Care Home: Woodgreen Nursing Home

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What the care home does well We found a very relaxed atmosphere in the home. Both people living there and staff were friendly, helpful and keen to be involved in the inspection process. There is an activities plan but, as important to support this, we saw spontaneous engagement between staff and people in the home ongoing throughout the day. It was pleasing to see that the usual compulsory daytime TV was not used in this home, alternative background music presented a more relaxed atmosphere. People told us that TV was used selectively and they liked that. There was evidence of chosen lifestyles with people spending some time in their bedrooms throughout the day. One person told us he likes to stay in his room, enjoying his interests and has all meals delivered to his room. The husband of a person living in the home told us that he visits every day for a large part of the day. He says is always made welcome by staff and can enjoy time with his wife in the privacy of her room if they wish. We saw people receiving visitors in the lounge, dining and bedroom areas. In contrast to the previous medication concerns we found good practice and recording of other health care issues. The practice and recording of wound care was to good professional standards. What has improved since the last inspection? Many necessary improvements have been made since the last inspection. Details are outlined in the body of this report. The serious concerns regarding medication have been satisfactorily addressed. There is now a safe system of medication in the home and people can be re-assured by this. Some people said at the last inspection that there were insufficient activities. The home have listened to people and provided a broader range of activities to meet the majority of peoples needs and expectations. This is an ongoing process. The number of bedrails in use has reduced significantly. Risk assessments are now carried out prior to installing bedrails and the person/relatives consulted. They now sign risk assessments. We looked at bedrails in use and found they met safety standards in the way they were fitted and all had protectors as added necessary security. There was previously insufficient reliable hot water supply to bedrooms and a requirement was made. This has been remedied with fitting of a new boiler and some safety valves in bedrooms. We saw regular weekly checks of the temperature of hot water in bedrooms and bathrooms that confirmed hot water is now adequate and within safe limits. A new care planning format has been introduced. Considerable work has been involved but all care plans have now been transferred to the new format. This has had the effect of reducing the amount of information to a more concise and easily read document and also has involved a review of the information previously held. Information is now current and relevant. Peoples weights are now recorded monthly for all. Where weight loss occurs, referrals are made to GP/Nutritional experts and people then weighed weekly to closely monitor further changes. A requirement to audit staff recruitment and training files to provide all information that is easily accessible and understood, has been implemented. All files are new with a fly-sheet check list of applications, references, checks and monitoring. This is a vast improvement. Training records have been transposed into a training matrix easily identifying training completed and training required. The recording of complaints has been improved. They are now recorded chronologically with outcomes recorded and results notified to the complainants within 28 days. The manager has carried out training for staff in infection control. We had some concerns at the last inspection that staff training did not match staff practice. What the care home could do better: Some aspects of medication need further action. There was confusion about application of eye drops and creams provided to people in their bedrooms with a separate MAR (Medication Administration Record) chart. Instructions for their use were not clear either to staff or the person. The home should review all creams and eyedrops in use to ensure clarity for staff and to ensure that the prescriber`s instructions are being followed. It is important to record all medication put in waste-bins for disposal. This is vital for an audit of the system. The codes at the bottom of MAR sheets should be used correctly to record why medication is not given. The practice of staff supporting people with feeding should be reviewed to ensure this is done in a sensitive and relaxed way at the persons pace and in a sitting position. The home need to review the practice of transferring people from wheelchairs to hoist in the main corridor area before being transferred to the toilet. This will ensure that privacy and dignity is not compromised. The audible alarm for the central nurse call monitor is inadequate. It is important to ensure that the alarm can be heard in all parts of the home. This is important when people are calling for assistance, particularly at busy times. The Service Users Guide must include the weekly fees charged for care at Woodgreen. Key inspection report Care homes for older people Name: Address: Woodgreen Nursing Home 27 Wood Green Road Wednesbury West Midlands WS10 9AX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Peter Dawson     Date: 2 5 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Woodgreen Nursing Home 27 Wood Green Road Wednesbury West Midlands WS10 9AX 01215560381 01215052772 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Woodgreen Care Home Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 40 The registered person may provide personal care (with nursing) and accommodation to service users of both sexes whose primary care needs on admission to the home are within the following categories: Older People (OP) 40 Date of last inspection Brief description of the