Care Home: Woodbury View

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What the care home does well Overall, people living in the home are being treated well and have a good quality of daily life. Relatives are happy with the service.Woodbury ViewDS0000068189.V378394.R01.S.docVersion 5.3The home makes sure it knows what care people need, before and after they move into the home. Staff know how to give the support people need with their personal, social and health care. People living in the home can lead active lives. They make choices wherever possible about what they want, with careful support from staff, family and advocates. Daily life is varied, visitors are welcome, and the food is good. People go out of the home to many different activities in the community. Staff work hard to provide a variety of interesting experiences for the people who live in the home. People living in the home can let staff know if they are unhappy, and staff know what to do if this happens. The home is clean, comfortable and homely, with pleasant individual rooms. Staff are qualified and have a positive approach to their work, so they can support the residents well. The manager is qualified and is committed to providing a high quality of life for people living in the home. What has improved since the last inspection? The manager is now involved with helping people to decide whether to move into the home, and people can have a trial period to see if they get on with other residents. The home has begun to use advocates to ensure difficult decisions are made in the best interests of the person concerned. Staff have begun to arrange regular health checks for people living in the home. Medication is stored more safely and staff have had more training about this. Hygiene has been improved in the laundry room. Staff discuss the needs of people living in the home, during staff meetings, to ensure a clear and consistent approach. What the care home could do better: Written information about the home should be updated to ensure it gives an accurate and complete picture of the home for people who may consider moving in.Woodbury ViewDS0000068189.V378394.R01.S.doc Version 5.3 Written plans for care, and for managing risks to people in the home, should include all aspects of people’s lives and should be more regularly updated. There should be clear guidance and training for staff about what to do if they were to have concerns about people in the home receiving poor care or illtreatment. The company should consider how to increase shared space, especially in the living / dining areas and the corridor. They should also arrange for repairs and maintenance to be done more quickly. Staff arrangements should be improved so people’s activities and welfare are never affected by a lack of regular staff. Staff should get more regular training to keep their skills up to a good level in all aspects of care. The company should be monitoring the service on a regular basis and providing more regular support for the home’s manager, to ensure the service can improve. Some aspects of safety in the home should be better managed, to ensure the safety of the people living there. Key inspection report CARE HOME ADULTS 18-65 Woodbury View Martley Road Lower Broadheath Worcester WR2 6QG Lead Inspector Debra Lewis Key Unannounced Inspection 12th November 2009 10:15 Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 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 home adults 18-65 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. Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 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 Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Woodbury View Address Martley Road Lower Broadheath Worcester WR2 6QG 01905 641745 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) Lifeways Community Care (Gloucester) Ltd Mark Anthony Tandy Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users, including those who will have an additional physical disability, must be sufficiently ambulant to access all parts of the building. 19th November 2008 Date of last inspection Brief Description of the Service: The Home is situated in the village of Lower Broadheath on the outskirts of Worcester City, close to the village Post Office and shop. It is a detached chalet-bungalow with a level, private garden. There are five bedrooms with ensuite facilities and domestic style living accommodation. The home has two ordinary vehicles for community access. The providers have written information about the service that can be sent out to interested parties. The current fees were not stated in the Service Users’ Guide. Additional charges are made for personal items such as clothes, toiletries, some continence aids, personal services such as chiropody and haircuts, and the cost of some activities. A holiday allowance is budgeted for but the service users may need to pay some costs. The registered provider of the home is Lifeways Community Care (Gloucester) Ltd. The responsible individual for Lifeways is Mr Paul Marriner. The registered manager of the home is Mr Mark Tandy. Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for the service is 1 star. This means the people who use this service experience adequate quality outcomes. We, the Care Quality Commission, undertook an unannounced inspection of this service over one day from mid morning until early evening. This was a Key Inspection of the service, which means that we checked all of the standards that have most impact on service users. The home manager and staff did not know we were coming. This type of inspection seeks to establish evidence which shows that residents are safe, and experience positive outcomes. This report includes what we found during the visit to the home, as well as any relevant information that we have received about the home since the last inspection. Before the inspection an Annual Quality Assurance Assessment (AQAA) was completed by the manager. The AQAA is a self assessment and a collection of information that each registered provider has to complete and send to us within agreed timescales. It tells us how providers of services are meeting the needs of people living there, and it is an opportunity for them to share with us what they are doing well and what their plans are for the service. We also sent surveys to professionals working with people in the home, to staff, and to the people living in the home. We met and talked with staff on duty and with the registered manager. The people living in the home were unable to tell us their views, but all had relatives who told us in the surveys what they felt life in the home was like, for their family member. We looked at the building and whether it is well kept and safe. We checked records that staff keep, for example about what care they are giving to the people living in the home. We looked at what had changed since the last inspection. What the service does well: Overall, people living in the home are being treated well and have a good quality of daily life. Relatives are happy with the service. Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 6 The home makes sure it knows what care people need, before and after they move into the home. Staff know how to give the support people need with their personal, social and health care. People living in the home can lead active lives. They make choices wherever possible about what they want, with careful support from staff, family and advocates. Daily life is varied, visitors are welcome, and the food is good. People go out of the home to many different activities in the community. Staff work hard to provide a variety of interesting experiences for the people who live in the home. People living in the home can let staff know if they are unhappy, and staff know what to do if this happens. The home is clean, comfortable and homely, with pleasant individual rooms. Staff are qualified and have a positive approach to their work, so they can support the residents well. The manager is qualified and is committed to providing a high quality of life for people living in the home. What has improved since the last inspection? What they could do better: Written information about the home should be updated to ensure it gives an accurate and complete picture of the home for people who may consider moving in. Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 7 Written plans for care, and for managing risks to people in the home, should include all aspects of people’s lives and should be more regularly updated. There should be clear guidance and training for staff about what to do if they were to have concerns about people in the home receiving poor care or illtreatment. The company should consider how to increase shared space, especially in the living / dining areas and the corridor. They should also arrange for repairs and maintenance to be done more quickly. Staff arrangements should be improved so people’s activities and welfare are never affected by a lack of regular staff. Staff should get more regular training to keep their skills up to a good level in all aspects of care. The company should be monitoring the service on a regular basis and providing more regular support for the home’s manager, to ensure the service can improve. Some aspects of safety in the home should be better managed, to ensure the safety of the people living there. 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. Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is some written information available about the home, but more information is needed to ensure people can get a clear picture of the service. Before people move into the home, the service ensures they know about and can meet that person’s needs. Potential residents also have the chance to visit the home and get to know it, to see if they will be comfortable with the service and with the other people living there. EVIDENCE: We talked with the manager and staff. We looked at the home’s written records and information, such as the Statement of Purpose, service users’ guide, and assessments of people’s needs. We also took into account what relatives had told us on behalf of the residents when they replied to our surveys. No new people had moved into the home since the last inspection. We were told that the last person who had moved in had their placement reviewed after about 2 months to see if they had settled in well, and we saw this person Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 10 mixing with other people in the home, all of whom seemed relaxed with each other. At the time of the inspection the home had a new referral who had been to visit the home 3 times with carers and family. The registered manager said he was involved with the referral process and would be ensuring that a full assessment of the person’s needs was received in the home before they agreed to the placement, so they could judge whether they could meet the person’s needs. The home had written information about its purpose in a Statement of purpose, which included good detail. It had been adapted from another home’s document so mentioned another home and another region’s manager, so needed amending. There was also information available in a Service Users’ Guide, intended for potential residents, their families and placing authorities. This was in the form of simple information in short sentences, to make it easier to explain to potential residents. It did not contain the full range of information needed, for example it did not state the fees charged. Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has written plans for the care of people living there, which would be better if they were more comprehensive and more up to date. People living in the home are well supported by staff to have choices and make decisions about their lives. People can do ordinary activities which may have some risk and staff are aware of the risks. EVIDENCE: We talked with the manager and staff in the home. We looked at the home’s written records and information, such as care plans and risk assessments. We also took into account what relatives had told us when they replied to our surveys. Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 12 There were written care plans for people living in the home, which covered most relevant areas of their lives. Most were up to date, but some had not been reviewed since December 2008. We did not see plans for the social and activity side of people’s lives, but there was plenty of evidence that this aspect was being addressed in practice. Plans included details of people’s preferences, which had been ascertained from how they responded or from family advice. For example there were details about preferred gender of the carer giving personal care; and details about how someone liked to be awoken gently and gradually in the mornings. Staff and relatives were clear that people living in the home, while they may not be able to use speech, could express whether they were unhappy or happy with any situation and this was used to gauge their preferences. An independent advocate had been obtained in order to help make a decision on behalf of one person, who required a difficult medical procedure which could cause problems for that person. The advocate had been engaged in order to ensure the person’s best interests were being independently promoted. This was good practice. Risk assessments were in place for most activities people did, and were reasonably up to date. One risk assessment we saw mentioned that a person’s toiletries needed to be “locked away” as there was a risk of the person swallowing them. We saw toiletries on an open shelf in this person’s bathroom. The registered manager told us that this person was unable to reach up to that shelf. We advised that the risk assessment was therefore inaccurate and it must state precisely what precautions were needed, otherwise staff could become complacent about risk management. The manager said he would amend the risk assessment. Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 14, 15, 16, 17. People using the 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 living in the home lead varied and interesting lives, and take part in a variety of activities in the community. Daily life in the home is flexible, and does not stick to fixed routines. Family and friends are welcome in the home, and people living in the home have a good variety and choice of food. EVIDENCE: We talked with the manager and staff. We looked at the home’s written records and information, such as care plans, records of activities and food records. We also took into account what relatives had told us when they replied to our surveys. Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 14 The registered manager told us that “We support a varied social integration for each service user as an individual. We access especially the more local community …. We promote individuals to have regular family visits and to this end all current service users maintain good family support both in and out of the home. Daily routines do reflect the emphasis on individuality of routine. The home supports individuals to have both times in communal areas and especially time alone with or without direct support, understanding each service user’s right to time alone. We encourage service users to help make beverages. The staff team support each service user’s individual right to eat their meals where they choose within the home either around the dining area, lounge area or own room. We promote maintain and record the theme that service users have full access to beverages and food regardless only of risk assessed times i.e. naked flames and sharp knives.” We saw evidence to support this approach during the inspection. We found that the manager and staff work hard to enable as wide as possible a range of activities for people living in the home. Each person was taking part in a morning and an afternoon activity each day, with named staff allocated to provide specific support. This was being done in a “person-centred” way for example the activities were things the person enjoyed, the staff member allocated would usually be someone who had a shared interest in the activity and/ or a rapport with that person. Activities included music, having a foot spa, watching a DVD, swimming, going out for a drive, personal shopping, visiting a garden centre, having a meal out, walking in the village, a visit to Malvern Spa, attending college, working at a care farm, going to a pub. Records and discussions showed that there were no set routines in the home; there were planned activities, but no-one was pressured into getting up at a certain time, attending activities if they did not feel like it, or going to bed at any set time. Family involvement in the home was evidently welcomed by staff. People living in the home were encouraged and supported to do some of their own daily living tasks, such as laundry or making drinks, with appropriate gentle support and monitoring by staff. This aimed to help increase their skills and their sense of achievement and control. The food provided was regularly changed and staff were aware of each person’s preferences. Each person had their own cupboard with a supply of favourite foods and drinks which they could have at any time. The home did not have a policy on assessing people’s nutritional needs; it would be good practice to do this. Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People using the 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 living in the home get the support they need, in the way that suits them, with their personal care and health care. Staff look after their medication in a safe way. EVIDENCE: We talked with the manager and staff, and observed practice in the home. We looked at the home’s written records and information, such as care plans and medication records. We also took into account what relatives had told us when they replied to our surveys. People living in the home needed staff support with personal care. This was recorded in their plans, including how they preferred to be supported. Staff described how each person had their own way of expressing what they liked or did not like, and also how families would add their knowledge to what staff knew. We observed staff responding in a warm and calm way to people living in the home. Plans included details of choices regarding the gender of staff Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 16 giving personal care. In practice there were few male staff but where possible they were allocated to support a man living in the home with his personal care. There was evidence that people’s health needs were usually being met, for example we saw plans for seizure care and for “as required” medication. We saw records of appointments with GPs and other medical professionals. A psychologist was involved with looking into one person’s occasional behaviour. The home kept a record of people’s behaviour where it indicated that there may be a problem, as well as when it indicated that they may be particularly content. This helped them to ascertain what could be causing each person’s happiness or displeasure, so they could take steps to improve matters. The last inspection noted that there was not a record of any annual health checks or well man / well woman checks. We did not find them on this occasion either, but after the inspection the registered manager told us that he had arranged Well Person appointments for all people living in the home for December. The registered manager also told us that