Care Home: WCS - Woodside

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What the care home does well People receive a full assessment of their needs prior to be accepted to live at the home to make sure their needs can be met effectively. People told us that they were satisfied with how staff looked after them and were complimentary of the staff. Comments we received included "care staff are brilliant" "very nice" "carers are very good". Details of all social activities provided are displayed on notice boards in the home and include pictures of the planned activity so people have a clear understanding of the activity to be provided. The home has a "Friends of Woodside" Committee that aims to raise funds for extra social activities for people such as day trips, in house activities and entertainment. This committee is made up of a group of volunteers who have relatives or friends residing at the home. What has improved since the last inspection? The complaints procedure has been updated and this was accessible to people living in the home and their families so that they know how to raise any concerns regarding the home. New hard flooring has been fitted in all dining areas and there has been new corridor carpets and new dining furniture provided on all three floors which has much improved the environment for people. There are various systems in place to help measure the quality of care and services people receive including resident meetings being held on a monthly basis. Care plans have been reviewed to identify short term health problems so that appropriate plans of care can be put in place to meet these needs. Medication management has improved and records demonstrated this was being managed appropriately for people. People now benefit from a clean environment which promotes good infection control. What the care home could do better: Care plans need to be kept up-to-date when the needs of people change and records must show that the needs of people are being met. A "Service User Guide" should be made available to people which contains a summary of our inspection report, sample contract and statement of Terms & Conditions for the home so that they have all the information they require to make an informed decision on whether to stay at the home. People spoken to about the food commented it was "alright", "very good food", "could be better", "on whole the food is reasonable but sometimes not" suggesting some improvements in this area would benefit people living in the home. Menus should include details of all meals, snacks and drinks that are being provided so that people living in the home are aware there is a range of choices available to them each day. The laundry system continues to need improvement to ensure items are appropriately laundered and returned to people. People told us "They need a proper laundry person who takes pride in the clothes". "One thing that is bad is so much stuff disappears, that`s terrible if you send something to the laundry, you are not always certain of getting it back". Key inspection report Care homes for older people Name: Address: WCS - Woodside Spinney Hill Warwick Warwickshire CV34 5SP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sandra Wade     Date: 1 6 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: WCS - Woodside Spinney Hill Warwick Warwickshire CV34 5SP 01926492508 01926498848 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): WCS Care Group Ltd Name of registered manager (if applicable) Miss Victoria Britton Type of registration: Number of places registered: care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 38 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 38, Old age, not falling within any other category (OP) 38 Date of last inspection Brief description of the care home Woodside care home is managed by Warwickshire Care Services Ltd who has managed the home since it transferred, along with a number of other homes providing care, from Warwickshire County Council in 1992. Warwickshire Care Services Ltd is a voluntary sector organisation. The home is situated on the outskirts of Warwick, within a housing estate. Close by is a small parade of shops, including a post office, Care Homes for Older People Page 4 of 34 Over 65 0 38 38 0 3 0 0 6 2 0 0 9 Brief description of the care home newsagent and general store. There is also a local pub. Both Warwick and Leamington Spas main shopping centres are within a 5 to 10 minute bus journey. The bus stop is directly outside the home. Woodside is registered as a care home providing personal care to 38 older people; this includes a registration to care for older people with dementia. The home has a dementia unit on the ground floor. The first and second floors can accommodate 15 people. All rooms are single; there are no en suite rooms. The home can offer one respite place and regularly looks after up to four additional residents for day care above its 38 place registration. Each floor has a lounge and dining area which have been fitted with kitchenettes. On each floor there is also one bathroom and there is a shower room provided on the first and second floors. A passenger lift is available so that people can access the upper floors, there are also ramps leading to outside areas to ensure people can easily access all areas of the home. Woodside is a non-smoking home and there is only provision to smoke outside the building. Woodside has a garden area to the rear and a secure garden leading off the dementia care unit. Parking spaces are available to the rear of the home but these are limited. The fees at the time of this inspection were not published and therefore the home would need to be approached directly to establish these. There are additional charges for hairdressing, newspapers, personal toiletries and clothing. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The last key inspection took place on 30 June 2009. This inspection took place between 8.20am and 6.45pm. Two people who were staying at the home were case tracked. The case tracking process involves establishing an individuals experience of staying at the home, meeting or observing them, discussing their care with staff and relatives where possible, looking at their care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. A completed Annual Quality Assurance Assessment (AQAA) was received from the service prior to the inspection detailing information about the care and services Care Homes for Older People Page 6 of 34 provided. Questionnaires were also sent out to people within the home to obtain their views of the service. Information contained within the AQAA and outcomes of surveys have been included within this report as appropriate. Records examined during this inspection, in addition to care records, included staff training records, staff duty rotas, kitchen records, accident records, financial records, complaint records, quality monitoring records and medication records. People were observed in the lounge/dining areas to ascertain what daily life in the home may be like. A tour of the home was undertaken to view specific areas and establish the layout and decor of the home. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Care plans need to be kept up-to-date when the needs of people change and records must show that the needs of people are being met. A Service User Guide should be made available to people which contains a summary of our inspection report, sample contract and statement of Terms & Conditions for the home so that they have all the information they require to make an informed decision on whether to stay at the home. People spoken to about the food commented it was alright, very good food, could be better, on whole the food is reasonable but sometimes not suggesting some improvements in this area would benefit people living in the home. Care Homes for Older People Page 8 of 34 Menus should include details of all meals, snacks and drinks that are being provided so that people living in the home are aware there is a range of choices available to them each day. The laundry system continues to need improvement to ensure items are appropriately laundered and returned to people. People told us They need a proper laundry person who takes pride in the clothes. One thing that is bad is so much stuff disappears, thats terrible if you send something to the laundry, you are not always certain of getting it back. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering moving into the home are able to access information about the care and services provided and benefit from having their care needs assessed so that they can be sure the home can meet their needs. Evidence: We received an Annual Quality Assurance Assessment (AQAA) from the home stating that an information pack is made available to prospective residents. We found this to be the case. The information pack included a brochure with pictures of the facilities in the home, Statement of Purpose and an information sheet. These documents gave some valuable information about the care and services provided. We did not see a specific document which the home could call a Service User Guide containing a summary of our inspection report, sample contract and statement of Terms & Conditions for the home as required. These documents can help people make a decision on whether to stay and need to form part of a Service User Guide. Care Homes for Older People Page 11 of 34 Evidence: The manager said that copies of the full inspection report are made available to people upon request. We could not evidence that people had been issued with copies of the information packs or inspection reports. People spoken to about information they received did not confirm they had received these documents from the home although they were positive about the admission process. One person told us that they had visited the home and staff had been very helpful in giving them information, they said that Social Services had given them a booklet about finding a care home. Another told us that this was the home nearest to visit and they were invited to look around without having an appointment. They stated the girls are so nice to X and commented how friendly the staff were when they came to visit prior to their relatives admission. The AQAA stated Admissions are not made to the Home until a full needs assessment has been undertaken by the Manager or the Care Manager and trial visits are encouraged. We were told that one person had visited the home and had seen the rooms available and was able to make a choice of which room they would like. On viewing the records for two people we found that detailed assessments of their needs had been carried out so that appropriate plans of care could be developed to enable staff to meet their needs effectively. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are treated respectfully and their health and personal care needs are met although it was not clear these needs are always met in a consistent way by staff. Evidence: It was evident from our observations that the personal care needs of people living in the home were being met and people spoken to were positive about their quality of life. People looked cared for in that their hair had been combed and their nails were trimmed and clean. People were observed to be wearing clothing appropriate for the time of year which reflected their individual cultural, gender and personal preferences. People told us that they were satisfied with how staff looked after them and were complimentary of the staff. Comments we received included care staff are brilliant very nice carers are very good. The Annual Quality Assurance Assessment (AQAA) received by the home stated they have A superb excellent care planning process which is continually being developed. Care Homes for Older People Page 13 of 34 Evidence: We case tracked two people living in the home. (The case tracking process involves establishing an individuals experience of staying at the home, meeting or observing them, discussing their care