care home Woodgreen Nursing Home is a privately registered care home providing nursing care for up to 40 elderly people. Situated opposite Brunswick Park on a main road between Walsall and the M5 motorway, it is within walking distance of Wednesbury town. There is car parking at the front of the home surrounded by mature garden borders. There are two lounges, a conservatory and a large dining room which is split up be a fireplace all on the ground floor. The garden to the rear of the property is pleasantly landscaped with borders, patio and a small lawn. The Home has single and shared bedrooms, Care Homes for Older People Page 4 of 30 Over 65 40 0 1 0 0 3 2 0 1 0 Brief description of the care home located on both ground and first floor, the majority of which have en-suite facilities. There is a staff call system throughout the home. There is a small passenger lift that enables people access between the ground and first floor. There are two adapted bathrooms that can be used by dependent people and also a number of toilets throughout the home. The home arranges for the chiropodist, dentist and optician to visit on a regular basis and arrange visits by the GP, as people need it. Ancillary services of catering, cleaning, laundry and maintenance are provided in-house. The mobile hairdresser visits regularly and an additional charge is made for this service. Information about the range of fees the service charges in not available in the service user guide. Readers of this report are asked to contact the home directly for this information. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was carried out by one inspector on one day from 08:30 - 18:00. The home did not know we were coming. Our last key inspection of this service was on 3rd December 2009 when we made 16 Requirements and 7 Recommendations. Many surrounded the poor management of medication in the home and as a result we served a Statutory Requirement Notice on the service on 30th March 2010 - a legal action to ensure compliance with our regulations. Two Random Inspections were carried out by our Pharmacist on 10th March 2010 and on 19th May 2010. On the last random inspection the Pharmacist found that the requirements regarding medication had been satisfactorily met including compliance with the Statutory Requirement Notice. The focus of this inspection was, therefore to ensure the improvements made in medication management continue and to review the other requirements made at the Care Homes for Older People Page 6 of 30 last key inspection. For this inspection we did not have the benefit of a completed AQAA (Annual Quality Assurance Assessment) completed by the service or written feedback from people using the service and others. The reason for this was that we brought this inspection forward to swiftly review the progress being made. We made efforts to speak to as many visitors, staff and people living in the home as possible. There were 23 people living in the home at the time of this inspection. We saw most of them and spoke with about 10 of them. We were able to speak with 3 visiting relatives and the staff on duty on the day. We also spoke with the Registered Manager, although she was not working that day and also a brief conversation with the Provider who called into the home. We conducted the inspection mainly with the Deputy Manager and Clinical Nurse on duty to whom we fed back our findings at the end of the inspection. We inspected the communal areas of the home and also a sample of bedrooms. We looked at: Care plans, risk assessments, complaints records, medication records, staff records and training and other records relevant to the inspection process. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? Many necessary improvements have been made since the last inspection. Details are outlined in the body of this report. The serious concerns regarding medication have been satisfactorily addressed. There is now a safe system of medication in the home and people can be re-assured by this. Some people said at the last inspection that there were insufficient activities. The home have listened to people and provided a broader range of activities to meet the majority of peoples needs and expectations. This is an ongoing process. The number of bedrails in use has reduced significantly. Risk assessments are now carried out prior to installing bedrails and the person/relatives consulted. They now sign risk assessments. We looked at bedrails in use and found they met safety standards in the way they were fitted and all had protectors as added necessary security. There was previously insufficient reliable hot water supply to bedrooms and a requirement was made. This has been remedied with fitting of a new boiler and some safety valves in bedrooms. We saw regular weekly checks of the temperature of hot water in bedrooms and bathrooms that confirmed hot water is now adequate and within safe limits. A new care planning format has been introduced. Considerable work has been involved but all care plans have now been transferred to the new format. This has had the effect Care Homes for Older People Page 8 of 30 of reducing the amount of information to a more concise and easily read document and also has involved a review of the information previously held. Information is now current and relevant. Peoples weights are now recorded monthly for all. Where weight loss occurs, referrals are made to GP/Nutritional experts and people then weighed weekly to closely monitor further changes. A requirement to audit staff recruitment and training files to provide all information that is easily accessible and understood, has been implemented. All files are new with a fly-sheet check list of applications, references, checks and monitoring. This is a vast improvement. Training records have been transposed into a training matrix easily identifying training completed and training required. The recording of complaints has been improved. They are now recorded chronologically with outcomes recorded