Care Home: Woodboro Residential Home

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What the care home does well People living at Woodboro spoke positively of the staff and of the meals and services offered. Residents spoken with at Woodboro stated in relation to the environment “It is very nice” and one resident survey returned stated “They look after us well and our wishes come first”. Woodboro provides care of an intuitive nature, supporting people in an environment that is homely and well maintained. During the visit to Woodboro, people living at the home and staff were spoken with. All seemed positive about the home and the people living there appeared at ease, and were happy to talk with us. Interactions between staff and the people living at Woodboro observed during this inspection were positive.Woodboro Residential HomeDS0000071012.V376618.R01.S.docVersion 5.2Staff at Woodboro were generally positive in their approach to their work and from observation and discussion appeared to work well together to meet the needs of those living at the home. Surveys received from residents stated on more than one, “It is very clean and welcoming” and “The care is very good”. The home was clean and tidy offering homely accommodation to the residents. The residents seen were relaxed and clearly felt at home in the environment and can use all areas of the building. All the records and files were generally well maintained and easily accessible. Interactions between staff and residents were friendly and appropriate. What has improved since the last inspection? Improvements have been made to fixtures and fittings, repairs have been undertaken, making the surroundings pleasant for people living there. There have been some improvements in care planning, medication practices and the way people are supported to make choices around activities. This will help to ensure peoples needs an be met fully. Service users were seen to have both variety and choice in the food they wished to eat. This will ensure residents receive adequate nutritional intake. A quality assurance and a quality monitoring system are in place to measure success in meeting the aims, objectives and the Statement of Purpose of the home. What the care home could do better: People moving into the service whether permanent, for respite care or as an emergency, should have all their needs, strengths and aspirations documented. This will ensure that the service is fully aware of these and how they will support them before they agree to the admission. Each person should have a comprehensive plan of care which should be more person centred and indicate the assistance required to aid the person’s predominant needs such as physical, social and healthcare needs, and these should correlate with the daily evaluations to ensure all service users individual care needs are met and that staff are aware of these needs. The home’s recruitment procedures must be robust and all staff must have appropriate checks such as CRB checks in place before they start work, so that residents are protected.Woodboro Residential HomeDS0000071012.V376618.R01.S.docVersion 5.2Some consideration has been given to basic training needs, some shortfalls were noted, particularly core training. There was evidence of some basic training courses, but it was not clear that all staff are annually receiving refresher training and updates in courses such as moving and handling, POVA, first aid, medication and fire training. Regular, formal supervision sessions must be introduced to ensure staff are competent and have the right skills in their role. Key inspection report CARE HOMES FOR OLDER PEOPLE Woodboro Residential Home 29-31 Skelmersdale Road Clacton On Sea Essex CO15 6BZ Lead Inspector Helen Laker Key Unannounced Inspection 15th July 2009 09:00 DS0000071012.V376618.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodboro Residential Home Address 29-31 Skelmersdale Road Clacton On Sea Essex CO15 6BZ 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) 01255 420090 01255 430991 Mr Emmanual Klotey-Tetteh Collison Mr Emmanual Klotey-Tetteh Collison Care Home 22 Category(ies) of Dementia - over 65 years of age (22), Old age, registration, with number not falling within any other category (22) of places Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category only: Care Home only - Code PC To service users of the following gender: Either Whose primary needs on admission to the following categories: Old age, not falling within any other category - Code OP Dementia - aged 65 years and over - Code DE(E) The maximum number of people that can be accommodated is 22 Date of last inspection 23rd July 2008 Brief Description of the Service: Woodboro is an established care home, which has a registration for twenty-two older people aged 65 years and over, of whom all may require care by reason of dementia. The home has provision to incorporate care for two respite admissions and four interim placement (transitional) residents on short term care packages. In addition to this the home has a contract with Essex County Council for ten spot purchase beds. Fees are £390.39 to £409.91 per week. Hairdressing, chiropody, dentistry newspapers and magazines are all charged at cost. Toiletries are charged at £3.50 per month and activities are charged at £20 per month with residents consent. The premises consist of a large family house, with an adjoining connecting bungalow, in a residential area of Clacton on Sea. Woodboro is within walking distance of the town centre and the railway station. Clacton on Sea has the usual amenities of shops, post offices, library and leisure facilities. The seafront and promenade are also close by. The accommodation comprises of twenty- two single rooms; nineteen with ensuite wash hand basin and toilet and three with wash hand basin only. Bedroom accommodation is on the ground and first floor. Access to the first floor is by staircase or passenger lift. Toilet and assisted bathing facilities are found on each floor. Catering and laundry services are in-house. Communal areas consist of a dining room, a main lounge room and a small quiet lounge/visitors room. All are located on the ground floor. There are gardens at the front of Woodboro. Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 5 The rear of the property is paved for parking, with a patio area and the front gardens are laid with lawn and flowerbeds. Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key unannounced inspection looking at the core standards for care of older people took place on a weekday between 09:00 and 15:00. The registered proprietor and staff were present throughout and assisted with the inspection process by supplying records and information. This report has been compiled using information available prior to the visit such as surveys sent out, evidence found on the day of inspection and the annual quality assurance assessment (AQAA), which is required by law and is a self-assessment completed by the service. The AQAA provides an opportunity for the service to tell us what they do well and areas they are looking to improve and/or develop. It is anticipated that some improvement be noted as this contributes to the inspection process and indicates the homes understanding of current requirements, legislation changes and own audited compliance. This document will be referred to as the AQAA throughout the report. During the day the care plans and files for four of the residents were seen as well as three staff files, the policy folders, the medication administration records (MAR sheets), some maintenance records and the fire log. The manager also supplied a copy of the duty rotas, the menus, and other pertinent documentation which was required. A tour of Woodboro was undertaken and eight residents, six staff (care and catering) and the proprietor Mr Collison were spoken with. What the service does well: People living at Woodboro spoke positively of the staff and of the meals and services offered. Residents spoken with at Woodboro stated in relation to the environment “It is very nice” and one resident survey returned stated “They look after us well and our wishes come first”. Woodboro provides care of an intuitive nature, supporting people in an environment that is homely and well maintained. During the visit to Woodboro, people living at the home and staff were spoken with. All seemed positive about the home and the people living there appeared at ease, and were happy to talk with us. Interactions between staff and the people living at Woodboro observed during this inspection were positive. Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 7 Staff at Woodboro were generally positive in their approach to their work and from observation and discussion appeared to work well together to meet the needs of those living at the home. Surveys received from residents stated on more than one, “It is very clean and welcoming” and “The care is very good”. The home was clean and tidy offering homely accommodation to the residents. The residents seen were relaxed and clearly felt at home in the environment and can use all areas of the building. All the records and files were generally well maintained and easily accessible. Interactions between staff and residents were friendly and appropriate. What has improved since the last inspection? What they could do better: People moving into the service whether permanent, for respite care or as an emergency, should have all their needs, strengths and aspirations documented. This will ensure that the service is fully aware of these and how they will support them before they agree to the admission. Each person should have a comprehensive plan of care which should be more person centred and indicate the assistance required to aid the person’s predominant needs such as physical, social and healthcare needs, and these should correlate with the daily evaluations to ensure all service users individual care needs are met and that staff are aware of these needs. The home’s recruitment procedures must be robust and all staff must have appropriate checks such as CRB checks in place before they start work, so that residents are protected. Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 8 Some consideration has been given to basic training needs, some shortfalls were noted, particularly core training. There was evidence of some basic training courses, but it was not clear that all staff are annually receiving refresher training and updates in courses such as moving and handling, POVA, first aid, medication and fire training. Regular, formal supervision sessions must be introduced to ensure staff are competent and have the right skills in their role. 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. Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and Standard 6 does not apply to this service Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People considering moving into the home can be assured that their needs will be considered before any agreement to their admission. They cannot be fully assured that these needs will always be documented fully and their needs identified so that staff can be confident that these needs can be met. EVIDENCE: Both the Statement of Purpose and the Service Users’ Guide have previously been assessed and contain all the relevant information as required by regulation. They were both reviewed and revised in February 2008. A further review was noted to be required due to reflect the current updated details for the Care Quality Commission (CQC) Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 11 At the site visit, Mr Collison, the registered proprietor/manager confirmed he would do this and had also included the services available to support the DE (E) category and also equality and diversity within these two documents. Copies of these documents were given to us at the site visit and each was considered in detail following the site visit. These documents currently meet the standard required. Prospective residents generally have full and accurate information to help them decide whether or not the home can meet their needs and what services they can expect to receive. This was confirmed in surveys. One stated “I was told enough to choose this home and another relative spoken with on the day of inspection stated “I chose this home as I was told it was good and they provide everything my relative needs.” As part of the case tracking exercise the admission paperwork for four people who live in the care home was sampled and