Care Home: Woodford Court

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What the care home does well Woodford Court is a purpose built wheelchair accessible home. All of the bedrooms and ensuites have the appropriate equipment that enables service users to be as independent as possible. Comprehensive and detailed assessments are undertaken prior to a resident being admitted to the home. All prospective service users and their relatives are invited to visit the home before making a decision to move in. Most of the service users require a high level of support with their personal care needs and this is carried out in a sensitive way that promotes their independence and choice. Discussions with those service users were possible indicated that they were happy with the care and support they were receiving. "I like living here", "the staff are nice". What has improved since the last inspection? There were six requirements set at the last inspection and five of those have been met. There has been an improvement in the standard of care plans and they follow the principles of person centred care. Further works is being undertaken on areas such as, personal development, lifestyle choices, end of life, gender care preference and sexuality. These care plans have been developed and are working documents that are easily read and understood by the care staff, and from reading them a clear sense of the person is gained. Care plans are being regularly evaluated and reviewed. Care staff have undertaken training in safeguarding adults and mandatory training such as moving & handling has been updated. Care staff are now receiving regular supervision and yearly appraisals. What the care home could do better: CARE HOME ADULTS 18-65 Woodford Court 6-8 Snakes Lane West Woodford Green Essex IG8 0BS Lead Inspector Julie Legg Unannounced Inspection 9th June 2008 10:00 Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodford Court Address 6-8 Snakes Lane West Woodford Green Essex IG8 0BS 020 8502 9502 020 8504 5237 lorraine.parker@scope.org.uk 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) SCOPE Care Home 12 Category(ies) of Physical disability (12) registration, with number of places Woodford Court DS0000025937.V366154.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. Physical disability - Code PD The maximum number of service users who can be accommodated is: 12 6th November 2006 Date of last inspection Brief Description of the Service: Woodford Court is a care home providing accommodation and support for service users whose primary care needs are physical disability. The home is operated by SCOPE. Woodford Court comprises two adjacent bungalows with a shared garden. The bungalows are purpose built and provide a high standard of accommodation for adults with physical disabilities. Each bungalow comprises single bedrooms with en-suite bathrooms, which include tracking from bed to bath, avoiding the need for separate lifting equipment. Each bungalow has its own kitchen, dining and communal lounge area. There is wheelchair access throughout both buildings, with self-opening doors to allow independent access. Woodford Court is situated in a residential area of the London Borough of Redbridge. It is close to shops, open spaces and transport links to central London, Ilford and Essex. The home has its own transport, but residents also have the use of a taxi card. A copy of the Statement of Purpose and Service User Guide is made available to both the service users and their relatives. Copies of both these documents and the most recent inspection report are available in the reception area of the home. The fees for the home are £692.00 - £1620.00 depending on the individuals assessed needs. This information was given by the manager gave on the day of the inspection (09/06/08). Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this home is 2 star. This means the people who use this service experience good quality outcomes. The inspection took place over one day commencing at 10.00 and was completed by 18.45. The manager was present from lunchtime and was available for feed back at the end of the inspection. Discussions took place with the manager and care staff. Further information was gathered from service users, relatives and social and health care professionals. A tour of the home was undertaken and all of the rooms were seen to be clean and free from any offensive odours. Service users’ files were examined and case tracked; including care plans and risk assessments. Staff files and other records kept at the home such as, medical charts, and maintenance files and staff rotas. The views of health and social care professionals were sought. There was no response from the health care professional and the social care professionals were of the opinion that the service continued to meet the needs of their service users. Additional information relevant to this inspection has been gained from the Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment tool, which all providers are required to complete once a year. It focuses on how well outcomes are being met for people using the service. It also provides us with some statistical information about the service. We had a general discussion on the broad spectrum of equality & diversity issues and the manager was able to demonstrate a good understanding of the varied needs around religion, sexuality, culture, disability and gender. Woodford Court has undergone a major staff restructuring in the past nine months; The previous manager who had been in post for many years left the organisation A new manager was appointed in November 2007, however the manager’s role has changed and she is responsible for Woodford Court and a day service, which is located in Chingford. Senior support workers have had to reapply for post and are now team co-ordinators, with more managerial responsibilities. A discussion with the manager and some of the people living at the home as to how they wished to be referred to in this report. They expressed a wish to be referred to as ‘service users’. This is reflected accordingly throughout this report. We would like to thank the service users, relatives, manager and staff for their input during this inspection. Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Daily records must reflect the well-being of the service users and these records must link to service users’ care plans. Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 7 There needs to be consultation with the service users and their families regarding a programme of leisure activities in the home and in the community that meet their wishes and aspirations. Some of the décor in bungalow A is now beginning to look ‘tired’ and needs repainting and some refurbishment. The registered person must maintain the environment so that service users are able to live in comfortable home. The registered person must ensure that all staff files should hold up to date information including evidence of any training that has been undertaken and a recent photograph. Also that staff receive training that is appropriate to the health and welfare of the service users. It is a recommendation that the manager should be having a discussion with the organisation as to whether a maintenance/gardener post would be appropriate. As stated above there has been an organisational restructure at Woodford Court and surveys and telephone conversations with relatives would indicate that there are still some anxieties and concerns: There are worries how a manager can split themselves in two (managing two services). They have not had a meeting with the manager. Since the new structure not sure who to talk to. It is strongly recommended that the manager arranges to meet with the relatives so that anxieties and concerns regarding the service can be shared. 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. Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2 and 3 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Prospective service users and their relatives have the information they need to be able to make an informed choice about moving into the home. The assessment of needs and information received from health and social care professionals means that staff have detailed information to enable them to determine as to whether they can meet the needs of prospective service users. Prospective service users know that the home can meet their needs. EVIDENCE: The Statement of Purpose detailing the aims, objectives and philosophy of the home and a Service User Guide detailing terms and condition of residence and service user rights are available. These documents are available in visual format for service users requiring alternative method of communication. The current service users have been living at the home for some considerable time, the majority since 2000 and the most recent 2004. It would be procedure of the home to ensure that any prospective service users are appropriately assessed prior to admission. The home would carryout their own Person Led Assessment of Need (PLAN), which determines how the home will support the individual’s immediate requirements as well as their future aims Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 10 and aspirations. PLAN demonstrates the service user, significent others and relevant agencies involvement and contribution. The admission process would be designed around the needs of the prospective service user. The prospective service user may make several visits to the home and possibly an overnight stay. This will ensure that they like the home and to meet the other service users. The transition period would also give staff the opportunity to get to know the prospective service user and to know whether they can meet their needs. One relative stated “We were given every opportunity to look around and for A to spend as much time as possible in getting use to the home.” Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7,8 and 9 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users’ identified needs are reflected in up to date care plans and risk assessments. This information provides staff with the information they need to satisfactorily understand and meet individual service users’ needs. The home assists service users to make decisions about their lives and maximise their independence wherever possible. EVIDENCE: Individual files were available for each service user and records of four service users were case tracked. There has been an improvement in the standard of care plans and they follow the principles of person centred care. The care plans cover areas such as personal, social, health, communication, dietary, mobility and cultural and religious needs. However further works is being undertaken on areas such as, personal development, lifestyle choices, end of life, gender care preference and sexuality. These care plans have been developed and are Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 12 working documents that are easily read and understood by the care staff, and from reading them a clear sense of the person is gained. One service users plan states, ‘I don’t use the bleep system but I will shout for attention and I don’t like getting water in their eyes’. Another one states, ‘I have camomile tea before going to bed and I like music playing whilst I go to sleep’. Every service user also has a ‘getting to know you’ document, which gives details of service user’s past (early and adult life), major life events and family background. For some of the service users verbal communication is limited but the staff are aware about the different ways the service users communicate either through noises, communication board and facial expressions. There was evidence that care plans are being evaluated on a monthly basis and regular reviews are also taking place. Three of the files that were case tracked showed that they have been reviewed within the last three months. All of the service users are involved in regular meetings that are chair by a person outside of Woodford