people had had general health reviews with their GPs, and epilepsy support plans reviewed with the epilepsy nurse (we saw an example of this). We looked at how the home was managing medication for the people who lived there. We found evidence that medication had been discussed with the relevant psychiatrist in order to review whether people’s medication needs were changing, which is good practice. Medicines were being stored and recorded in a safe way. We noted that records of medication that had been given were completed well. In one case the pharmacy had continued to include on the recording chart a medication that had been discontinued. We advised that this should be removed if possible, but until this was done by the pharmacy it should be crossed out and marked as discontinued by senior staff to avoid any potential confusion. Most staff had had training in medication administration and the registered manager told us that further training was arranged so all would be trained by the end of November. Senior staff had extra training in medication management. Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home can express whether they are happy or not, and their families are confident that staff will respond to any concerns. Staff do not have clear training or guidance about how to best protect people in the home from abuse. EVIDENCE: We talked with the manager and staff. We looked at the home’s written records and information, such as the record of complaints and compliments. We also took into account what relatives had told us when they replied to our surveys on behalf of the people living in the home. We looked around most of the home, including one bedroom, shared bathrooms, smoking area and living and kitchen areas. We talked with people living in the home and with staff. The home had a policy on managing concerns and complaints, which needed updating as it referred to a previous manager. People living in the home were unable to voice their concerns, but staff and families told us that they were able to express if they were unhappy. Family members had regular contact with them and visited the home often, so were able to raise any concerns. One relative said they had a “very good response Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 18 from the manager” to a concern. We saw records of concerns raised, which included details of how the concerns had been resolved by the home, showing that the home takes concerns seriously and acts to put them right. We (the Commission) have not received any complaints about the home since the last inspection. The home also has a policy for staff on protecting people living in the home from abuse. This was an old policy which needs altering as it was misleading. It implied that staff should investigate possible abuse, whereas in fact this could interfere with a proper investigation; any potential abuse must be reported to the local authority and their safeguarding co-coordinator will direct any investigation. The senior staff we spoke with were aware of this, but if any less knowledgeable staff followed the home’s policy they could damage a proper investigation. Following a concern about some poor practice which was looked into at the last inspection, we were told by the company that staff would be re-trained in alerting procedures. However on this visit we found that few staff had had such training. Only 4 staff (out of 12) had done “alerter” training and only 1 staff had done training in Safeguarding. This lack of training combined with a misleading procedure could mean that people living in the home are not as well protected as they should be from abuse. The Commission has not received any allegations of abuse at this service since the last inspection, but a proper procedure should always be in place and well known by staff, in order to provide the best protection for people living in the home at all times. Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28, 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual rooms are well furnished to people’s tastes, and have good facilities including toilets and showers. The shared areas of the home are pleasant but not very spacious if the home is fully occupied. The home is usually kept well maintained and safe, but repairs are sometimes a bit slow to get done. EVIDENCE: We looked around most of the home, including some bedrooms, lounge, kitchen and dining area. We talked with staff and the manager. The home is an extended family home on two floors that has been adapted into a care home. It is on the edge of a village with rural aspects and on a main road. There is car parking and a good-sized level garden that is relatively secure. There are plans to remove some raised edges in the garden to make it more accessible for people living in the home. Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 20 The shared rooms include a lounge with a small dining area, laundry room, a spacious kitchen and a shared toilet. The lounge/diner is relatively small for a group of five people with such special needs, and we noticed that the corridor was very narrow, making it tricky for people to pass each other especially as some people living in the home were unsteady on their feet. Previous plans to convert some of the garage space into a sensory room have not been put into action. There are four single bedrooms on the ground floor. On the first floor there is one resident’s bedroom and two other rooms currently used as offices. All bedrooms have en suite facilities with either a bath or a shower. There is comfortable seating and entertainment equipment. The bedrooms we saw were furnished according to the taste and interests of the people who lived in them, and looked homely and comfortable. Each person has their own towels and bed linen. Some rooms were due to be redecorated and have new carpets, which were on order. A maintenance worker from the company is generally available to deal with any repairs. However when he is unavailable e.g. on leave or busy with other work, the registered manager has to find suitable local trades people and undertake appropriate checks, which delays the process of getting things done and uses considerable management time. A comment from staff was that “If things are broken it can take a long time to get them repaired”. Dates were given in the AQAA to show all equipment and installations have been routinely serviced and we saw some supporting evidence during the inspection. Approved fire prevention systems are in place and checks are being made. The home was clean and fresh. Staff follow cleaning schedules during the day and night, and some extra deep cleaning took place this year after it was noted that the home was in need of freshening up. The access to the laundry is through the dining room, which is not ideal. A hand basin has now been installed so staff can wash their hands before leaving the laundry room. It is going to be fitted with a temperature regulator so that one of the people living in the home can start to do some of their own laundry. Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are qualified and have a positive approach to the people living in the home. There are usually, but not always, enough staff to meet the needs of the people living in the home. We were told that staff are checked before starting to work in the home to reduce the risk of employing unsuitable people, but the evidence of these checks was not available. Staff have some training but they need more regular training in order to be able to provide the best quality of care in all areas of their work with people in the home. EVIDENCE: We talked with the manager and staff. We looked at the home’s written records and information, such as training records and staff rotas. We also took into account what relatives had told us when they replied to our surveys. The last inspection found that the service was suffering from a rather unstable staff team. On this occasion we found that the staff team was more stable, and Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 22 when relief staff were used they were normally from a pool of several regular relief staff who had become familiar with the home and the people living there. Staff levels were normally 3 care staff during the day. Some staff felt this was acceptable, others felt this was insufficient, one person stating that as some service users need two-to-one support, if they go out this leaves 1 staff member with 3 other service users. As there is a high risk of seizures meaning people need to be observed by staff most if not all of the time, this level of staffing may not always be sufficient. One person commented that the occasional use of agency staff meant people could not do their normal activity plan. Another commented that people living in the home could make choices “as long as staffing levels allow”. One person felt that agency workers did not always get a full introduction to the home or the people living there. It appears that staffing has improved, but still needs attention. Most staff were doing or had done NVQ (National Vocational Qualifications). New staff had induction training meeting common induction standards, then did NVQs. No staff were doing LDQs (learning disability qualifications) as the company did not provide access to this training. The last inspection recommended that staff should do this training. Senior staff had NVQ level 3. Some wanted to access level 4. We were told that the company did not provide this level of training until someone was in a management post. It would be good practice for them to do this earlier in order to inform their current work and prepare for career development. The company’s recruitment policy appeared to meet required standards, for example requiring 2 references and CRB (Criminal Records Bureau) checks before staff started work in the home. The manager told us that he sees references and CRB checks and does the staff interviews. However we were unable to check the staff records as they were held centrally by the company, rather than being held in the home as is required. Staff training records were kept individually, rather than as a matrix showing the needs of the team as a whole. The registered manager provided individual training records to us after the inspection. We found that training could be improved as there were some significant gaps. For example, some staff did not have training in food hygiene or infection control, although all were involved with food preparation and personal care. Many staff had not had training in safeguarding procedures. We looked at some minutes from Team Meetings and noted that the needs of people living in the home were being discussed within the team, as is good practice. Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an approachable and qualified manager, who is committed to providing a positive lifestyle for people living in the home. He does not always have the time and support needed from the company, to do his job to the best of his ability. The company does not regularly seek the views of people living in the home about the service they receive. The home is mostly safe but could be kept safer for people living there. EVIDENCE: We talked with the manager and staff. We looked at the home’s written records and information, such as checks on quality and on health and safety. Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 24 We also took into account what relatives had told us when they replied to our surveys. The home’s manager has been in post for 1 ½ years and has been registered with this Commission since April 2009. He has suitable experience and qualifications. His approach to his work is centred on improving the lives of the people living in the home. Comments from staff and from surveys distributed to staff, professionals and families suggested that he is seen as a good manager, with an open approach, who listens and values staff opinions, and is organised. One comment was that staff would appreciate more team building work, so the area of working with staff team dynamics could be something he could develop. During the inspection we observed that he had an approachable manner and that he was generally well organised, however the fact that he has only 3 days available for managing the home (the other 2 days are spent on direct care work) has meant that he has not been able to develop the service as he would wish to, or to update documentation as promptly as he would like. Homes are expected to monitor their service on a regular basis, using an organised system of quality assurance. This was not being done at Woodbury View. The registered manager did provide us with a detailed AQAA (Annual Quality Assurance Assessment) which provided accurate information about the service. The registered manager had had two line managers during the past year and that post had been empty since August. This meant that monthly monitoring visits, which are a legal requirement, had not been done as they should be. We saw 5 reports of these visits from earlier in 2009, then