and results notified to the complainants within 28 days. The manager has carried out training for staff in infection control. We had some concerns at the last inspection that staff training did not match staff practice. What they could do better: Some aspects of medication need further action. There was confusion about application of eye drops and creams provided to people in their bedrooms with a separate MAR (Medication Administration Record) chart. Instructions for their use were not clear either to staff or the person. The home should review all creams and eyedrops in use to ensure clarity for staff and to ensure that the prescribers instructions are being followed. It is important to record all medication put in waste-bins for disposal. This is vital for an audit of the system. The codes at the bottom of MAR sheets should be used correctly to record why medication is not given. The practice of staff supporting people with feeding should be reviewed to ensure this is done in a sensitive and relaxed way at the persons pace and in a sitting position. The home need to review the practice of transferring people from wheelchairs to hoist in the main corridor area before being transferred to the toilet. This will ensure that privacy and dignity is not compromised. The audible alarm for the central nurse call monitor is inadequate. It is important to ensure that the alarm can be heard in all parts of the home. This is important when people are calling for assistance, particularly at busy times. The Service Users Guide must include the weekly fees charged for care at Woodgreen. Care Homes for Older People Page 9 of 30 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre admission assessments are to a good standard. Crucial information about charges should be available to people considering admission. Evidence: We made a recommendation in the last report that the Service Users Guide should be updated and include the weekly fees charged by the home. This has not been done. We saw that fees were included in a blank contract but, of course it is important for people to know what they would have to pay for care before making a decision about admission. We saw a completed pre-admission assessment for a person admitted recently to the home. This was good and gave comprehensive information allowing the home to make a decision about the persons care needs and ensuring they could be met. The pre-admission assessment was used as a basis, with the multi-agency Care Homes for Older People Page 12 of 30 Evidence: assessment, for establishing a care plan. We also saw that under the new care planning format regular monthly reviews of the care plan had taken place. The assessment was an ongoing process. People told us that they were invited to visit the home prior to admission, some said they have left their relatives to make the decision about the suitability of the home for them. Care Homes for Older People Page 13 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Changes to care planning and improved management of medication mean that peoples personal and health care needs can be fully met. Evidence: At the time of the last key inspection this outcome area was Poor, with 13 requirements made including 10 in relation to medication. Three requirements related to: Ensuring assessments were updated and reviewed to reflect changes. There must be comprehensive risk assessments for bedrails before they are used and people must be weighed monthly with records to monitor weights. Since the last inspection the home have introduced a new care planning format. Over the past months considerable work has been done in establishing this. Previous care plans were lengthy documents in lever arch files that have been reviewed and condensed to provide a more concise document containing only current information needed to meet peoples assessed needs. Care Homes for Older People Page 14 of 30 Evidence: We sampled 4 care plans to view the changes made. We found risk assessments for nutrition, waterlow (risk of pressure damage), moving & handling a falls. All had been updated and risks reduced or eliminated. Bedrail risk assessments, of concern on the last inspection, had been reviewed and we were told the number of bedrails in place has reduced significantly to 7 since the last inspection. Risk assessments are now made before and not after they had been provided, the person/relatives had been consulted about their use and signatures obtained. The care plans we examined had all been reviewed on a monthly basis and recorded any change in levels of dependency. We looked at wound care including pressure damage. One person presently has pressure damage having acquired this in hospital. She was discharged with grade 4 (serious) pressure damage. Some progress has been made and we saw regular recording of daily dressing changes, swabs taken, dressings defined with grade of the pressure sore and photographs ertr all with the care planning information. This had been handled well to high clinical standards. We saw in another care plan for a person with complex health care needs that two superficial breaks to the skin had been recorded previously and for some reason graded 3 (Sterling scale). This was incorrect information, although the skin integrity had quickly improve with no damage. This person had other wound care needs and records clearly showed ongoing treatment and review - again to a high standard. We looked at weights for people and saw that all are now weighed monthly. One person who had a weight loss of 3.4Kg in a month was referred to the GP/dietitian and a food/fluid intake chart established. Regular daily recording of inputs had been ongoing. There had been changes to full-fat milk, butter and bulk diet and the person is weighed weekly. Nutritional assessments are in place for all. Three people need staff assistance with eating During the inspection we noticed two people being fed by staff. In both instances the person feeding was standing over the person and the