Care Home: Woodland Hall

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What the care home does well What has improved since the last inspection? A considerable number of improvements have been made, including in respect of all previous requirements. The service user guide had been updated to ensure that it contains the required information to help enable prospective residents and their representatives make informed decisions about moving into the home. The case records of residents now contain sufficiently detailed and up-to-date care plans and risk assessments to better enable staff to provide appropriate care to residents. Attention has been sufficiently given to ensure that residents receive appropriate oral hygiene and dental care. Improvements have been made to ensure that the recording and administration of medication is sufficient to ensure that residents receive the required treatment. There has been increased training made available to staff, resulting in better care being provided and better levels of satisfaction about the care provision. This includes in respect of helping residents to be more independent and have more control over their lives where possible. It has also resulted in good confidence amongst people about the complaints and whistle-blowing processes, and in staff and management being seen as approachable. We saw that the area in front of the home has now been redeveloped into a pleasant garden with raised flowerbeds and seating. It has also been designed to provide a different sensory aspect across each corner, and to enable residents to both enjoy the area and grow food in it. Bedroom doors now have memory boxes securely attached to them. These boxes, attractively-styled, contain items that the resident likes or is used to, which in some cases is helping them to locate their room. Redecoration and refurbishment work across the whole home has started. Finally, the home has received an award from Care UK for the significant number of compliments it has received in 2007. CARE HOMES FOR OLDER PEOPLE Woodland Hall Woodland Hall Clamp Hill Stanmore Middlesex HA7 3BG Lead Inspector Clive Heidrich Key Unannounced Inspection 09:30 6 and 13th August 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodland Hall Address Woodland Hall Clamp Hill Stanmore Middlesex HA7 3BG 020 8954 7720 020 8954 5582 manager.woodlandhall@careuk.com 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) Care UK Nirmala Kumaree Juggapah Care Home 72 Category(ies) of Dementia (72), Mental disorder, excluding registration, with number learning disability or dementia (72) of places Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 72 22nd August 2007 Date of last inspection Brief Description of the Service: Woodland Hall is a continuing care/respite facility that is owned and managed by Care UK. It had been registered as an independent hospital since it opened in 1995, but voluntarily changed its registration to that of a care home with nursing during the summer of 2005. Woodland Hall is a purpose-built, two-storey building that is currently registered to accommodate 72 people whose primary need on admission is either dementia or mental disorder. The service provided is contracted to Harrow Primary Care Trust. The home is located in attractive and peaceful grounds in-between Harrow Weald and Stanmore. It is reasonably close to a few local shops and facilities. Ample parking is available at the front of the home. All bedrooms are single rooms with en-suite toilet and washbasin facilities. There are numerous communal toilets and bathing facilities across the home. Laundry and catering services are located centrally on the site. Woodland Hall is divided into six separate areas that each accommodates 12 people, although there are connecting lounges for four of these areas. The areas are: Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 5 Greenview (1) - accommodates 12 female residents. Bluebell (2) - accommodates 12 female residents. Cedar (3) - accommodates 12 female residents. Parkview (4) - accommodates 12 female residents. Sunshine (5) - accommodates 12 male residents. Hillside (6) - accommodates 12 male residents. There were 14 vacancies at the time of the inspection. A copy of the Service User Guide, and the fee range, are available on request, and also in the entrance hall. Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This inspection took place to consider the overall quality of service experienced by people at the home, and to check that the home has complied with the requirements of the previous inspection. The service was requested to complete an Annual Quality Assurance Assessment (AQAA) well in advance of the inspection. This provides the service with the chance to explain how it meets the National Minimum Standards. This pre-inspection paperwork was duly returned to the CSCI in good time. Surveys were sent to the home for distribution amongst a reasonable percentage of people involved in the home. Surveys were consequently returned directly to us by seven people on behalf of residents, along with one health professional and one staff member. Their views have been incorporated throughout the report. A co-inspector undertook the first day of inspection on 6th August 2008. It took a total of five and a half hours to complete. The lead inspector then visited on 13th August for six further hours to complete the process. During these visits, we met with people who live in the home, staff working there, a number of relatives and a few other visitors. Much of the environment was checked including all communal areas, and care practices were observed in communal areas. A number of records were analysed. Feedback was provided to the manager at the end of the visit. We are grateful to everyone involved in the home for their patience and helpfulness before, during, and after the inspection. What the service does well: We generally received very positive feedback about the service provided at the home. Comments especially from relatives include “Woodland