Court. Relatives and advocates are also involved with the service users and assist them in decision making within the home such as, redecoration of bedrooms. Most of the service users attend either day services or a local college. Service users are able to participate in menu planning, shopping trips and gardening, though some relatives stated that they felt more service user participation in the home could be encouraged. The daily records should reflect the care being given on a day-to-day basis and relate to each service user’s care plan. There has been a slight improvement in these records since the last inspection, in that records are now being regularly completed, however these do need to relate more specifically to each service user’s care plan. The manager is aware of the shortfalls in the daily records and is currently working on them. This is Requirement 1 Risk assessments were looked at as part of the case tracking process, and those seen were detailed and covered areas such as personal safety & protection, skin pressure care, moving & handling, use of bedrails and hoists, leaving the building and behaviours that challenged. These risk assessments have been forwarded to service users’ care plans. There was evidence that risk assessments are being regularly reviewed. Staff were observed interacting with the service users in a friendly and respectful manner. Staff were seen to ask service users what they wanted and offered them different objects to assist the service user with what they wanted. Staff also advised service users of what they were going to do such as “I’m going to take you to the toilet, is that ok?” and the appropriate assistance was given. Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 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): Standards 12,13,14,15,16 and 17 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users have some opportunities for personal development within the home and most have access to day service s and educational placements. Leisure activities within the home and community could be more varied. Service users are offered and encouraged to eat a healthy diet. EVIDENCE: Service users’ care plans identify lifestyle choices, such as local leisure activities, activities within the home, day service and college placements and family contact. Service users have opportunities for personal development and some service users’ leisure activities are individualised. Most of the service users attend either day service s or college throughout the week. One of the service users is supported to attend a day service in Tottenham and another service user goes to the shops every day on his scooter. Service users are supported to exercise their choice in relation to their particular religious Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 14 observance and to attend their choice of worship. Activities that are undertaken within the home include arts & crafts, karaoke, watching television, listening to music and staff reading and talking to service users. At Easter the service users made Easter cards and Mother’s Day cards and pancakes on Shrove Tuesday. The staff have arranged a cultural evening, where staff are going to bring different dishes that represent their different cultures. One of the members of staff is teaching one of the service words and songs in her language. Activities in the community have consisted of trips to cinema, day trip to Clacton, shopping trips, holidays and restaurant meals. One service user stated, “I feel really happy”, another service user stated, “It’s boring sometimes”. Five relatives felt that there could be more activities within the home comments were: “Sometimes they are just sat in front of the television”, “social activities are lacking”, “at weekends, parents provide almost all recreational opportunities”, “activities could be more age appropriate”, “need to look at what the service users are interested in”. Three relatives felt there could be more interaction between staff and service users comments were: “encourage interaction between staff and service users by doing things together”, “although staff seem to have some spare time, very few occasions when they interact with service users (e.g. to play games, draw/paint)”,” more interaction between staff and service users”. The manager needs to consult with service users and relatives about the programme of activities. This is Requirement 2 The home does have its own minibus but there seems to be some difficulties in service users accessing the vehicle due to a lack of drivers. According to a relative “X was a driver but since he left transport has gone to pot”. The manager has been in post since November 2008 and all of the relatives stated that they had not had a relatives’ meeting since her taking up her post. It is a recommendation that the manager arranges to meet with the relatives so that anxieties and concerns can be shared. This is Recommendation 1 All of the service users have their own televisions and music centres in their bedrooms and there was evidence of their particular interests and hobbies. Posters of racing cars and pop stars as well as cuddly toys were all apparent. The majority of the service users receive visitors, some more regularly than others. Some of the service users visit family at home, staying over for the weekend. The majority of the relatives stated that they felt welcomed when visiting Woodford Court. Comments were; “I am always made to feel welcome”, “very welcoming and relaxed atmosphere”. There are no set house rules and service users were observed to go about the home freely. At the time of the inspection one service user arrived back from the shops, some service users were sitting in the garden colouring in books, one service user was watching television and other service users were at day service or the local college. Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 15 Service users decide on the menu for the week. The home does not employ a cook and care staff shop, prepare and cook all the meals. The staff are well aware of what each person likes to eat and those service users who have special dietary needs, such as liquidized meals. Religious and cultural dietary needs are also known and catered for and this is recorded in care plans, for example ’no red meat, pork or lamb’. On the day of the inspection there were more than adequate quantities of food available, including fresh fruit and vegetables. Drinks and snacks are readily available. Service users decide on the menu for the week. One service user stated, “The food is great”. Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19 and 20 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. Residents receive personal support in the way they prefer and their physical and emotional needs are met. There are clear medication policies and procedures for staff to follow; this will ensure that service users are safeguarded with regard to their medication. EVIDENCE: Care plans and daily records were discussed with the manager. The care plans identify health and personal care needs and how these needs should be met. Though service users do not have a choice in relation to same gender care when receiving personal care, one service user stated, “It’s alright, I don’t mind”, one relative felt it was an area that should be looked at. However all of the relatives were very happy with the support their siblings received with their personal care. Comments were “She and her clothes always looks nice and clean”, “the care is fabulous, she is assisted to have a shower every day”, “personal care is fine”. Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 17 Records examined showed that service users have health action plan. All of the service users are supported to access dental care, opticians and chiropody. Referrals to specialist health care professionals for example speech & language therapist, dietician, physiotherapist, mental health team, tissue viability nurse, learning disability team, GP and hospital out-patient appointments. One relative stated, “She has really blossomed”. One of the service users has a hospital admission coming up in the near future and there are some issues over funding for staff to accompany and support them. Both health and social services are involved with this situation. There are policies and procedures for the handling and recording of medication. Medication is stored in a locked medicine cupboard in the staff office and is appropriate to ensure the safekeeping of medication in the home. Staff have received medication training and there is a list of staff that are competent in the administration of medication. The manager regularly checks the medication records to ensure compliance. An audit was undertaken of the management of medication and Medication Administration Record (MAR) charts were examined. None of the service users are able to self administrate. Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 People using this service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Service users’ views and their complaints and concerns are listened to and acted upon. Staff have undertaken training in safeguarding adults this will ensure that there is a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a written complaints policy and procedure, which is in different formats including pictorial. The complaints policy is widely advertised and both service users and relatives are aware that they can initiate this at any time. The manager stated that she welcomes complaints and suggestions about the service. Most of the service users have relatives who visit regularly and they have a monthly meeting, which is chaired by a volunteer. This gives the service users another forum in which to discuss any concerns. Two of the service users were asked who would you tell if you was unhappy about anything in the home one service user stated, “my mum”, another stated “my dad or X” (a member of staff). In discussion with relatives, it was obvious that they were aware of the complaints procedure and would have no hesitation in making a complaint if necessary. Staff spoken to were aware of the complaints procedure and how to deal with complaints and concerns made to them. The complaints log was inspected and indicated that there had been two complaints in the last twelve months, both of these complaints had been dealt with Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 19 appropriately and to the satisfaction of the complainants. There has also been one safeguarding issue within the past 12 months and this had been dealt with appropriately and no further action was required. The home has a comprehensive ‘Safeguarding Adults’ polices and procedures; these include the local authority (London Borough of Redbridge) policy and procedure. The manager was clear in that incidents needed to be reported to the local authority as part of the safeguarding procedures. Four staff members that were spoken to confirmed that they had attended training. They were also clear on what constituted abuse and their responsibility in reporting any potential or actual abuse. Staff files indicated that staff have attended training in ‘safeguarding adults’. Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24,25,26,27,28,29 and 30 People using this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home is clean, safe and free from any offensive odours, however some redecoration and some refurbishment needs to be undertaken to ensure that the service users’ home is comfortable. The bedrooms of the service users suit their needs and promote their independence. EVIDENCE: The home comprises of two purpose built bungalows and each consists of six en-suite bedrooms, each with their own large open plan kitchen/diner and lounge. In the last 12 months some of the bathrooms have been updated and some of the bedrooms have been redecorated. All of the bedrooms are of a generous size, each with their own toilet and walkin showers. There are electric overhead hoists and specialist beds were required. All of the bedrooms are decorated in individual colour schemes, some of the service users stated that they had been involved in choosing the colour Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 21 scheme. Service users’ interests and hobbies were also apparent, with posters adorning the walls, televisions, CD players, family photographs, and soft toys, which made every bedroom individual. In each of the bungalows there is a laundry room, toilets that are situated near the lounge and an assisted bathroom (for those service users who prefer to bath). The bathroom in bungalow A is only used infrequently however the trolley needs to be removed. The open plan kitchen/diner lounges are spacious and allow the service users access to all areas. The kitchen units in bungalow A are looking tired, the manager advised the inspector that quotes have been received and she is hopeful that the refurbishment will be taking place within the next three months. The communal areas including the corridors are in need of some redecoration and some floor covering needs to be replaced. Three of the relatives commented on the environment. Comments were: “The home has lost some of its homeliness”, “environment clean and pleasant, although some areas need refurbishment and redecorating”, “The kitchen/diner lounge could do with a lick of paint”. This is Requirement 3. The garden is accessible to all of the service users and there are raised flowerbeds, which enable the service users to assist with planting and watering the plants. The garden is well maintained; this is due to relatives and volunteers, as the home does not have a designated gardener. This is commendable, however the service should not just be relying on the goodwill of people who visit the home. One relative stated, “We could do with more assistance with the gardening”. The manager should be having a discussion with the organisation as to whether a maintenance/gardener post would be appropriate. This is Recommendation 2 Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32,33,34 and35 People who use this service receive good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Staffing levels are satisfactory and there are sufficient staff on duty to meet the individual needs of the service users. Service users benefit from a staff team who mostly have the skills and training to meet their needs. The procedures for the recruitment of staff are robust and provide safeguards for the service users living in the home, however information on staff files needs to improve. EVIDENCE: Staff rotas were inspected and they correlated with the staff members on duty. There was sufficient staff with the appropriate skills mix to meet the needs of the service users. The home has a very stable workforce; many of the staff have worked at the home for at least five years and longer and only two staff have left the home within the past 12 months. There has been little use of Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 23 agency workers as most gaps in the rotas (sickness/annual leave) are covered by the home’s internal bank staff. The manager advised that the organisation has looked at the staffing structure of the home and has introduced ‘team co-ordinators’; the main part of their duties is that they are responsible for the shift. The manager has also taken on new responsibilities and is also responsible for a local day centre. There are clear recruitment policies and procedures. Staff files are kept in a locked cabinet. Four staff files were examined; all had a completed application form, proof of identity, the necessary references, POVA first and Criminal Records Bureau (CRB) checks. All files had a copy of the job description and a copy of their contract. All interviews are undertaken within an equality & diversity framework; all candidates are asked the same questions and their responses are recorded. Service users are involved with the recruitment process. Staff files should have a recent photograph of the person, however three of the files did not have a photograph and the other file had a photograph of the person but also showed a service user. The manager and staff confirmed that staff had undertaken an induction that is in line with Skills for Care and the Annual Quality Assurance Assessment (AQAA) also confirms this, however this could not be evidenced from staff files. All staff files should hold up to date information including evidence of any training that has been undertaken and a recent photograph. This is Requirement 4 SCOPE as an organisation employs a workforce from diverse cultures and backgrounds. In discussion with the manager and staff they were able to demonstrate an awareness of the importance of understanding and appropriately meeting all of the needs of the service users, wherever possible around equality and diversity issues. Information included in the AQAA identified that staff have attended equality and diversity training, which is ongoing. This training ensures that the spiritual, cultural, sexual and other diverse needs of the service users are met through meaningful ‘person centred’ care. More than 50 of the staff have obtained their NVQ 2 in care and the team coordinators have obtained their NVQ 3 and some have or completing their NVQ assessor’s award. All new members of staff undertake an in-house health & safety staff induction day and a one-day induction at head Office. Staff have undergone mandatory training in areas such as first aid, moving & handling, infection control, food hygiene and safeguarding adults. Other training undertaken by care staff includes diversity training, dysphasia awareness, feeding techniques, administration of medication and fire safety. Some of the service users experience epileptic seizures but there was no evidence on staff files that they have attended training in epilepsy awareness. It is essential that all staff have an awareness of epilepsy to enable them to support service users appropriately. This is Requirement 5 Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 24 The manager has established links with the local training collaborative and has registered with a local college for NVQ training. The manager is currently undertaking a training audit to ensure that all staff are up to date with their mandatory training and to identify future training needs. Service users and relatives were complimentary of the staff, “I cannot fault the staff”, “they are all dedicated to the service users”, “I am really happy here”, “they are all kind”. Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,38,39, and 42 People who use this service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The home is managed by a qualified and experienced manager, this means that service users’ health, safety and welfare are promoted and protected and that the home is run in their best interests. EVIDENCE: The current manager has been in post since November 2007 and has applied to the Commission to become the registered manager. She is a qualified Mental Health Nurse and has worked in disabilities for the past twenty-seven years in health, social care, housing, voluntary, statutory and private sectors. She has sound knowledge of financial planning and how the operational plan Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 26 for the home fits in with these. She has responsibility for the financial budget of the home and is aware of her budgetary limitations. Effective systems have been introduced to monitor practice and compliance with record keeping, adherence to policy and procedure and further work is being undertaken in the administration of medication. It was evident that the home is run for the benefit of the service users and effort is made to retain the independence of the people who live in the home and for them to exercise choice and control over their lives. The manager with the support of the team co-ordinators is working to continuously to improve the service and provide an increased quality of life for the service users. The Annual Quality Assurance Assessment (AQAA) was completed and the information gave a clear picture of the current situation within the service and the areas for improvement over the next 12 months and the ways they are planning to achieve these. The manager has also developed an action plan for the service that clearly identifies areas of improvement with timescales. A representative of the registered organisation undertakes monthly Regulation 26 monitoring visits to monitor and report on the quality of the service being provided. Copies of these reports are available to the Commission. The home benefits from the quality assurance procedures of the registered organisation SCOPE. Information is gathered from service users’ meetings, quality assurance questionnaires and from complaints and compliments. Two relatives stated that they had not had a meeting with the manager, though had met with her individually. As stated earlier in the report it is a recommendation that the manager arranges a meeting with the relatives to discuss with them the way forward for the service. Record keeping is of a good standard with records being kept secure in accordance with the Data Protection Act. A wide range of records were looked at including safety checks and accident/incident reports. The Commission receives Regulation 37 notifications, which advise us of any significent events within the home that has an adverse effect on any service user These records were found to be up to date and accurate. The annual Gas safety inspection took place in July 2007 and the 5-year Electrical safety certificate was dated August 2005. Fire drills are taking place regularly; fire extinguishers received their annual check in April 2008 and the Fire Brigade undertook an inspection in September 2007 with one requirement stated. Fridge and freezer temperatures are taken and recorded daily and food that was stored in the fridge and freezer was covered and dated when opened. Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 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 3 X X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X X 3 X Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 28 Yes Are there any outstanding requirements from the last inspection? 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 YA6 Regulation 17(1)(a) Requirement The registered person must ensure that daily records reflect the well-being of the service users and that records are linked to the care plan. Previous timescale of 31/03/07 partly met The registered person needs to consult with the service users regarding a programme of leisure activities in the home and in the community that meet their wishes and aspirations. The registered person must maintain the environment and that service users are able to live in comfortable environment. The registered person must ensure that all staff files should hold up to date information including evidence of any training that has been undertaken and a recent photograph. The registered person must ensure that staff receive training that is appropriate to the health and welfare of the service users. Timescale for action 31/10/08 2 YA12 YA13 YA14 16(2)(n) 30/11/08 3 YA24 16(2)(c) 30/11/08 4 YA34 Schedule 2 (1)(5) 31/10/08 5 YA35 18(c)(i) 31/10/08 Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 29 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 2 Refer to Standard YA14 YA28 Good Practice Recommendations It is a recommendation that the manager arranges to meet with the relatives so that anxieties and concerns regarding the service in particular leisure activities can be shared. It is a recommendation that the manager should be having a discussion with the organisation as to whether a maintenance/gardener post would be appropriate. Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Woodford Court DS0000025937.V366154.R01.S.doc Version 5.2 Page 31 - 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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