with staff and relatives where possible, looking at their care files and focusing on outcomes). Tracking peoples care helps us understand the experiences of people who use the service. We found two different formats of care plans in place for the two people case tracked. The manager told us that this was due to care plans being subject to ongoing review. The format of the first care plan included staff initials against pre-written information to confirm the person had a particular care need and then staff signing against another set of pre-written information showing the support or actions required. There was no dedicated section for staff to record any information themselves within this format. We were told that this person was prone to pressure areas/sores so looked at the records specifically for this care need. The records stated that the person was prone to pressure areas due to lack of mobility and sitting for long periods. A specialist bed and cushion had been obtained to help relieve the pressure on the skin and it was stated the person should receive regular input from the district nurse. Body charts had been completed but it was not clear from these if any of the sores had healed or improved or if the person still had any pressure sores at all. Assessment records indicated that the persons skin had not been broken but other care records showed the skin had been broken. Discussions with staff confirmed that incorrect scorings had been recorded as the persons skin definitely had been broken. One member of staff confirmed they were applying cream to the persons skin each day and the person had been discharged from the district nurse recently as their skin was fine. Another member of staff said that the person still had a sore area. It was evident that this form of care plan was not effective in giving an accurate picture of the persons current health. We found that the level of detail provided by the member of staff also was not documented clearly in the care plan records. Staff were however able to explain how they were supporting the person to ensure their care needs were being met. Staff confirmed that they would record any changes to the persons health in the daily diaries and this was found to be the case. It was not evident that the care plans were always being updated when changes were being identified. If care plans Care Homes for Older People Page 14 of 34 Evidence: are not kept updated this could result in carers not being aware of changing needs which could lead to an oversight in a persons care. Records indicated that the person was not eating well and their weight had fluctuated resulting in food and fluid charts being implemented. There were no weights recorded after December 2009 to show that this was continuing to be monitored. Staff told us that this was because the weighing scales were broken. The manager gave an explanation for this and advised actions had been taken for them to be repaired. A care file for a second person was viewed. The care plans within this file also had a scoring system where staff indicated next to preprinted information what the needs of the person were. The difference with this care plan was that there was a section where staff could hand write the actions required to meet the persons needs as opposed to initialing a preprinted list of actions. The care file confirmed that the person had Alzhiemers Disease and staff were to guide them when becoming confused and disorientated. There were clear records in regards to what the person needed assistance with and what they could do independently for themselves. Staff had recorded that the person was struggling to eat meat due to a health condition they had. They had requested that the meat be blended but not the vegetables. Staff had recorded how much the person had appreciated this and that they had thoroughly enjoyed their meal as a result. Daily diary entries showed that the person had refused personal care on a number of occasions during the past two months. This information was not reflected in the care plan for personal care. Staff spoken to said that if the person refused care they would ask another member of staff to assist them or pass the information on the next shift. Management staff advised that a new guidance document had been developed to assist staff in managing behaviours around dementia and staff had been advised to refer to this. The daily diary also listed a number of skin complaints for the person including a cut, rash and sore foot. None of these were reflected in the care plans seen so it was unclear how these had been managed. Staff were able to confirm actions that had been carried out to address these problems. Discussions with staff confirmed that they sometimes found it difficult working with so many separate care documents and they were still getting used to new ways of Care Homes for Older People Page 15 of 34 Evidence: working. For example there were food and fluid charts, daily diaries, activity diaries, care files, cream application records, district nurse diary all of which were being kept separately. The manager advised that from 1 April 2010 new care records were being implemented for all people living in the home which were structured in a way that should ensure care needs are clearly recorded and updated appropriately. We looked at the way the home manages peoples medication. Medicines were being stored on each floor in medicine trolleys and there was an appropriate cabinet for the storage of any controlled drugs. A monitored dosage (blister packed) system was being used whereby staff push out tablets or capsules from sealed pockets on a card on the days required. Medicines were being ordered monthly and photocopies of prescriptions retained before being dispensed by the pharmacy. This helps staff to make sure all medication ordered has been correctly prescribed and no new medication has been added by mistake. We were told by the manager that there had been a review in medication practices and regular audits were taking place to ensure this was being managed effectively. The AQAA completed by the service stated Medication records are constantly kept up to date. We audited the medicines of people involved in case tracking as well as others by comparing the quantity in stock against the signatures on the medicine administration records (MAR). These were correct, indicating that medicines had been administered correctly. People living in the home were observed to be treated with respect. For example, personal care was provided in private and people were spoken to respectfully. One person said that staff always knocked the door before entering their room and they appreciated this because they had a commode in their room which they used. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to a range of social activities and have a choice of meals on a daily basis and there are ongoing improvements in these areas to ensure the health and social care needs of people are met. Evidence: The Annual Quality Assurance Assessment (AQAA) completed by the home stated Residents are involved in choosing activities each month through monthly resident meetings with the Care Manager. Each resident has a pictorial activity plan delivered to them each month and they are also displayed on notice boards throughout the home. Residents in the home have increased opportunities for social interaction and activities by accessing the homes Day Care facility. We found this to be the case. The care files for each person contained details of a life history, interests, important relationships and personal preferences to assist staff in providing person centred care. We also saw the home had recently implemented a programme of care which encourages goals to be achieved for people with dementia to help increase their mental stimulation and feelings of wellbeing. An Activity Organiser was in post who works full time and plans and delivers social activities on a weekly basis. All social activities provided are displayed on notice boards in the home and include pictures of Care Homes for Older People Page 17 of 34 Evidence: the planned activity. People are able to access the homes day care facility to join in social activities if they wish. On the day of inspection bingo took place in the lounge on the middle floor and staff were observed to ask people if they would like to join in. Some people were engaged in their own activity such as reading or knitting. The people in the dementia care unit were not seen participating in social activities although diaries did confirm they had participated in some. People spoken to said: We do have bingo but we pay for that two pounds, I think they could take us out sometimes we dont go out anywhere very much at all staff put the cd player on and there is bingo today, sometimes they do painting and colouring. Comments on what the service could do better included more games and more activities in the day care area even though it is good. Staff record in Life Diaries the social activities each person has taken part in each day. Activities recorded included: sitting in reception talking to staff, walking to the shop with a carer, singing, manicure, making cakes, collecting the washing and watching tv. Staff had taken pictures of people participating in activities to include in the life diaries and there were also photographs of people engaged in activities on the walls around the home. Resident meetings were being held regularly and a copy of the notes viewed listed outside visits that people would like to take place. The manager said that it was planned some of these would be organised in finer weather. The AQAA stated that different church services take place in the home on a regular basis and that people are encouraged to access the local community to meet their religious beliefs with the support of relatives and friends. The AQAA stated: Meals are very well balanced and highly nutritious. This has been achieved via the implementation of the Nut Meg menu, which has specifically designed for older people. In addition the home has achieved the Healthy Heart Heart Beat Award and Gold Award following inspection from environmental health. The food served meets the needs and the choices of residents including those who have swallowing or chewing difficulties. Resident feedback on the food provided and mealtimes is checked. Where needed the service is adapted to meet the needs and wishes of the residents. We found that food is prepared and delivered to each floor on a hot trolley and care Care Homes for Older People Page 18 of 34 Evidence: staff serve the food. On the day of our visit people were observed to have soup, chicken casserole with vegetables followed by bananas and custard or yoghurt. Staff confirmed other choices were bubble and squeak and cherry pie. Some of the meals had been prepared with each item blended and others had been prepared with just the meat blended. Discreet and sensitive assistance was given to people who needed help eating their meal. Some people on the dementia unit took a long time to eat their meals but staff did not rush them and prompted people where this was required. People spoken to about the food commented it was alright very good food could be better on whole the food is reasonable but sometimes not. Meals provided are detailed on the nutmeg menu system. We were told that the home is provided with these menus to ensure meals are nutritionally balanced. This does mean that although people are asked about meals, they are being given meals from a set menu. The manager advised that people can have a choice and can be given alternatives. One person spoken to said we usually have a choice but when it comes to it I cant have the choice they explained this was because is was not available to give. Menus seen did not list breakfast choices or snacks and drinks that can be made available to people at any time. This was raised during the last inspection to the home. Food and fluid charts seen for those that were not eating well did not show a wide range of finger foods, snacks and drinks were being provided. We did see that cakes and biscuits are provided during the morning and afternoon breaks in addition to the hot drinks. A picture menu had been developed of the main meals provided to help people make a choice of what they would like to eat although we did not see this used on the day of our visit. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate procedures are in place to manage any complaints or allegations of abuse to help protect people living in the home. Evidence: The Annual Quality Assurance Assessment (AQAA) completed by the service stated: The home has an open and transparent atmosphere, which welcomes complaints and suggestions about the service. The home uses complaints and suggestions positively and learns from them. All complaints are fully investigated, addressed and the actions taken in response to them are fully recorded. Outcomes are checked by the manager with each complaint. We found that since the last inspection the complaints procedure had been updated to include contact names and addresses and this was detailed in the information pack that the home stated they provide to people upon admission. Since the last inspection we have received two safeguarding referrals, one relating to staff behaviour and the other in relating to a person left alone to eat in their room. Both of these referrals were not upheld although there were some recommended actions that the home were advised to take. We looked at the record of complaints and concerns maintained in the home and there were a number of these which covered a range of areas, evidence was available to Care Homes for Older People Page 20 of 34 Evidence: confirm that concerns raised verbally had been acted upon in addition to the more formal, written complaints. The manager had copies of letters she had written in response to complaints received and it was evident she had invited complainants to let her know if they were not happy with the outcome of her investigation. One person commented that something the home could do better was to listen to complaints and to help suggesting this person had not had a positive experience in regards to concerns they had raised. During our last inspection we found people were not happy with the way their laundry was being managed with items going missing or not being returned. During this visit people told us they continue to experience problems despite there being a new system in place where a numbered button is attached to the clothes. One person told us its an absolute nightmare, when we came here they said we didnt need to label the clothes because they had a system in place. They need a proper laundry person who takes pride in the clothes, There has been problems, the majority comes back, we have lost a few items. One thing that is bad is so much stuff disappears, thats terrible if you send something to the laundry you are not always certain of getting it back, last week it was so bad I had no nighty to put on. Things go missing, good stuff goes missing. The manager acknowledged that there were problems with the laundry system and advised she had raised this with the provider with a view to discussing other options to resolve these ongoing problems. Prompt action needs to be taken to resolve this ongoing issue to demonstrate concerns are being effectively managed on an ongoing basis. People spoken to stated they knew who to speak to if they were not happy and it was clear they felt at ease to do this. Staff spoken to were clear about their responsibilities in dealing with any concerns and recording these. Systems were in place to manage any allegations of abuse including a policy and procedure for staff to follow should this be observed or identified. Staff spoken to were aware of their reponsibilities for reporting this and for ensuring the safety of any person in the home who may be affected. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely environment which is subject to on ongoing refurbishment to ensure this remains safe and comfortable for people to live in. Evidence: The Annual Quality Assurance Assessment completed by the service stated: The home is designed to provide small group cluster living. The kitchenettes on each unit are designed to enable and promote the involvement of residents in domestic tasks and as part of maintaining self help skills. We found this to be the case. The manager told us that since the last inspection there had been improvements made to the home including new hard flooring in dining areas on all three floors, new corridor carpets and new dining furniture on all three floors. During our tour of the home we noted that these changes had taken place which had much improved the environment for people. The one exception was the carpet noted in the dementia unit lounge which remained marked and stained. The lounge areas had comfortable sofas and easy chairs as well as high backed chairs. We saw that new large widescreen televisions had been purchased for the lounges which people were taking advantage of during our visit. Aids and adaptations were available for people living in the home in order to promote Care Homes for Older People Page 22 of 34 Evidence: their independence including hand rails in corridors, raised toilet seats, grab rails around toilets, wheelchairs, walking aids and four mechanical hoists for the safe moving and handling of people. We found that the bathroom on the ground floor had part of the flooring missing and did not appear to be in use. The manager explained that the bath was being moved so that it was more accessible for people and it was hoped this would be completed in the next few weeks. Bedrooms were noted to be of varying sizes and a nurse call facility was available in each bedroom so that people could summon assistance if required. None of the bedrooms had an ensuite facility but commodes were seen to be provided in rooms where these had been requested. There were also communal toilets on each floor of the