inspected. Records seen indicated that two residents were admitted for a permanent stay and had had an initial assessment completed. The third and fourth sampled were for residents who were admitted for respite and interim placements and only one had an assessment completed. There was evidence of completion of the admission process as detailed in the National Minimum Standards 2 – 4, namely the service user is provided with a statement of terms and conditions. However the needs assessments seen for three of the files were inadequately completed with one word descriptors such as ‘independent’ and ‘fine’ and another was not completed and could not be found although we were told this had been completed. Another assessment was shown to us for a prospective service user (not yet admitted) and this was also brief and non specific. A COMM 5 (Social Services Assessment) was seen for all files reviewed. The proprietor/manager stated ‘We find that the information provided to us in these documents is incorrect and missing with blank spaces in some cases.” This was also reported at the home’s last inspection and the home was advised to ensure they feedback to the local authority regarding this and the specific issues, however the home must ensure that they also independently complete a full needs assessment with a care plan identifying how people’s care needs are to be met. A discussion took place with the proprietor/manager confirming that whether for a short term placement or long term the pre admission process must be the same and the home should undertake their own assessment to ensure what care is required and what action is needed and by whom. Although this planning and record keeping was evident in part it was agreed with the proprietor/manager that it should be more organised to ensure that the resident’s individual needs are fully met and attention paid to the dating and signing of documentation. New paperwork for short term and long-term residents is now in place for all residents to ensure consistency. Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 12 Woodboro does not offer intermediate care. Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service will overall have their health needs met, and are adequately protected by the homes management of medication. They cannot be sure that their care needs will be documented sufficiently well so the individual healthcare need is clear to staff to ensure that the people living at Woodboro are safeguarded and protected. EVIDENCE: The care plans for four people living at the home were considered at this visit and their support was case tracked. The plans demonstrated a response to the assessment documentation seen and contained elements of the individual’s personal, social and health needs of daily living. Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 14 The plans have all been reviewed with new paperwork in place. We were told they have been made more person centred. The AQAA also states “Person centred care plans are fully updated and all in place to be tried and tested”. Daily record sheets were seen which detailed the food eaten by residents and health care issues detailed in the Manager’s Report sheet and the medical record sheet. Photographs of the people living at Woodboro were found on the care planning documents seen. Care plans include a short personal overview of the person, intended to support staff in gaining an immediate insight into the person and the issues that affect them. The care plans are then broken down into a cardex system. A lot of the sections such as bowel management and bathing require a tick box response only. These were recorded infrequently and did not record evidence of routines and choices. For example one care plan reviewed indicated the service user was self caring with personal cleansing and dressing. However a discussion with staff highlighted that this person could become confused putting on extra clothes, and needed some help with washing. Another staff member spoken with also confirmed that all residents need assistance with bathing, however none of this was recorded. Additionally these care plans were noted to require individualising by adding details of specific conditions that may affect the service user. An example of this was a plan reviewed which made reference to a specific confusion and wandering problem in the pre admission assessment, but this was not identified within the new care plan as an issue for that individual which would need monitoring. Another two care plans reviewed made reference in one case to the service user being prone to falls and using a sensor mat and another to someone having a mattress put at floor level the day before the inspection for safety reasons, but this was not identified in the care plan and appropriate risk assessments had not been formulated to support this. Overall the care plans were seen to contain information that gives some indication, albeit brief sometimes of the person’s abilities and care needs. There was evidence of some areas of their health, personal and social needs being identified and instructions provided to staff in how to support these. There are general considerations made in the plan of how the person’s independence can be supported and the instructions that would provide staff with sufficient information to meet the person’s needs to a safe level. This requires more detail to ensure they are also maximising the person’s abilities. There were also some areas which required further clarification in daily living needs compared to the information gathered during the assessment of needs process or in daily records. This was particularly significant where daily records did not correlate with problems identified from that assessment. Some evaluations were noted to be repetitive and comments such as ‘all care as plan’, ‘appears well and content’ and ‘seems fine’ did not indicate how the service users overall need is met in an individual way. Another plan stated Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 15 “Wandered around all day. Appetite and fluid intake good” this was repeated word for word on more than one occasion, this indicated the care plan itself had not been referred to. The home uses a handover book for communication which will