exercise appeared a mechanical process. This was brought to the attention of the deputy manager who will ensure this process is changed. We observed - and two visitors told us that they had concerns about the toileting process. Many people require the use of a hoist and taken to the toilet by wheelchair, then hoisted onto the toilet. The toilet most used is directly in the reception area. The toilet will not accommodate both hoist and wheelchair for transfer, therefore people Care Homes for Older People Page 15 of 30 Evidence: are being hoisted from wheelchairs in the main corridor area then taken into the toilet. This has obvious implications for privacy and dignity and has been raised in previous inspection reports. The home should urgently review this practice to ensure this aspect of personal care does not compromise the privacy and dignity of the person. The medication shortfalls at the time of the last inspection were potentially serious and required urgent action. Deficiencies were evident across all areas of the system including the recording, handling, safekeeping, safe administration and disposal of medicines. We made requirements to improve all those areas. Our Pharmacist was involved in an assessment of this situation. We issued a Statutory Requirement Notice - a legal document requiring the home to comply with the requirements by a defined date - otherwise further legal action would be taken. The home worked hard and carried out all the changes needed to the medication system. Our Pharmacist carried out a Random Inspection on 19th May 2010 and found that all the requirements had been met and there was compliance with the Statutory Notice. Prior to this inspection the medication system in the home had been further inspected by both Sandwell and Walsall PCT (Primary Care Team). We found on this visit that the our earlier requirements and concerns had continued to be addressed. However we did find some further shortfalls that need to be addressed. These relate mainly to administering eyedrops and creams. These are now on separate Medication Administration Records (MAR) left in the persons bedroom with the drops and creams in a secure area. In relation to one person we found that 3 different eye drops were adminstered at varying times of the day. There were no clear instructions about their use. These included twice daily to affected eye or as directed. This person self-administers the drops with supervision from staff. Staff said that they were for both eyes. Clear instructions must be recorded on the MAR sheet in the persons bedroom. The same person was prescribed two creams. One is applied twice daily but during the medication cycle the record showed the evening application had only been applied for half the number of days. One cream is to be applied to the head, the other to another part of the body, but the site was not stated in the records and the person we saw in his bedroom said he did no know which cream was applied, how often and where. The home should review the administration of eye drops and creams to ensure there are clear instructions for staff including where they should be applied, how and when. Care Homes for Older People Page 16 of 30 Evidence: We looked at the administration of anti-coagulant medication that was of serious concern due to lack of stocks on the last inspection. We found that this had been monitored very closely and there was sufficient medication for the remaining three days of the medication cycle. We saw that a person had been prescribed a liquid supplement in 125ml bottles to be administered twice daily. Only one 125ml bottle had been supplied by the Pharmacy. The home had contacted the GP but this had not been resolved. The home were advised to contact both the GP and Pharmacy as this was not being administered as prescribed. Medication to be disposed of is entered in detail on a disposal sheet and put in a disposal bin. One bin had been sealed and the disposal sheet completed, but we found just 5 tablets in another bin for disposal that had not been entered on a new sheet. This must be done to ensure an accurate audit of the system can be made. A new system for checking/auditing the medication system requires that at each handover the nurse in charge must check MAR sheets and stocks of medication. There have been necessary vast improvements to the medication system, but there are some areas that need further review. Care Homes for Older People Page 17 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are often spontaneous. Staff engage well with people and there is evidence of peoples chosen lifestyles and wishes. Evidence: We made 2 recommendations at the time of the last key inspection: Consult people about activities and establish an activities programme. People should be consulted about choice on the teatime menu. We found that there had been discussions with people about choice of activities and there is a daily list of activities. The activities have been event driven - birthdays, Easter, Summer Fayre etc. but the preparations are extensive and people have been involved in all the preparations as well as the actual events. There is now an activities folder to record them and the whiteboard in the reception area gives a list of staff on duty, meal choices, activities and other information. There is an excellent garden area at the rear of the home with landscaped, manicured gardens and lawns. The area is very pleasant, private and secure. There is good extensive garden seating with tables and 2 gazebos in the lawned area so that people have shade if they wish. The day of this inspection was very hot, people were sitting Care Homes for Older People Page 18 of 30 Evidence: out in the garden during the afternoon, drinks and ice-cream were served. People said that they had enjoyed the day and that this was not a one-day event, but they made use of the garden throughout the summer. We also saw staff sitting and talkiing with people during the day either when ongoing care was being