Care Home: Woodcote House

What the care home does well Woodcote house provides a comfortable and homely environment for the people who use the service. People told us "I like living here", "I asked if I could live here", "I don`t want to live anywhere else" and "this is a nice friendly home". Staff have developed very good trusting relationships with the people they support. Individuals told us that they were sure that the staff would help them if they had any problems or complaints. Staff were described as "great" and "lovely people". One person said "staff always listen and give me a lot of support when I need it". We observed good interactions between staff and people who use the service with care taken to protect the privacy and dignity of individuals. Staff were seen to take time to sit and talk with people or join in activities such as dancing. Certain people who use the service clearly enjoy helping with day to day domestic activities and we observed this was encouraged by the staff group. The mix of older and younger people works well in this relatively small home. Care plans give good information on the strengths of individuals as well as their needs and provide good information on supporting people. People who use the service told us that they enjoy the food and that the chef talks to them on a day to day basis. What has improved since the last inspection? Since the last inspection new windows have been fitted throughout the building. Fire doors which were causing some problems have been replaced. Plans are now in place for the refurbishment of the kitchen. The organisation has started a quality monitoring and assurance system which includes getting the views of people who use the service, relatives and other professionals. CARE HOMES FOR OLDER PEOPLE Woodcote House 167 Sandy Lane South Wallington Surrey SM6 9NP Lead Inspector Liz O`Reilly Key Unannounced Inspection 09:00 21st December 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodcote House Address 167 Sandy Lane South Wallington Surrey SM6 9NP 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) 020 8395 4010 020 8395 5668 brookcarehomes@blueyonder.co.uk Brook Care Homes Elizabeth McNally Care Home 11 Category(ies) of Dementia (11) registration, with number of places Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Dementia - Code DE (of the following age range: 50 years and over) The maximum number of service users who can be accommodated is: 11 Date of last inspection Brief Description of the Service: Woodcote House is an extensive family style house set on a busy road to the south of Wallington. Though a distance away from local ‘town’ facilities, the home is close to bus connections and a few local amenities such as a newsagent, nearby garden centre, etc. The service no longer provides nursing care, the home now only provides residential care. The majority of people who use the service have dementia or related conditions although four of the people currently using the service are under other excepted categories. The house has seven single bedrooms and two double-occupancy rooms. Toilets and bathrooms are provided around the building. People who use the service have access to two lounges and a dining room. A large garden with a patio area is available to the rear of the building. The house has a pleasant lounge, an adjoining dining room and a second lounge. An outbuilding part of which houses the laundry is used by the few people who smoke if the weather is poor. Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one Regulation Manager and one Regulation Inspector on 21st December 2007. During the course of this visit we had the opportunity to speak with people who use the service and staff. Surveys were left at the home for people who use the service and staff. Surveys were also sent to a sample selection of relatives. Judgements in this report are made taking into account information obtained from all of the above sources as well as observations made at the time of this visit. What the service does well: What has improved since the last inspection? Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 6 Since the last inspection new windows have been fitted throughout the building. Fire doors which were causing some problems have been replaced. Plans are now in place for the refurbishment of the kitchen. The organisation has started a quality monitoring and assurance system which includes getting the views of people who use the service, relatives and other professionals. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 7 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 Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 People who use this service receive good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken. Assessments involve the individual concerned and their family or representative. Admissions only take place if the service is confident staff have the skills and abilities to meet the assessed needs of the individual. Further work needs to be carried out on the information available on the service. EVIDENCE: People who use the service told us that they had enough information about the home before moving in. A number of people told us that they made their own choice about living at Woodcote House. The service has recently changed its category of registration from a care home with nursing, to a care home. The service user guide and statement of purpose need to be amended to take into account these changes. Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 9 We found senior staff were aware of the implications of this change in that they cannot admit anyone who has nursing needs which cannot be met by the district nursing service. We found the people using the service at the time of this visit did not require nursing care. We found pre admission assessments in place on each file we examined. Copies of the care management assessment are provided to the service where people are supported in their admission by social services. Staff from the home also carry out their own assessment of individual needs and choices before admission. This assists in making sure that the service can meet the needs and aspirations of the individual. Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use this service receive good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans provide good information on the needs and strengths of individuals. People who use the service are provided with personal support in a sensitive manner while encouraging independence. The health care needs of people who use the service are met. Medication is well managed. EVIDENCE: People who use the service responded ‘always’ when asked if they received the care and support they needed. We examined a sample of four files for people who use the service. We found good care plans which addressed the needs, wishes and strengths of individuals. Staff are have compiled good information and are provided with guidance, through the plan, on how to provide the appropriate care and support. Care plans could be improved with the inclusion of more detail on the preferences of individuals particularly around personal care. The forms used Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 11 for care planning should be updated to remove ‘nursing action’ as this is no longer provided directly by the service. Risk assessments are completed around health and personal care issues and are used to support people in an appropriate way while not restricting individual choices. People who use the service responded ‘always’ when we asked if they received the medical support they needed. We found good records were kept of any contact with healthcare professionals for each person. Arrangements are made for people to keep appointments in the community or if needed for healthcare staff to visit the home. District and community psychiatric nurses visit if needed. We looked at a sample of medication records. These were found to be up to date and accurate. Medication profiles were in place, up to date and accurate. Medication is stored securely and all staff who administer medication have received appropriate training. We observed staff interacting with people who use the service in a positive manner throughout out visit. Staff were seen to take care to respect the privacy and dignity of individuals. Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the service receive good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are offered a good range of activities taking into account individual strengths and needs. Staff are active in supporting people to maintain or re establish relationships with family and friends. People who use the service told us they enjoy the food provided. EVIDENCE: People who use the service told us they enjoyed various activities. A member of staff is allocated throughout the day to support people with activities. In addition an occupational therapist visits the home once a week. An activities file is kept for each person. Information on the life story of individuals who use the service is sought and recorded. This can assist staff in interacting with individuals as well as providing insight into some of the life experiences of people they support. We observed people taking part in dancing, reading, singing and talking with staff. As well as group activities such as board games, discussion groups and exercises, staff also take time to engage people in one to one activities. Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 13 The younger people using the service take part in activities, clubs and classes in the local community. Three people had a holiday in Bognor Regis this year. We found people were supported to take part and assist with domestic daily living activities. One person was assisting the chef in the main kitchen after lunch. Two people told us they go out to get the newspapers from local shops. People are supported to follow the religion of their choice in the way they wish. Arrangements can be made for representatives of different religions to visit the home. If people prefer they will be supported to attend local religious centres. People who use the service and staff told us that visitors were welcome at any time. Individuals also spend time away from the home staying with relatives for weekends. We found care planning emphasised in all areas the importance of choice for people who use the service. The feedback we received about the food provided was all positive. People told us the food was “great”, “very good”, “lovely”, “I always enjoy my food” and “I am always given a choice”. We asked if people had enough to eat and each person said they did. The chef confirmed that the kitchen is accessible at all times and food was always available between meals if anyone felt hungry. We saw that fresh fruit was available and that people were offered choices at each meal. Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service receive good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A system for recording complaints or concerns is in place and people who use the service know how to make a complaint. Individuals are protected from abuse. EVIDENCE: People who use the service told us they knew how to make a complaint and know who to speak to if they had any concerns. The organisation has a system in place for the recording of any complaints. There were no complaints or concerns recorded. Staff informed us that any concerns are to do with minor day to day issues which are dealt with straight away and so they do not need to be recorded. Staff could record these issues so that the management can asses if there are particular areas which throw up more concerns than others. None of the people we spoke to had any complaints about the service. People we spoke to expressed confidence in the staff group to deal with any complaint or concern they might have. Staff are provided with training on safeguarding adults which ensures that they can recognise abuse and are aware of their responsibilities to report any Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 15 allegation or suspicion of abuse. The local authority safeguarding adults procedure is available in the home and would be followed by staff if needed. Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, 25 & 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are provided with a comfortable, homely environment. The home is well maintained and kept clean. The lack of low surface temperature radiators or radiator covers poses a risk to people, particularly those with fragile skin. EVIDENCE: People who use the service told us that the home was “always” fresh and clean. We found the home to be warm, comfortable and clean. Three people invited us to look at their bedrooms. These rooms were well furnished and personalised. People told us they liked their rooms and made their own choices about where they spent their time. Bedroom doors are not fitted with appropriate locks. This issue has been raised a number of times in inspections. Each person needs to be offered a Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 17 key to their bedroom so that they can lock their door when they wish with staff having access to a master key for use in an emergency. Since the last inspection of the service new windows have been fitted. Staff informed us that plans were being made for the refurbishment of the kitchen. We found the metal radiator guards too hot to hold a hand against for more than a few moments. This issue must be addressed to protect people who use the service from burns and skin damage. Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are enough staff on duty to meet the needs of people using the service. The recruitment procedures protect people living in the home. Staff are offered good opportunities to increase their knowledge and skills through training. EVIDENCE: Feedback about the way staff carry out their duties was very positive. People told us “staff are wonderful”, “very kind”, “always there” and “I really like them, they look after us”. We observed staff working in a considerate and caring manner when talking to and supporting people who use the service. People told us that staff do listen to them and act and that staff are always available when needed. We did not examine staff files from this home during this inspection. A regulation inspector had recently examined staff files for this organisation and found them to be well managed, including the appropriate pre employment checks. Staff told us that they were offered good opportunities for training which assists in ensuring that people are supported by a well informed staff group. Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 19 All staff have taken part in a dementia care course over several weeks carried out by a local further education college. Senior staff have qualifications in metal health and learning disabilities. All senior staff are qualified nurses. We found staff to have a detailed knowledge of the needs, strengths and preferences of the people they were supporting. Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a well run service. The checks carried out by staff assist in ensuring the health and safety of people who use the service, staff and visitors. The organisation listens to the views of people who use the service and take these into account in the running of the service. EVIDENCE: At the time of this inspection the registered manager was temporarily managing another service. An acting manager was running the service. However the registered manager is visiting the home on a regular basis to offer support to the acting manager. On the day we visited the registered manager was available in the home. Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 21 People who use the service gave positive comments on the manager and we observed evidence of very good relationships between the manager and the people she supports. People told us that they can speak to the manager at any time. The small number of people living in the home means that the manager is available and meets with people who use the service each time she is on shift. However the record of formal meetings with people who use the service was not up to date. This issue should be addressed. The organisation has a quality monitoring and assurance system which includes consultation with people who use the service, relatives, representatives and other professionals. Surveys are sent out and a report is produced each year which reviews the service. We did not examine individual financial records during this inspection. Records are held at the head office of the organisation and a sample of these records were examined recently by another regulation inspector these were found to be up to date and accurate. Staff told us that they felt well supported by the management and were provided with regular one to one supervision. A record of staff supervision is held in the home. Regular checks are carried out to ensure the health and safety of people using the service. We found the fire alarm system was checked each week, fire drills carried out on a regular basis and the alarm system professionally maintained. To reduce the risk to people using the service staff check the temperature of hot water accessible to people on a regular basis and the temperature of the water before they assist anyone into a bath. Regular maintenance is carried out on any lifting equipment and annual checks are done on any portable electrical equipment. In order to further protect people who use the service action must be taken to ensure that radiators do not pose a risk to individuals. A record of any accident is kept and reviewed by the manager. Records showed low levels of accidents. Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 22 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 2 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 23 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 OP1 Regulation 5&6 Requirement To make sure that people who use the service and prospective service users are provided with up to date information the Statement of Purpose and Service User Guide must be amended to take into account the change in registration. People who use the service must be provided with appropriate locks on their bedroom doors with each person offered a key to their room Staff must be provided with a master key for use in an emergency. Timescales of 30.01.06 & 30.03.06 not met. In order to protect the safety of people who use the service action must be taken to make sure that the surface temperature of radiators or radiator guards do not pose a risk of burns or skin damage. Information on how this will be achieved must be provided to the CSCI. Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 24 Timescale for action 01/04/08 2. OP19 12(4) & 23(2)(e) 01/06/08 2. OP38 13(4) 01/04/08 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 OP7 Good Practice Recommendations Consideration should be given to adding the details of the preferences of each person who uses the service in relation to personal care. Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Woodcote House DS0000007206.V352639.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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