home. Bedrooms were tidy and had been made homely to suit each individual with personal possessions on display. The manager confirmed they continue to decorate bedrooms as they are vacated. The home has pleasant gardens which are secure and suitable for wheelchair users. We were told that fundraising continues to enable a Summer House to be provided. There were no unpleasant odours noted in the home and those areas viewed were found to be clean and tidy. Facilities available for the management of the laundry include two washing machines and one drier. Staff have access to a sink to wash their hands and there are systems in place for managing any heavily soiled items to help prevent any spread of infection. Although there were arrangements for sorting dirty laundry, we found that open weave baskets were being used which can be difficult to clean and maintain hygiene. Care Homes for Older People Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive support from adequate numbers of staff who are subject to ongoing training to ensure they provide safe and suitable care to people living in the home. Evidence: The Annual Quality Assurance Assessment completed by the service stated: The Home is fully staffed with a generous supply of relief staff recruited. Warwickshire Care Service has a comprehensive recruitment procedure which is followed by the management in the home. All elements of recruitment are accurately recorded and the required documents are always received prior to any employee starting work. We discussed staffing arrangements with the manager who told us there were 30 people accommodated in the home on the day of our visit. We were told there were six care staff on each day and that two care staff were allocated to each floor. At night there were three care staff. In addition to this the manager stated she worked in a supernumerary capacity and a senior carer worked two supernumerary shifts per week to complete care plans and observe staff practices as part of their supervision. The manager stated that a member of catering staff worked in the kitchen each day and there were dedicated housekeeping staff to complete the cleaning and laundry. Duty rotas viewed showed that these staffing numbers were being achieved with the Care Homes for Older People Page 24 of 34 Evidence: exception that on some occasions there had been two night staff on duty and not three. People spoken to were very positive in their comments about the staff. We were told care staff are brilliant, always very friendly do look after them well very happy with staff and how they are treating my mother carers are very good, one or two exceptionally good. Care staff spoken to said they liked working at the home. A comment card received from a member of staff stated: The carers are good at teamwork and work well together. We observed staff spending some time with people during our inspection and staff spoken to were knowledgeable about peoples needs and abilities and offered appropriate support while encouraging people to retain their independence. The personnel files of two recently recruited staff were examined and both contained evidence that Criminal Record Bureau (CRB) had been applied for. Satisfactory Protection of Vulnerable Adult (PoVA First) checks were obtained and satisfactory references received before new staff members started working in the home. On one application form there was a gap in employment and it was not evident the reasons for this had been explored. This was discussed with the manager. Robust recruitment practices should safeguard people living in the home from the possibility of abuse. Staff training records were not fully developed to demonstrate that all staff had completed mandatory training including, fire safety, food hygiene, manual handling and medication. A member of staff spoken to stated they had not recently completed training on fire or food hygiene but they had completed moving and handling and first aid training. The manager advised that all staff training information was in the process of being recorded on a data base and once this was complete they would have a clearer picture of training completed and training required. We were told that new staff complete induction training based on the Skills for Care Common Induction Standards. This training is completed over a number of weeks so that staff can build up their competencies to care for people safely. The manager said that staff retain their training records but she was able to produce copies of certificates showing us that the training had been completed. Care Homes for Older People Page 25 of 34 Evidence: Training records viewed showed that out of the 35 care staff employed by the home there were 18 who had completed a National Vocational Qualification (NVQ) II in care qualification and had received certificates. Care Homes for Older People Page 26 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to monitor the quality of the service to help ensure the home is run in the best interests of the people living there. Health and safety checks are undertaken to reduce any risks of harm to people living in the home. Evidence: The manager has been working at the home since January 2009. She has worked in residential care for over 23 years and has 14 years experience of working in care management. She has attained numerous qualifications including the Registered Managers Award. We found that the manager has continued to make improvements to the service to help raise the standards within the home. The Annual Quality Assurance Assessment completed by the service stated: There is a robust system of quality assurance. Consultation occurs with residents on a monthly basis. An annual service review publically shares the outcomes of the quality assurance evidence and highlights trends We found there were various systems in place to help measure the quality of care and Care Homes for Older People Page 27 of 34 Evidence: services people receive. Resident meetings were being held on a monthly