provided or in the quieter moments staff just sitting and talking to people in a natural way. We felt that staff were aware of the need to stimulate people and we saw eveidence of this. It was stated at the last inspection that the teatime menu seems to be always sandwiches. We examined the teatime menus and found that there was always a hot dish alternative. We noted that large slices of home-made cake were served as well as other sweet alternatives. Several people we spoke with told us that they were very satisfied with the food provided. Comments included we can have anything we want. The food is excellent and no-one could complain about it. We spoke with people visiting their relatives. They all gave very positive accounts of the care being provided and indicated they were highly satisfied. Comments included the staff are wonderful, they will do anything for my mother. We think this is a very good home, we are always kept informed of any changes. The only concerns expressed by two visitors seen related to the unsatisfactory toileting arrangements mention earlier in this report. There were indications of chosen lifestyle. One person prefers to stay in his room where he pursues his own interests. He told us he enjoys the views of the park and can see people moving around in the busy road that he likes to watch. He has all meals delivered to his bedroom and leads a chosen, occupied and satisfying life. We saw a lady in the lounge area reading at 8.30 am. She has been resident for 10 years, enjoys reading and also the company of others during the day and she loves seeing the garden from her chair. She said I like to keep active and occupied, I have no complaints at all about the home or the staff. Another person said I have been here 5 years and am quite satisfied, the staff are always there when you want them. Care Homes for Older People Page 19 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their views are listened to and acted upon. Safeguarding procedures are in place to protect people. Evidence: There is a complaints procedure that is available to all people living at Woodgreen and also visitors. Complaints had not been recorded satisfactorily at the last inspection. We saw the complaints book on this visit and found that 2 domestic type complaints had been recorded and both been acted upon. No referrals by the home or externally have been made to the Safeguarding team since the last inspection. We spoke with staff who had knowledge of the forms of abuse and the procedures in place for reporting them. There has been some refresher training for staff in Safeguarding in recent months. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well maintained home, that is homely and comfortable and meets their needs. Evidence: We had some concerns about the environment at the last inspection. People did not have a constant supply of hot water to their bedrooms. We made an immediate requirement to change this situation. We visited days later and found that a new boiler had been fitted and new regulators fitted to taps. They had done what we asked. On this visit we saw the weekly checks of hot water outlets in bedroom and other areas, all had been found to fall within the required safe limits. We randomly checked some bedrooms and found the hot water temperature to be within safe limits. At the last inspection we found the home clean but some carpets and furniture worn. We asked the home to consider replacement of the carpet on the first floor that was a trip hazard. On this visit we found that the carpet on the first floor landing had been replaced throughout the first floor corridor area. We were told that all beds had been replaced and all bedroom furniture replaced. Carpets had been replace in bedrooms and all chairs in bedroom areas belonging to the home had been replaced. Some lounge chairs have also been replaced. The only area seen to be unsatisfactory on this visit was the dining room carpet that indicated renewal may be appropriate, but we Care Homes for Older People Page 21 of 30 Evidence: were told that this was due to be deep-cleaned. Carpet in this area clearly had hard wear and spillages. We saw that double bedrooms were being used as single rooms, due to the difficulty of letting shared rooms. Only one room is for shared use, the people concerned having made a conscious decision to share. We activated the call system in the home whilst talking to a lady in her bedroom. Staff did not respond for 8 minutes, we then asked why that was so. A member of staff took us to the room where the call system activates a buzzer and light to show the call point activated. In fact there were 4 lights showing, meaning 3 other people had summoned assistance. The buzzer was virtually inaudible outside the room. This was at 10 am which is a busy time in the home. Staff were all engaged in providing personal care for those rising or had breakfast. They were very busy unaware that the call system had been activated. It is important that the home addresses this situation swiftly. Either the nurse call system is relocated to a more prominent position or the audible alarm is replace with one that can be easily heard. There are bedrooms on the 2 floors of this home and it is important that the nurse call system can be heard on both floors in all parts of the building. On the last inspection we found that bedrails had not been fitted safely, having extensive gaps and no protectors. There had not been required risk assessments before fitting the guards. An immediate requirement was made and subsequent visit showed improvements. - On this visit we found the number of bedrails in use had been significantly reduced, risk assessments completed prior to fitting and looking at 2 bedrails in use we found the required gaps were satisfactory and both had protectors fitted for additional safety. Standards of hygiene throughout the home were high and there were no mal-odours present. Staff have received training in-house relating to infection control since the last inspection. The home presented well in this inspection. Clearly efforts have been made to improve general decoration, replacements and presentation. The garden area provided a pleasant backdrop with comfortable facilities and focal point for pleasant summer days. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are adequate staff numbers, recruited with the usual checks to ensure protection of people in the home. Staff training is satisfactory. Evidence: A requirement was made at the last inspection to audit the staff recruitment files and ensure all information is readily available. Files were disorganised and information difficult to find. We found on this inspection that new files had been established for all staff and contained all required information in well organised, indexed files. There were front sheets to record all recruitment information including dates references and checks and other information had been received. We looked at a sample of two staff files and found that good recruitment practices had been followed to ensure people in the home were protected by preventing unsuitable staff working with the vulnerable group. Training records were also poor at the time of the last inspection. The home have now established a training matrix giving an up to date record of training undertaken or required. Care Homes for Older People Page 23 of 30 Evidence: Training in the Mental Capacity Act and Deprivation of Liberty Safeguards had not taken place at the time of the last inspection. The Manager has attended a course and cascaded the information to staff. Other staff are accessing this training in August 2010. 17 staff are to complete training in Safeguarding between May - December 2010. Seven staff have already completed this training. All care staff have completed training to NVQ2 level and other completing NVQ3. There were 5 care staff on duty during this inspection. This included: Nurse in Charge, Deputy Manager, 1 x Senior carer and 2 Care assistants. Usually the Registered Manager is on duty - this was her day off, although she did call later in the day. Additionally there were adequate numbers of support staff on duty this included: Chef 7 - 2pm Kitchen assistant 7.45 - 2. Laundry assistant 6.30 - 11.15. 2 domestic workers working 4 hours each. There is also a maintenance person who works 30 hours per week. There are 3 people on duty at night including a nurse and senior carer. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management have addressed areas identified for improvement ensuring that people live in a risk free environment. Evidence: Many areas of concern were evident in the last inspection report that should have been identified by management. These had not been identified in the AQAA (Annual Quality Assurance Assessment) or Development plan of the home prior to the last inspection. We made immediate requirements and issued a legal notice requiring the home to address concerns identified around the following areas: Poor management of medicines, poor risk assessments, potentially unsafe bedrails, inadequate hot water supply to bedrooms, poor recording in care plans and other records. The home submitted an improvement plan to us stating how they would address these issues. Considerable work has been done to address these shortfalls and improve standards. Care Homes for Older People Page 25 of 30 Evidence: The majority have been satisfactorily addressed as stated in this report and we will continue to ensure that the improvements made are sustained. Regular unannounced monthly visits are made to the home under Regulation 26 by the provider who provides a written report on his findings. We expect monthly monitoring and also the monitoring systems put into place by the Manager to identify any shortfalls in service and standards that may occur. There are now audits in place for medication, care plans and health and safety standards. We found during this visit that the Registered Manager is called Matron by people in the home, staff, visitors and other professionals. Notices posted in the home were signed Matron. The home should consider whether this is a title fitting a modern care home setting. The Registered Manager was not on duty at the time of this unannounced key inspection, she did visit for a short time, but it was not possible to form a judgment about her management style. People in the home and staff spoke positively about her during conversations with them. We are aware that she and all staff have worked hard and made considerable improvements since the last inspection. Many staff have worked for several years in the home. We were impressed with their knowledge of peoples needs and saw positive engagement and friendly exchanges between staff and people in the home during the inspection. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The Service User Guide should be updated to include the range of fees the home charges each week for residency. This will ensure people have all the information they need in making a decision about the suitability of the home for them. Medication not given must be recorded with the corect code at the bottom of MAR sheets. This will ensure clarity when medication is not given. The provision of eye drops and creams must be reviewed to ensure there are clear instructions to staff so that these can be administered in accordance with the prescribers instructions. Detailed records must be kept of all medication disposed of. This will facilitate auditing of the medication system. The home should review the toileting arragements near the reception area to ensure that peoples privacy and dignity are not compromised. 2 9 3 9 4 9 5 10 Care Homes for Older People Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 6 19 The nurse call alarm system must heard in all parts of the building to ensure swift responses to calls for assistance from people in the home. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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