none since July, until a visit from another home manager in November. This means that the manager and the service have not been effectively monitored or supported by the company’s line management system. This remains a concern especially as the registered manager is quite new in post and therefore needs such support in order to develop and work effectively. The company does not carry out annual quality assurance checks based on surveys of people living in the home, relatives and other interested parties. They should be doing this to ensure the service develops in line with the requirements of the people who use it. The home had two sets of policies. One set came from the company, and the section for registered services (such as Woodbury View) was empty. The home also had their own folder of policies, compiled by a previous manager. Many of these needed revision and updating, as they often mentioned the previous manager, but, more importantly, they were not all consistent with current practice in the home. Health and safety in the home was mostly managed well, but there were several areas of concern, as below: Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 25 Hazardous substances such as cleaning chemicals were stored in a cupboard in the laundry room. We were told that the room and the cupboard were usually locked, but during the inspection they were both unlocked and so these hazardous substances were accessible to people living in the home, causing a risk of harm. The manager said that there would almost always be staff with the service users and they would not go into that room. However it remains a potential hazard and the registered manager agreed that these substances should be kept locked away. Some people living in the home needed staff supervision and support with eating, as they were at risk of choking. This was not recorded in a risk assessment. It was recorded in their care plans, and staff were aware of the need to stay with them, but particularly as this activity carries such a high risk it needs to be recorded as a risk assessment and flagged up as a high risk. The home’s night time fire procedure had been altered in response to comments from the previous Commission’s inspection. The new procedure was for people living in the home to remain in their rooms, which had 30 minute fire doors, and a phased evacuation to take place. We also noted that a fire consultant’s report from April 2009 stated that if this was the procedure, then 60 minute fire doors would be needed. The company’s safety manager had investigated the cost of these doors and later had judged that 30 minute doors were sufficient. The fire authority had not seen or approved the procedure in detail. Another Fire Safety Policy stated that staff were to “Evacuate the building immediately”. This conflicting evidence meant that we could not be clear whether the procedure was safe. Following the inspection, the registered manager told us he had emailed Hereford and Worcester fire officer asking him to call and review with him the fire risk assessment and evacuation plan. It is important that there is no doubt about the single, official procedure which must be followed, and whether this procedure is safe. Other than these aspects, most health and safety checks and procedures were being done as they should be. Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 4 26 x 27 4 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 2 2 x 2 x Version 5.3 Page 27 Woodbury View DS0000068189.V378394.R01.S.doc Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA9 YA42 Regulation 13 (4) (a)(b)and (c) Requirement Risks to people living in the home must be identified, and avoidable or unnecessary risks must be removed as far as possible. Specifically, the risks associated with service users’ access to hazardous substances; with service users eating; and with fire procedures at night. This will make the home safer for people who love there. Timescale for action 31/12/09 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 YA1 Good Practice Recommendations You should update all written information about the home, such as the Service Users’ Guide, to ensure it contains the required range of information so people can make a fully informed choice about the service. Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 28 2 YA6 Make sure the care plans contain all the detailed information staff need to help them meet peoples needs. Include in goal planning development on life and communication skills. Hold review meetings at least every six months. (Repeated from last key inspection in 2008.) 3 YA23 You should ensure that all staff in the home are clear about the prevention of abuse and about the correct procedures to be taken in the event of any such concern. This will help to reduce the risks of harm or abuse to people living in the home. 4 YA24 Give consideration to how the communal space can be increased, particularly if a fifth person is to be admitted. (Repeated from last key inspection in 2008.) 5 YA32 All staff should be given the opportunity to gain the Learning Disability Qualification. (Repeated from last key inspection in 2008.) 6 YA33 Ensure the staffing arrangements meet the needs of the residents and fulfil the aims of the service. (Repeated from last key inspection in 2008.) 7 YA34 You should ensure that there is evidence kept in the home of all proper recruitment procedures being carried out, including the relevant records for new staff and agency or bank staff. You should carry out an assessment of the training needs for the service as a whole, and ensure that all staff receive the training they need in order to carry out all aspects of their work with people living in the home, in a safe and professional way. The provider should ensure that the manager is well supported and given the time he needs to fulfil his legal responsibilities. DS0000068189.V378394.R01.S.doc Version 5.3 Page 29 8 YA35 9 YA37 Woodbury View (Repeated from last key inspection in 2008.) 10 YA41 Regulation 26 monitoring visits should be carried out every month to ensure the directors are kept informed about the service. (Repeated from last key inspection in 2008.) 11 YA42 The registered manager should undertake training in Health and Safety and specifically in risk management. Woodbury View DS0000068189.V378394.R01.S.doc Version 5.3 Page 30 Care Quality Commission Care Quality Commission West Midlands 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). 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