cross reference to other documentation. For example for one person who had been taken to hospital it directed staff to the care plan. The information still needs to be consistently transferred to the care plan though to ensure they reflect actual needs and practice. Reviews were also noted to not be consistent and timely, and evidence of resident and relative involvement was not clear in the documents reviewed. It is recognised that new paperwork is still “work in progress” it is necessary for all residents to have full individually developed care plans to ensure what care is required and what action is needed and by who. The AQAA states under how they have improved “Have trained eligible staff in record keeping and care planning”. Staff spoken with agreed that the new paperwork system should ensure consistency with the home’s care planning processes and that they had undertaken training in this area. The AQAA also acknowledges that the home expects “To update care practices to reflect new trends and ideas to further enhance individualised care”. People spoken with who lived at the home said that they felt they are well cared for by staff. One person said “I have no complaints, they look after me very well” and one relative survey returned stated “They care for my relative very well and all their needs are always met”. The AQAA said that the service encourages independence where possible and respects equal opportunities and dignity through the provision of up to date well organised care plans that are reviewed by the manager and deputy. Medical record sheets were seen on the care planning files sampled and these gave evidence of visits by healthcare professionals including doctors, consultants and district nurses. An additional medication trolley had been purchased to facilitate safe secure storage for all medicines as they are being administered. The current practices in the home have been reviewed and revised, with medication either administered from the present medication trolley or from a secure storage box. The medication storage and recording practice of the service was inspected during the inspection visit. A review following a medication round showed there was a good application of dispensing undertaken by staff with clear understanding of responsibilities in signing and securing medications. The only minor issue identified related to two signatures not being evident on transcribed medications. This was discussed with the proprietor/manager and noted. Medication audits may be of benefit in this area to ensure best practice Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 16 and adherence to the Royal Pharmaceutical Society of Great Britain’s guidance relating to medication. The rapport between staff and people living at the home was good, and throughout the day of the inspection staff were attentive and respectful to people’s needs. They chatted and joked readily with people obviously enjoying their interaction. People spoken with during the inspection spoke fondly of the staff and wanted to tell us how much they appreciated the support they received. During the site visit, we observed occasions when good care practice was demonstrated with regard to distribution of drinks, help with meals and distribution of reading material. Surveys received from relatives were complimentary about dignity and choice, one said “I love it here it’s a home from home, I am looked after well”. Care planning records did also have evidence of thought being given to ensuring that the people living at the home are known by their preferred name and individual clothing is labelled either by staff or family. Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service will have opportunities to be part of the local community and be able to maintain contact with their family and friends following a lifestyle they would individually choose. They are provided with a varied diet that they enjoy. EVIDENCE: We were told that activities offered within the home have increased. Some evidence of attendance at activities was seen in care planning two out of six care plan records reviewed, but it was not always possible to see if the people living at Woodboro had an opportunity to choose what they wished to do. More detailed one to one recording of social interactions would evidence this. An activities diary has been introduced but this just states a generic entry on a daily basis for all residents. For instance it states “Residents had a lively day” indicating all residents had been lively at the same time. The proprietor informed us that staff have been allocated special responsibilities with two of Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 18 the staff being responsible for activity provision. The diary was noted to have gaps of up to 13 days in it at times when these staff were not on duty, therefore the recording system was not consistent and staff spoken with highlighted no reason why they could not write in the diary but ‘didn’t think they could’. There is a monthly charge for activities which usually covers external entertainers such as live theatre performances, chairobics, singers and a craft lady comes every month to entertain the residents. These are supplementary to the internal activities such as bingo, ludo, aerobic exercises offered within the home. However if service users do not wish to participate they are not charged for these events. The staff are enthusiastic and keen to promote the social aspect of care. They spoke of the ways in which they could circulate the information about activities in the home and ensure that it matches the expectations of the people who live in the care home and offer choices. Consideration needs to be given to offering a mix of one to one and group activities and with a view to providing specific activities for those people with dementia. One person living at Woodboro has a photographic life storybook and this was recognised as being beneficial to that individual. All residents have an activity life storybook and some were seen evidencing lifestyle events such as family reminiscence and the war. The AQAA confirms, “Albums of compilation of activities carried out so far, exhibits of products are displayed on premises”. A few visitors were seen to enter the home throughout