Care Home: Woodhill House HFE

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What the care home does well The manager makes a pre-admission assessment, with a visit to the prospective resident at home or hospital. Care plans show staff the best way to look after each person. ‘The home can do nothing more’, stated one resident, ‘as all my needs are met’. Many staff are long-term, and all work in well supported teams. One staff commented, ‘The staff are given thorough handovers by other staff and the Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 officers. The care given to the service users is always good and the majority of staff work well as a team and are dedicated’. Work routines in the home mean that there are usually enough staff available on each unit to support the people who live there. Staff confirmed they found the work manageable with the numbers of staff on duty. All of the staff contacted told us that the home provided good training, and 92% of the care staff team hold National Vocational Qualification Awards. Meals provided are varied, and the cook visits the residents to make sure they like what is on the menu, and to take on board any alternative suggestions. Residents told us they enjoyed the meals at the home. “That’s the thing about this place, the food’s always good”, said one. All of the home is modern, bright, airy and clean, and a very pleasant place to live. Dining areas are small and homely, and individual bedrooms are private and personalised with people’s own belongings. There are safe and attractive outside spaces for people to use. All of the staff were seen to treat the service users with respect, answering questions no matter how busy they were, and respecting confidentiality when speaking about individual care issues. They were polite and as attentive as possible, knocking on doors before entering. Residents told us they felt safe and well looked after. What has improved since the last inspection? The medication procedures followed by staff have improved, with regular audits by management aiming to ensure residents receive the correct medication at the correct time. This protects their health and welfare. The working routines of staff have been amended, so that there are usually appropriate numbers of staff available to look after the residents. Plans to develop activities in the home are in place, with one member of the staff team recently completing an Activity Coordinator’s training course. Records of any concerns or complaints are clearly recorded, with the actions taken and the outcome of that action. Staff told us they knew what to do if someone had concerns about the home. We saw that staff are provided with very relevant training courses, including challenging behaviour, infection control and safeguarding adults. The home also participates in a dementia awareness training programme.Woodhill House HFEDS0000033118.V377128.R01.S.docVersion 5.2The home has been able to recruit a settled staff team, enabling them to stop using agency staff as often. The manager commented that this ‘is enabling us to move forward with developing the quality of service that is being provided’. What the care home could do better: The manager could make sure that it is clear, with a signature of agreement, that the resident and their family have participated in the assessment of need, and the development of care plans and their reviews. Medication procedures could be further improved, by ensuring medication that is past its’ expiry date is disposed of at the right time. Also by ensuring any handwritten entries on the Medication Administration Record (MAR) are witnessed as correct by a second staff signature, and where any medication has been noted as ‘refused’ on a regular basis, could include the action to take to address this in the individual’s care plan. The care plan could hold more individual information about people’s social history, and preferred hobbies and activities, to help in the ongoing development of the activities programme. It was pleasing to note that the temporary manager had recognised areas the home needed to improve on, and commented on them in the self assessment document (AQAA) sent to us. Key inspection report CARE HOMES FOR OLDER PEOPLE Woodhill House HFE 60 Woodhill Lane Morecambe Lancashire LA4 4NN Lead Inspector Ms Jenny Hughes Key Unannounced Inspection 22nd July 2009 10:00 DS0000033118.V377128.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodhill House HFE Address 60 Woodhill Lane Morecambe Lancashire LA4 4NN 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) 01524 423588 01524 832981 julie.hagger@lancashire.gov.uk Lancashire County Care Services Julie Peirson Hagger Care Home 44 Category(ies) of Dementia (28), Old age, not falling within any registration, with number other category (16) of places Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home with nursing - Code N, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places 16) Dementia - Code DE (maximum number of places: 28) The maximum number of people who can be accommodated is: 44 Date of last inspection 24th July 2008 Brief Description of the Service: Woodhill House is a purpose built two storey home, located a short distance from the centre of Morecambe, with its shops and the seafront. It is at the end of a quiet cul-de-sac, overlooking the local cricket ground. There is space to park cars both at the front of the building, and in the car park provided at the side of the home. An attractive central courtyard provides seating and tables for residents and other smaller outdoor areas provide the same. The home provides personal care for older people, including people with dementia, and also provides nursing care to people with dementia. It is equipped to suit the needs of its residents. For example, there is a passenger lift to the upper floor, grab rails, raised toilet seats, assisted baths, and ramps for easy access. All of the rooms are single rooms, and toilets and bathrooms are conveniently situated, with some rooms being ensuite. There is ample communal space, with dining and lounge areas in each section of the home, some overlooking the cricket ground through the large windows. Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 5 A designated area is provided for people with dementia, with sufficient communal areas within this, and access to outside space. There is also a designated area for those people with dementia who require nursing care, again with communal areas, and access to outside space. Staffing is provided over 24 hours, every day of the year. As at July 2009, the fee scale ranged from £366 to £503.50, with additional charges for hairdresser visits, and extra newspapers and toiletries requested. More information regarding fees is available from the manager. Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of this home is two star. This means that people using the service experience good quality outcomes. This was an unannounced site visit to the home, in that the managers were not aware that it was to take place. The site visit was part of the key inspection of the home. A key inspection takes place over a period of time, and involves gathering and analysing written information, as well as visiting the home. The length of the visit was for 6 hours. Every year the registered persons are asked to provide us (Care Quality Commission, CQC) with written information about the quality of the service they provide, and to make an assessment of the quality of their service. We use this information, in part, to focus our assessment activity. This document is called the Annual Quality Assurance Assessment (AQAA) Surveys were sent and received from residents, and staff from the home. During the site visit, staff records and resident care records were viewed, alongside the policies and procedures of the home. The manager, residents and care and nursing staff were spoken to, along with visitors who called during the day. Their responses are reflected in the body of this report. A tour of the home was made, viewing lounges, dining rooms, bedrooms and bathrooms. Everyone was friendly and cooperative during the visit. What the service does well: The manager makes a pre-admission assessment, with a visit to the prospective resident at home or hospital. Care plans show staff the best way to look after each person. ‘The home can do nothing more’, stated one resident, ‘as all my needs are met’. Many staff are long-term, and all work in well supported teams. One staff commented, ‘The staff are given thorough handovers by other staff and the Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 7 officers. The care given to the service users is always good and the majority of staff work well as a team and are dedicated’. Work routines in the home mean that there are usually enough staff available on each unit to support the people who live there. Staff confirmed they found the work manageable with the numbers of staff on duty. All of the staff contacted told us that the home provided good training, and 92 of the care staff team hold National Vocational Qualification Awards. Meals provided are varied, and the cook visits the residents to make sure they like what is on the menu, and to take on board any alternative suggestions. Residents told us they enjoyed the meals at the home. “That’s the thing about this place, the food’s always good”, said one. All of the home is modern, bright, airy and clean, and a very pleasant place to live. Dining areas are small and homely, and individual bedrooms are private and personalised with people’s own belongings. There are safe and attractive outside spaces for people to use. All of the staff were seen to treat the service users with respect, answering questions no matter how busy they were, and respecting confidentiality when speaking about individual care issues. They were polite and as attentive as possible, knocking on doors before entering. Residents told us they felt safe and well looked after. What has improved since the last inspection? The medication procedures followed by staff have improved, with regular audits by management aiming to ensure residents receive the correct medication at the correct time. This protects their health and welfare. The working routines of staff have been amended, so that there are usually appropriate numbers of staff available to look after the residents. Plans to develop activities in the home are in place, with one member of the staff team recently completing an Activity Coordinator’s training course. Records of any concerns or complaints are clearly recorded, with the actions taken and the outcome of that action. Staff told us they knew what to do if someone had concerns about the home. We saw that staff are provided with very relevant training courses, including challenging behaviour, infection control and safeguarding adults. The home also participates in a dementia awareness training programme. Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 8 The home has been able to recruit a settled staff team, enabling them to stop using agency staff as often. The manager commented that this ‘is enabling us to move forward with developing the quality of service that is being provided’. What they could do better: 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. Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a clear assessment procedure, which is carried out for all residents. This means that the service provided is tailored to an individual’s needs and preferences. EVIDENCE: Individual records are kept for each of the service users, with a set procedure for admitting someone to the home. Four selected files showed that assessments of need had been carried out prior to admission. These are needed so that the manager can confirm that the staff in the home are able to give the appropriate care, before it is decided that the home is the right place for the person to live. Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 11 Some of the information was difficult to find, and the temporary manager advised us that the structure of the files was to be improved so that information could be clearly followed from admission to present day. There was not always clear evidence of resident and family participation in the assessments we viewed. One visitor said that their relative had no assessment before they were admitted, due to the manager being on leave, but they were very happy with the care being provided. The temporary manager now in place at the home told us they would always carry out this assessment, either at the person’s home, or in hospital, and we advised a signature of agreement from the resident or their family would confirm their participation. Any new information is passed to staff at the shift handover sessions, and through use of the Communication Book in each unit, which they read as soon as they start their shift. They are also able to view care plans. Staff surveys told us that the communication systems in the home usually worked well and one suggested, ‘The handover during the day could be more detailed to improve the knowledge of any incidents’, and another said ‘My team are supportive of each other, and communicate well’. Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of residents are well met in this home. EVIDENCE: There is a standard format for the care plans on each unit which, when completed fully, clearly identify the needs of each individual so staff know how best to look after people. In the care plans we viewed, it was not always clear what the most up to date information was, what was historical information, and if identified goals had been achieved or not. We saw that the temporary manager was in the process of restructuring the files. Staff we spoke to said that they found the restructured ones easier to work with and to find information. Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 13 We saw that the information held is being reviewed and improved to be more person centred for each resident, and more detailed so that any individual care needs can be linked to the care provided and the outcome of that care. For example, individual information such as ‘likes bedroom door closed’, and ‘will have an early morning cup of tea’, make the plans more personal and individual. The temporary manager told us of plans to make the information clearer on how problems, such as pressure sores, have been treated and progressed. She also noted that some issues raised in daily notes, which are recorded three times a day by staff, may need to be included in the care plan to be addressed more formally. This could be, for example, detail on interventions to use when it has been noted that a resident has started to develop behavioural problems. We also noted that the need to involve and liaise with relatives had been identified in the individual records by the home, but no action had been taken to do this. The recent information sent to us by the home shows that they have identified they need to address this, with the comment ‘It is felt that the home could more actively encourage the involvement of residents and/or relatives in the care planning/review process’. Staff told us that they felt the care plan system was good, that they used them on a daily basis and they tried to keep them updated. A resident told us ‘I am quite happy with the care I receive here and feel that all the staff are very helpful’. The organisation has comprehensive medication procedures in place. The pharmacy inspector visited the home on 17th June 2009, and had some concerns over some medicines not being administered correctly, and on some occasions medicines being out of stock, so that people missed prescribed medication. We viewed a selection of medication administration records (MAR) during this visit, and checked some medication stock. We found that there was good information held on medication for residents that was to be taken when required, for staff to refer to. We found the MAR were generally in good order, and stock checks we made were satisfactory. We noted that very regular audits of medication are taking place by management to ensure stocks are correct. We advised that any handwritten entries on the MAR should be countersigned, in order to confirm the information is correct, and the right medication is being administered. We also advised that if residents are regularly refusing medication, any action to address this should be included in their care plan. Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 14 We noted that some eye drops were outside their expiry date, although others were correctly due to be disposed of. We advised that procedures are reviewed to ensure medication is disposed of at the right time. We noted how some issues had been addressed by using good person centred practices, such as changing the time a person’s medication was administered to suit them better, and also the quick response to changing the type of medication for a person who had difficulty swallowing. All staff administering medication had completed accredited training, and we saw staff having their competency in handling medications assessed during our visit. Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home generally experience a good quality of life in this area. EVIDENCE: Some of the care plan information we saw did not hold much information regarding people’s social history, or what hobbies and activities they preferred. The individual care plans had no records of any regular activities being participated in. The update of the care plans being carried out should address this information. The staff we spoke to said that they try to be more person centred, having one to one contact with the residents rather than always in groups. They told us that at present there is no set activities programme in the home, and a decision is made depending on what people wish to do on that day. They told Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 16 us that they try to take people out, but it depends on staffing levels and the weather. Residents told us their visitors could go to the home at any time. Activities logs are held on each unit in the home, and although the one we examined had not been completed for a few weeks, it did show what activities had taken place. These included