basis. The notes of these meetings showed they had discussed meals being provided and places of interest they would like to visit such as Hatton Craft World and the Stratford Butterfly farm. Questionnaires had also been carried out with people to find out their opinions of the service and there were also questionnaires sent to relatives regarding dignity and care. As a result of responses received the home had developed a list of objectives that they aimed to fulfil. Notes of a relative meeting showed that they had been advised of these objectives. The manager said that each month she will put a notice up showing how these objectives have been achieved and will ask relatives if they think the home have achieved them. The home has a Friends of Woodside Committee. This is basically a group of volunteers all of which have relatives or friends residing at the home. They aim to raise funds for extra social activities such as day trips, in house activities and entertainment. A Friends of Woodside newsletter showed that they had raised funds for a Puss in Boots pantomime at the home, a large flat screen television and DVD player in the dementia lounge and two Christmas shopping trips. Fundraising ideas included coffee mornings and a Summer tea party. Meetings dates had been published throughout 2010 to continue with discussions around the programme of fundraising activities for the home. The home can accommodate the safe storage of small amounts of money belonging to people. The Administrator manages any monies received and the records relating to any transactions undertaken. We checked the records for several people and found that separate receipts had been maintained for any transactions undertaken and money was correct in all checked but one. One envelope was short of a small amount. The manager felt this could be due to the person purchasing a bag of sweets and the record not being updated. This has subsequently been confirmed and the records appropriately updated. We looked at accident records and found that these were not being reported to us as required. We discussed this with the manager and advised that any accident or incident which impacts on the wellbeing of the person and which involved medical intervention or hospital visits must be reported to us. This is so we can be confident Care Homes for Older People Page 28 of 34 Evidence: the home are managing the health and safety of people appropriately. It was evident that appropriate health and safety checks were being carried out at the home. Records were seen to confirm gas, electrical portable appliance checks, fire alarm, bed rails, lift, sit on weighing scales and electrical wiring had been done. Hot water temperatures were being monitored and recorded to ensure these were not too high to scald people. The housekeeper confirmed that all staff completed health and safety training on a regular basis so that they were aware of their responsibilities in maintaining the safety of people. Care Homes for Older People Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must accurately reflect peoples needs and include how needs are to be met. This includes care plans for pressure ulcer management and any other skin condition. This will ensure that staff have access to the information they need to ensure peoples needs are being met. 20/05/2010 2 37 37 All accidents and incidents 30/04/2010 which impact on the safety and wellbeing of people must be reported to the Commission. This includes those where medical intervention is sought. This is to demonstrate these are being identified by the home and are being acted upon appropriately to safeguard people. Care Homes for Older People Page 31 of 34 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 It is advised that the home develop a Service User Guide which contains all of the required information so that people have access to all of the information they need to make a decision to stay. Care plans need to contain clear instructions for staff where they are required to complete additional care records which are kept separately to the care plan file. This is so that staff are clear about where information needs to be recorded in order to demonstrate the needs of people are being met. Body charts in use should clearly indicate any current pressure sores or skin conditions that could impact on the persons health and it should be clear whether any previously recorded pressure sores have healed. Action should be taken to ensure the weighing scales are maintained in good working order at all times so that the weight of people can be effectively monitored as part of maintaining their health. The social stimulation of people on the dementia care unit continues to need review to ensure peoples social care needs are met consistently. It is advised that the menus for the home include details of all meals, snacks and drinks that can be provided so that people living in the home know what is available to them each day. In view of comments received by people who use the service. Further work is needed in ensuring people are satisifed with the meals being provided. In view of the ongoing complaints regarding the laundry service the home should take swift action to ensure peoples laundry is appropriately laundered and returned to them. It is recommended that the marked and stained carpet in the dementia unit is replaced so that this area is more pleasant for people to use. Suitable containers should be used for the storage of dirty laundry that can be easily cleaned to prevent the spread of any infection. There needs to be a clear training schedule which shows all Page 32 of 34 2 7 3 7 4 8 5 12 6 15 7 15 8 16 9 19 10 26 11 30 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations staff training completed and planned. This is to demonstrate that all staff have completed training within the required timescales to maintain their competency to care for people safely. Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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