one referral has been made to POVA (Protection of Vulnerable Adults). Two safeguarding referrals have been made, which the Commission is involved with and are being investigated. 100 of staff responding in a survey verified that they understood adult protection procedures. Similarly, staff spoken to understood these procedures. In the AQAA the provider has verified that all of the staff Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 20 have received training on this. Additionally, people living in the home said that they were confident that Deepdene Care managers had asked them for feedback about the team and had listened whilst they described their experiences to them. Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 21 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 There are challenges in respect of maintaining a satisfactory level of cleanliness and decoration at Woodtown House. However, areas of the home are tired and worn and in need of refurbishment and do not fully provide service users with a homely, comfortable and safe environment in which to live. Measures are in place that minimise the risk of cross infection to people living in the home. These can be improved further by implementing best practice in terms of cleaning and use of equipment in the laundry This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a mixed response from people living at the home about whether the home was kept fresh and clean. 33 of people responding in a survey felt that the home was not clean enough. Whilst 66 felt that it was ‘sometimes’ kept clean. In the AQAA the provider has verified that there are two staff and Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 22 a maintenance person on the staff. Additionally, that there is a refurbishment plan in place. A new staff room has been developed and the company is using an external health and safety consultant. Maintenance certificates for the oil, electrical and fire installations verified that external contractors had inspected all of these. A tour of the premises took place. Bedrooms varied in size and layout. All were personalised and the level of cleanliness varied. Parts of the home, namely communal areas look tired and are in need of decoration and updating. The inspector met a number of people throughout the course of the inspection and observed a handful of people doing domestic chores such as cleaning toilets and restocking toilet rolls for which they receive therapeutic earnings. Domestic staff verified that two further cleaners were being recruited so that there is cover seven days a week up till 6pm in the evening. Maintenance staff told the inspector that an audit of the premises was planned soon after the new manager starts employment [6th August] and timescales are to be agreed for the refurbishment of the home. With regard to infection control measures, the provider verified in the AQAA that an audit using the department of health guidance has not been carried out. Additionally, 5 out of 20 staff have attended training about infection control. Soiled linen was seen on the floor of the laundry in front of the washing machine. Best practice is that soiled linen should be put into a receptacle for that purpose or alternatively into a disposable bag that is then placed directly into the sluice/washing machine for cleaning as part of a no touch technique. When asked staff verified that there was no cleaning procedure or rota for the laundry. The inspector did however see that there was a plentiful supply of aprons and gloves, which staff used appropriately. Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 23 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 Staff have been appointed and started working between January and May 2007, without references or other important documentation being received. However, Deepdene Care investigated this, followed the disciplinary procedure and has instigated policies and procedures that ensure that the right people are recruited to protect service users. There is a high level of reliance on agency staff. The level of staffing restricts the ability of the service to deliver person centred support, or provide activities that people have requested and Deepdene Care are actively trying to address this. The service recognises the importance of training, and is trying to deliver a programme that equips staff with the knowledge and experience to care for people, but has not always been in a position to provide this training due to the turnover of staff this year. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In a survey, people had mixed views about the support and availability of staff due to the high turnover. Similarly, staff raised concerns about the turnover of staff, sickness levels and reliability upon using agency staff since the change of Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 24 ownership. In the AQAA, the provider also recognised these problems and verified that in the last 3 months 227 nursing shifts and 560 care shifts have been covered by agency staff. Duty rosters seen for the month prior to the inspection also verified reliability on agency workers staffing the home. These showed that there is a registered nurse on duty at all times during the day. In addition, there is a cleaner, maintenance person and cook on duty. The inspector discussed the use of agency staff with the responsible individual for Deepdene Care who was concerned about this also. She verified that a comprehensive recruitment drive was underway and terms and conditions were being looked at to attract skilled and motivated staff. Current vacancies are Administrative Assistant; part time Nurse, two Care Support Workers and a cleaner. Aadditionally, the responsible individual felt that the leadership that the new manager would bring would also have a positive affect on the team in general. Under previous ownership a requirement was made in respect of recruitment practices. The organisation informed the Commission that it had acted swiftly to address this issue and had led to the dismissal of a senior member of staff for failing to follow procedures. The inspector saw correspondence on files indicating that the human resources department provides support and guidance to the acting manager about recruitment practices. Four staff files were inspected; two written references, CRB and POVA checks had been obtained. References for two out of four staff had, however, been obtained after the start date of employment. These staff had been recruited at the beginning of the year. The responsible individual verified that it was an audit of the same staff files earlier in the year had alerted the organisation to the fact that procedures were not being followed and had followed the disciplinary procedure as a result. The inspector selected another file for the newest employee. This demonstrated that robust recruitment practices were in place and that all references, including POVA and CRB checks had been obtained before the individual commenced employment with the organisation. All of the staff responding in a survey had undertaken induction training. The provider in the AQAA verified that induction training is based upon ‘Skills for care’ common foundation standards. The majority of staff in a survey verified that training is funded. Nine or 45 of the care staff hold an NVQ in Care. One or 10 of care staff are also in the process of working towards this award. The inspector was shown individual portfolios that contained certificates for various training events that had been attended. Additionally, a training and development plan is in place that links directly to minimum standards, meeting the needs of people living at the home and the aims of the service. Therefore, this demonstrates that the organisation is committed to developing the staff. Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 25 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 Deepdene Care has the skills and ability to ensure efficient running of the home, which gives value for money and delivers effective outcomes for the people who use the service. Quality assurance systems are evident and ensure that people’s views are respected in this home. People are supported to manage their own money where possible. Where this is not possible there is a clear reason why. Individuals have access to their records whenever they wish. The organisation has reviewed all relevant health and safety requirements and legislation, and closely monitoring its own practice to ensure that people are safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 26 As mentioned previously in this report, a new manager had been recruited and was due to commence employment on 6th August 2007. The responsible individual verified that an application for registration would be made to the Commission shortly after the new manager commenced employment. Staff and people living in the home told the inspector that the responsible individual and operations manager visited regularly to provide support, seek their views and address any issues that arise. However, everyone felt that the home needed a manager to enable them to move on with a number of projects and described the home as being like “a ship without a captain”. Deepdene Care had instigated a number of quality assurance measures and had concentrated on auditing systems to identify where shortfalls might lie and current best practice. Having done this, the organisation provided the Commission with a detailed AQAA identifying what is done well at Woodtown House and what needs to be improved there. In addition to this, the Commission is aware that the organisation has had to deal with a number of series issues and has done so effectively in partnership with commissioning teams, the Commission and other professionals. We examined records relating to internal audits carried out in May and July, which demonstrated that thorough checks were being undertaken and issues addressed promptly where needed. The people that the inspector met throughout the course of the inspection felt that their views were respected. People reported that they had recently been asked for feedback about the care and support they receive at a meeting held at the beginning of July. They were positive, albeit a little apprehensive about plans for the future of the home but all felt that it would definitely benefit them. An agenda for the next meeting was seen in the dining room. People said that they are encouraged to write down whatever they want to discuss and do so at the monthly community meeting. A representative from Deepdene Care had attended every meeting held since taking over ownership of the home. Comprehensive Health & Safety policies and procedures were seen. People living in the home and staff said that the procedures had been “tightened up”. In the AQAA Deepdene Care verified that the organisation had used an external health and safety consultant to carry out an audit and were addressing shortfalls identified in the report. Staff spoken to verified that they had had recent moving and handling training. Hoists in use were last serviced in December 2006, the Health and Safety Executive guidance recommends that this should be done at least every six months. People told the inspector that they felt 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. A fire risk assessment and strategy in the event of fire was seen. All of the staff that the inspector spoke to had received training in the last twelve months. The inspector examined the fire log and established that the fire alarm system, emergency lighting and extinguishers had been regularly checked and properly maintained by an Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 27 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. Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 28 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 2 3 x 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 2 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 2 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 3 x x 3 x Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NA 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 2 Standard YA2 YA9 Regulation 14(2) a,b 13(4)c Requirement Timescale for action 15/02/08 3 YA12 16(2)m,n 4 YA32 18(1)b The assessed needs of people must be reguarly reviewed with them and documented. Risk assessments must show 15/02/08 that the safety, independence and choice has been considered and is regularly reviewed with people. Make arrangements to enable 31/03/08 people living in the home to engage in a wider range of social educational and occupational activities. Take steps to recruit and retain a 31/01/08 permanent team of staff to ensure that people living in the home receive good continuity of care as is reasonable to meet their needs. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 30 1 2 3 4 5 YA6 YA20 YA24 YA30 YA37 People living in the home should be involved in planning and reviewing their care to ensure that it meets their needs. People living in the home should be confident that all of the staff that administer medication to them do this safely by following Deepdene Care’s policies and procedures. People living in the home should be full involved in planning the decoration and refurbishment of the home and know when it will take place. 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. Apply for registration of the new manager to demonstrate that they have the required qualifications, experience and competency to run the home. Woodtown House Nursing Home DS0000068667.V339819.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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.V339819.R01.S.doc Version 5.2 Page 32 - 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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