reading papers, hand massages, scrabble, sing-a-longs, reminiscence, and a tai-chi class. Staff told us ‘chairobic’ exercises are carried out in the nursing unit. There is little information in each unit about what activities are available. Responses from residents about the provision of activities varied from ‘always’ having some, to ‘never’ and ‘don’t know’. One resident told us the home should ‘make activities available’. More structured activity plans and information may be beneficial for residents to choose and plan what they wish to do. The temporary manager told us that one of the management team had recently attended an Activity Coordinator’s training course, with the plan to be able to improve the range and quality of activities provided. The meals are planned on a 3-week menu, and the cook spoken to said that something different is offered if a resident doesn’t like the choice. The cook visits the service users to make sure they like what is on the menu, and a record of any special diets are kept in the kitchen. The choice at this visit was chicken or sausages, followed by sago pudding. The dining areas in the units are pleasant, small and homely, using small tables for four or six people to sit at. Meals are transported from the main kitchen to these dining areas in heated trolleys, where they are served piping hot and fresh to the residents from the mini-kitchens based there. Some residents preferred to have their meals in their rooms. Staffing routines around mealtimes have been addressed since our last visit, and care staff have time to stay with residents over meal times, as domestic staff deal with transporting pots to the kitchen for washing. Staff we spoke to said the system was much improved as they had more time to spend with the residents, and help them if needed. Residents told us they enjoyed the meals at the home. Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident all of their concerns will be listened to and acted upon. Staff have a good understanding of Adult Protection issues, which protect people who live in the home from abuse EVIDENCE: There is a complaints procedure in place, which is clearly outlined in the service user guide, and which is on display in the home. We saw a complaints record, where any complaints brought to the attention of the manager are recorded. The home has followed the good practice of recording all concerns and dissatisfactions, with their investigation and outcomes. These can give a good overview of how the home is operating, and where improvements can be made. There have been two investigations into the care of residents following concerns raised after serious incidents. The home has followed procedures appropriately. Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 18 All of the residents surveys stated that they knew who to speak to if they were unhappy and they knew how to make a formal complaint. The staff told us about how any problems were raised during one to one chats with residents, when they tried to solve any issues. The information sent to us by the home told us, ‘Through the re-introduction of Resident Group meetings, it is hoped that general day to day issues can be discussed and resolved at an early stage’. The self-assessment told us that staff have mandatory training in Safeguarding procedures, and guidance about what to do if they had any concerns that a service user is being abused. Training records showed that most staff had received their training, and refresher sessions. Staff we spoke to were clear on what to do if they had any concerns about a person’s welfare. People at the home said that they felt safe and well looked after. Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,21 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a well-maintained environment, which generally provides aids and equipment to meet the care needs of the service users. It is a pleasant, safe, and homely place to live. EVIDENCE: Woodhill House is a purpose built 2-storey accommodation, divided into 3 large units. Bedrooms, lounges and dining rooms are on both floors. Service users who have bedrooms on the upper floors may use them throughout the day if they wish. Staff support would be provided as required. Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 20 The home is modern, bright, airy, and a very pleasant environment to live in. There are various safe garden areas for residents to sit in the good weather, with the back of the home overlooking the local cricket pitch. Some service users enjoy watching the summer matches. Since our last visit the central courtyard area has been landscaped, making it a more attractive place to be. A small garden where produce is grown provides an interest for residents. Corridors are light, with windows along the length, and large plants and strategically placed seating give a comfortable feel to this building, which has its living units linked by these long corridors, and so is spread over a large area. The lounges in each unit are comfortable and welcoming. The temporary manager told us of plans to decorate the largest lounge to try and make it more inviting for residents and their relatives. The bedrooms are also modern and bright, with new furniture and matching bedding and curtains. Service users are welcome to bring personal belongings and small pieces of furniture if they wish, to help make their room their home. All of the service users spoken to said they liked their rooms very much. Random viewing of the rooms showed them all to be clean and tidy. Residents told us in surveys that the home is always fresh and clean. There are toilets and bathrooms around the home, some with assisted baths. General aids such as hoists, raised toilet seats, ramps and handrails help people with mobility problems, although some of the aids cannot be used in a bathroom which is too small, and toilets which are arranged in such a way that staff have difficulty in helping some of the very dependent service users who now live at the home. Staff have brought these problems to the notice of management. The laundry area is away from the kitchen and dining areas, and the manager stated that the home has infection control guidelines for staff to follow. The new staffing routines in the home have designated staff responsible for laundry duties on each shift, allowing the remaining staff to stay with the residents. Staff confirmed this was an improved way of working. Any maintenance needs are recorded and passed onto head office for them to allocate the work out. Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 21 Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home operates a good recruitment policy, which ensures that only people who are suitable for this type of work are offered an appointment. Training is provided, and this means that residents receive appropriate care and attention. EVIDENCE: We saw that staff files showed the necessary recruitment checks are made to ensure the protection of service users. References and Criminal Records Bureau checks were available in the files we viewed, and notes of the interview were made. New care staff are required to have full induction training, so they are clear on what is expected of them when they are carrying out their work. A check list is used to ensure all areas are completed and understood by the staff. Staff told us in surveys that the induction mostly covered everything they needed to know to do the job when they started. The staff group are a mix of qualified nursing staff, and care staff, experienced or young and enthusiastic, both male and female. Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 23 In answer to ‘What does the home do well?’ one response from a staff member in a survey was ‘Training. Supportive management team. Happy home environment’. There is constant training for staff, and we viewed a training matrix that showed ongoing planned training in areas such as moving and handling, food hygiene, first aid, safeguarding, risk assessments, mental health and challenging behaviour. The majority of staff have also attended National Vocational Qualification courses. The information from the home told us they plan to provide further training for staff in dementia awareness. The temporary manager told us about continually addressing the work routines of the staff, to enable them to spend more time with residents. Staff confirmed they found the new routines resolved many of the problems they had previously raised. The temporary manager also confirmed successful recruitment had provided a ‘more stable staff group with significantly less reliance on agency staff’, which provides continuity and consistency for residents. ‘I am quite happy with the care I receive here and feel that all the staff are very helpful’ stated a resident in a survey. Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems and practices in the home promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: Since the beginning of June 2009 there has been a temporary manager in post at the home, who is in charge of the day to day running of the home. She holds the Registered Manager’s Award, and is very experienced in caring for older people, and for people with dementia. Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 25 We saw that this manager was ensuring staff receive individual supervision sessions, and that issues raised by staff in the past were addressed. The action taken had lead to improved communication and better working routines. We saw that the manager had recognised the shortfalls there had been in staff supervisions, and that there had been an increase in the frequency of these. As the manager is not a qualified nurse, she told us that arrangements were being made with the Primary Care Trust (PCT) to provide clinical supervision sessions and support for the nurses working at the home. The area manager of the organisation provides constant support, and over the last year the management team of the home have held fortnightly meetings with the area manager to discuss operational matters. We saw minutes from these meetings, where any required actions to take were identified. We saw that the staff from each unit in the home had meetings to ensure they were aware of what was happening in the home, and in order to feedback any problems. The manager told us of plans to continue to support residents’ meetings, although they had not always been successful in the past. Relatives are welcome to attend if they wish. She told us that residents in the nursing unit are spoken to individually about things, rather than in a meeting, due to their conditions. We saw that there were always minutes from any meetings. Surveys are sent to residents to complete so that the home can get feedback about how it is performing. We saw that there are financial procedures in place where any financial transactions carried out for residents are properly recorded. All accidents are recorded, and in a general file, which gives good opportunity for an overview of any patterns emerging. Risk assessments are done, and what action to take. The self-assessment confirmed that general maintenance and standard checks of equipment are up to date. Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 OP7 Good Practice Recommendations It should be made clear that the resident and their family have participated in the assessment of need, the development of the care plan, and in the reviews of the care plan. Any handwritten entries on the MAR should be countersigned to confirm the information is correct. Any medication that is regularly refused should be addressed in the person’s care plan. Any medication that is passed its expiry date should be disposed of at the right time. The care plan should hold good information about DS0000033118.V377128.R01.S.doc Version 5.2 Page 28 2. 3. 4. 5. OP9 OP9 OP9 OP12 Woodhill House HFE residents’ social history, and preferred hobbies and activities, to aid the continued development of the activities programme. Woodhill House HFE DS0000033118.V377128.R01.S.doc Version 5.2 Page 29 Care Quality Commission Northwest Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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