the day and they were able to meet with their relative in the main lounge, in their room or in the small quiet lounge. Relatives spoken with stated “We are made welcome but it would be nice if they had more trips out.” They had no complaints and positively spoke about the home. Comments included “My relative is looked after well I do not have to worry” Mr Collison said that the home does not hold any money for any of the people living at Woodboro. This is normally managed by the person’s relative, solicitor or by the resident themselves. Within care plans records details were seen of personal possessions and an inventory is kept of items brought into the home. During this site visit, we observed lunch being served. It was served on the plate with the majority of the residents having their meal in the dining room. It was noted that consistent practice in the covering of meals was not practiced for instance a person eating in their room would receive a meal which was covered for transportation from the kitchen to the room but when a meal was transported from the kitchen to dining room this was not the case. Condiments, fruit squash and wine are and can be made available. A fourweek rotation menu is in place, with at least two choices offered at lunchtime and teatime. Service users were observed enjoying a meal of sweet and sour Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 19 chicken on the day of inspection. The catering staff were spoken with and showed a good knowledge of service user’s preferences and individual dietary needs. Food supplies are ordered and purchased throughout the week, with a variety of local suppliers and supermarkets used. There was a variety of food in store, including fresh, frozen, tinned and dried goods. Nutrition records evidenced choices made and the food eaten. Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can access the complaints procedure and generally be confident their concerns will be taken seriously. They can also be assured they will be protected from abuse as staff have appropriate training, and procedures and plans are in place to safeguard people living and working in the home. EVIDENCE: The home has an appropriate policy and procedure around complaints. No complaints have been received by the Care Quality Commission directly. Surveys returned spoke positively about the service indicating there had never been any situations which gave rise for complaints. The home does have a formal recording system for complaints. This was reviewed and showed that the home had responded appropriately to the complaints recorded. The size of the home and the family culture however ensures that any minor concerns are dealt with as they arise. Service users spoken with confirmed that they are confident that any concern would be sorted out. Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 21 The AQAA dataset confirms complaints as being dealt with by the home. The formalising of recording of complaints was discussed with the proprietor on the day of inspection and documenting minor concerns as well as major complaints and recording the outcome would demonstrate that people’s concerns are taken seriously and acted upon. Woodboro’s complaints procedure and policy were noted to need to be reviewed have been reviewed to reflect the Care Quality Commission (CQC) as the regulatory body. Copies were to be found in the home’s office and were on display in the home. One of the relatives spoken with on the day of inspection said that they had not raised a complaint, although they said they were aware of the home’s complaints procedure should they need to complain. Three surveys returned indicated that relatives were aware of how to make a complaint should the need arise. Service user comment cards offered positive comments saying “I love it here the staff are very kind.” whilst another said “This is not a residential home it is a home from home.” The AQAA states, “All staff have had POVA training and are CRB checked. All concerns are acted upon and service users listened to. A sample of staff files examined all contained evidence of Criminal Record Bureau (CRB) checks. Staff spoken with confirmed that they have received training around Safeguarding of Vulnerable Adults (SOVA) and reviews of records evidenced that updates are planned. Policies and guidance with regard to adult protection were found in the care home local authority guidance and a training package also available. Within the home’s guidance there was information on the different types of abuse and Essex County Council referral forms were readily available. At the time of this inspection there were no safeguarding issues raised or pending. Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in Woodboro benefit from a homely environment that is clean and pleasant and improvements are made to ensure people remain safe. EVIDENCE: A tour of the premises was undertaken at this site visit. There is a programme of routine maintenance and renewal of fabric and decoration at Woodboro, for decoration had taken place in most bedrooms. A loop system is in place in the main lounge which residents spoken with said had helped tremendously. A new table and chairs has been purchased for the paved area at the rear of the property. The home’s accommodation is generally pleasant, homely and bright. Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 23 All bedroom accommodation is single with all but three of the rooms having en-suite facilities. People who live at Woodboro had personalised their rooms, with small items of furniture, pictures, ornaments and photographs. One person who lives at Woodboro and who was spending some time in their room on the day of inspection explained they were involved in the choice of decoration for their room and had been able to bring personal possessions, some photographs and pictures into the home. Bedroom doors display the name of the person whose room it was and consideration has been given to aiding all residents, particularly those with dementia to locate their room, through colour coding, pictures, and objects of pictorial reference or photographs on their bedroom door depending on the residents’ personal choice. The importance of colour, smell and touch should be considered when caring for people with dementia. Feedback from service users and relatives spoken with did not highlight any issues with the environment. A side gate and back door are generally left open for staff access which could potentially present a security risk, and also may not protect service users who may wander due to dementia onto a busy road area. Since the last inspection a sign has been posted to ensure this access is locked once staff have used it for access to the home and vice versa for those leaving. If this does not happen persons may be able to just enter the home via this access without staff being aware. Staff spoken with confirmed they were more vigilant in this area. All bedroom doors can be locked and there was evidence of risk assessments in place on the sampled care plans, which detailed why the particular person did not wish to hold a key and lock their room. Woodboro has had an assessment of the premises and facilities by an occupational therapist. These assessments had been completed in March 2007 prior to new registration and copies of these reports were seen. The proprietor was reminded to ensure that these are kept up to date but the ones in place remain relevant to the home’s present facility. Woodboro has it’s own laundry facility located at the rear of the ground floor. Within the laundry there is one washer and one dryer (industrial) and one domestic condenser/dryer. Hand washing facilities and airing and drying facilities are in the laundry, with ironing completed by care staff overnight. Clean clothing is then placed in baskets ready to be returned to the people. To aid identification, Mr Collison said that new residents and their relatives are encouraged to label clothing with their name or care staff will label when a new resident is admitted. Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to receive the care they need by a staff team who have skills and knowledge to support them. The home’s recruitment procedure does not always provide the safeguards to ensure that appropriate staff are employed in sufficient numbers to ensure the people needs are met and they are safe. EVIDENCE: On the day of the inspection site visit there were eighteen people living at the home. Two care staff plus a senior care worker were on duty. The proprietor who is also the registered manager was also present and we were told he is usually on duty from 09.00am to 16.00pm weekdays with the exception of Thursdays. Additionally the deputy manager is on duty 8.00am – 4.00pm each weekday but was not on duty on the day of inspection. We were told by the proprietor/manager that agency staff were used but this was usually at weekends only. An on call system is available out of hours which consists of one member of care staff being available and the proprietor/manager can be contacted also. Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 25 A monthly staff rota was in place and this detailed three care staff were on duty throughout the day and two awake night staff. We were told that staffing levels are determined on the basis of the assessed needs of the people who live at the home. Staff spoken with on the day of inspection confirmed that the ration of night staff had decreased and one service user spoken with stated “There could be more staff especially at night when you need to go to the toilet, but I know they are busy.” In the AQAA, Mr Collison acknowledged that there is a need to review staffing levels more frequently, and that the ratio of staff on nights has decreased, but would increase particularly as the home has both short term interim placement beds (4) and respite beds (2) and is caring for people with dementia. The AQAA also highlighted that shifts were adequately covered but upon speaking to staff they stated they did feel extra staff would help and residents spoken with stated “You do have to wait sometimes but I know they are busy” A discussion took place with the proprietor / manager and the importance of the home’s duty of care to ensure sufficient staff are on duty was made clear, despite possible cost implications being involved if agency staff are used. On the basis of this discussion the home is to review their current rotas and agreed to submit redeveloped rotas to the CQC for review. There have been no new staff recruited since the last inspection. Staff recruitment files for two care staff were sampled. The staff recruitment practice and record keeping highlighted some shortfalls with regard to CRB checks. One file showed that a member of staff had been employed without having a CRB check completed by the home although one was present from another establishment unrelated to Woodboro. A discussion was held with the proprietor about CRB checks not being transferable and that the home must undertake their own to ensure staff are suitable and that service users are protected. Evidence of one reference missing was found on one file, an incomplete application form and employment history and the statement of terms and conditions and job description offered to the care worker was not on the staff file. The other file reviewed showed similar shortfalls but did evidence the home was using the common induction standards. The home’s AQAA states “Good recruitment selection process” More detail regarding this would have clarified the homes processes and better organisation is recommended. Mr Collison was reminded of the need to ensure that all staff are trained and competent to do their job. Evidence of staff induction was limited on the staff files reviewed and evidence of skills from their induction should be evidenced within their recruitment paperwork. Staff training records could not be reviewed in full at this inspection because evidence was not available in the form of certification, so it was not possible to see if training such as moving & handling, first aid and fire training are Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 26 undertaken by care staff on an annual refresher basis or at the intervals as recommended by the organisation that accredits the training. From the sample of records that were available. This is not always the case and further work is required on the development of an individual training and development assessment and profile. Within care staff files sampled there was evidence of some basic training courses such as Health & Safety, First Aid training, Client Handling Awareness and Care and Management of Dementia training. Staff attendance should be entered onto a training matrix, which would make it easier to highlight when updates are due. It was noted that the following courses had been highlighted for staff to attend. Dementia, Mental Capacity Act, Deprivation of liberty and Moving and handling Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living the home can expect it to be run in their best interests and residents can be confident they are protected by the home’s safe working practice and procedures. EVIDENCE: Consideration has been given to the management arrangements in the home and the deputy manager has enrolled on a NVQ level 4. Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 28 The proprietor Mr Collison states that Woodboro has a quality assurance and quality monitoring system in place. The AQAA does not mention anything with regard to this. Evidence of a formal monitoring system used in the house was evident on the day of inspection. Surveys were noted to be completed by service users with regard to living in the home, food, personal care and support. The latest quality assurance report formulated from these surveys on the 31/03/2009 indicated there were 55 of respondents. 75.4 of these were service users and 24.6 were relatives, friends and others. A discussion was held about how the home actions the results of these and for example it was highlighted that more than two choices of food would be preferable. On the day of this inspection there was evidence of two choices at lunch. Mr Collison said that the home does not hold any money for any of the people living at Woodboro. This is normally managed by the person’s relative, solicitor or by the resident. Staff records were sampled for evidence of staff supervisions. These were noted to be more consistent to ensure that supervisions take place at least six times a year. Staff spoken with confirmed they had supervision and the process followed for this. As highlighted previously in this report there was evidence of some basic training courses such as Moving and Handling. Future planned training include dementia and medication awareness. Servicing records for some appliances were sampled and inspected at this inspection. All were satisfactory and had been conducted in the last six to twelve months so were up to date including the records relating to the fire alarm testing and fire instruction and drills. The last fire drill recorded was 16/07/2009 The Commission has not received any Regulation 37 notifications since September 2008. Following discussion it was noted that the home may be sending these to the wrong address but in the case of three service users these had not been received For example one person had sustained a broken hip and was taken to hospital two days after admission, another had had a fall the day before the inspection. No records were available to support these events. Record keeping with regard to accidents, injuries, and incidents of illness or communicable diseases must be maintained to ensure all are noted, accurate and in good order. Regulation 37 must be sent promptly to the Commission and give full details of the event. Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x 3 x x x 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 3 x 2 Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement People moving into the service whether permanent, respite or emergency, should have all their needs, strengths and aspirations documented. This will ensure that the service is fully aware of these and how they will support them before they agree to the admission. Each person should have a comprehensive plan of care which should be more person centred and indicate the assistance required to aid the person’s predominant needs such as physical, social and healthcare needs, and these should correlate with the daily evaluations to ensure all service users individual care needs are met and that staff are aware of these needs. This is a repeat requirement from the last inspection timescale of 17th October 2008 not met The home’s recruitment procedures must be robust and DS0000071012.V376618.R01.S.doc Timescale for action 02/12/09 2 OP7 15 02/12/09 3 OP29 2 & 19 02/12/09 Woodboro Residential Home Version 5.2 Page 31 all staff must have appropriate checks such as CRB checks in place before they start work, so that residents are protected. This is a repeat requirement from the last inspection timescale of 17th October 2008 not met. Record keeping with regard to 02/12/09 accidents, injuries, and incidents of illness or communicable diseases must be maintained to ensure all are noted, accurate and in good order. Regulation 37 notifications must be sent to the Commission and give full details to ensure residents health and welfare is maintained. 4 OP38 37 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations Appropriate risk assessments must be in place for more dependant residents especially where service users may have health problems which present risk, and staff must maintain detailed records of such and review appropriately so that service users are safe at all times. Transcribed medications should evidence two signatures to ensure service users receive their correct medication. Staff numbers must reflect the staffing requirements to meet the dependency of the current service users. Staff training and annual updates must be maintained with certificated evidence of such, to ensure the home has competently skilled staff to meet service users needs The registered manager should obtain a qualification of NVQ level 4 in management and care (or the equivalent). This would ensure people living in the home benefit from a DS0000071012.V376618.R01.S.doc Version 5.2 Page 32 2. 3 4 5 OP9 OP27 OP30 OP31 Woodboro Residential Home robust management structure in which the manager has obtained the qualifications needed to meet the National Minimum Standard. Woodboro Residential Home DS0000071012.V376618.R01.S.doc Version 5.2 Page 33 Care Quality Commission Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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