Hall is a very good nursing home, my husband seems happy there”, “Staff treat my wife very well and with absolute respect – 100 ”, and “Hope I can live here if it comes to it.” A number of health professionals also provided positive feedback about the care and the staff. We found that the care provided is individually prepared and effort is made to address specific care needs of residents. There are high levels of respect for Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 7 residents, such as responding to quiet residents when they call. Effort has been made to ensure that residents are provided with social and therapeutic stimulation. For instance, some residents had been involved in the local Harrow horticultural show and won awards at this show. Residents receive well-balanced and varied meals. The religious and cultural meal preferences of residents are responded to. What has improved since the last inspection? A considerable number of improvements have been made, including in respect of all previous requirements. The service user guide had been updated to ensure that it contains the required information to help enable prospective residents and their representatives make informed decisions about moving into the home. The case records of residents now contain sufficiently detailed and up-to-date care plans and risk assessments to better enable staff to provide appropriate care to residents. Attention has been sufficiently given to ensure that residents receive appropriate oral hygiene and dental care. Improvements have been made to ensure that the recording and administration of medication is sufficient to ensure that residents receive the required treatment. There has been increased training made available to staff, resulting in better care being provided and better levels of satisfaction about the care provision. This includes in respect of helping residents to be more independent and have more control over their lives where possible. It has also resulted in good confidence amongst people about the complaints and whistle-blowing processes, and in staff and management being seen as approachable. We saw that the area in front of the home has now been redeveloped into a pleasant garden with raised flowerbeds and seating. It has also been designed to provide a different sensory aspect across each corner, and to enable residents to both enjoy the area and grow food in it. Bedroom doors now have memory boxes securely attached to them. These boxes, attractively-styled, contain items that the resident likes or is used to, which in some cases is helping them to locate their room. Redecoration and refurbishment work across the whole home has started. Finally, the home has received an award from Care UK for the significant number of compliments it has received in 2007. Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Woodland Hall DS0000063588.V369888.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 Woodland Hall DS0000063588.V369888.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. The home has developed a comprehensive Statement of Purpose and Service User Guide that are specific to the resident group and considers the different styles of support and care required to meet their needs. Admissions are not made to the home until a full needs assessment has been undertaken by the management team. EVIDENCE: The care records of five residents were inspected. Some of these records were held on computer and managed by a computer software system ‘Saturn 2’. The pre-admission assessments that were examined were noted to be appropriate and comprehensive. These assessments included details of the personal, mental, cultural and spiritual needs of residents. Risk assessments had also been prepared for residents admitted to the home. In addition, the Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 11 service’s pre-inspection paperwork indicated that the home has now compiled life histories for all residents admitted, in order to assist staff to better understand residents’ behaviours and provide them with individualised care. Residents in the home were noted to be clean and appropriately dressed. Staff were noted to be responsive towards residents who approached them, and gentle when interacting with them. Feedback from visitors informed us that they were very pleased with the care provided and indicated that residents’ care needs are attended to by staff whom they perceived as caring and kind. They further indicated that staff are welcoming and attentive. This positive feedback was also reiterated in the surveys we received. Comments made by relatives included, “The staff are very attentive and always quick to sort out any queries”, “The care and support from everyone is outstanding”, and “The staff are always on hand ready to help.” Following a requirement made in the last inspection report, we saw that the statement of purpose and service user guide have been updated and now included the required information. This includes the fees charged by the home and its philosophy with regards to the provision of dementia care. Management stated that the home does not provide intermediate care. Woodland Hall DS0000063588.V369888.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. The arrangements for meeting the healthcare and personal care needs of residents are satisfactory and are recorded in residents’ care plans. Residents are treated very respectfully, and their health needs are generally met. There is a good quality of care documentation, which helps to ensure that appropriate care is provided. Residents are protected by the home’s appropriate arrangements for the administration of medication. EVIDENCE: The surveys we received on behalf of residents indicated that people receive appropriate medical care and support. This was also reiterated by residents and relatives interviewed during our visit. They indicated that for instance that residents could easily see the doctor if they needed to. Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 13 Management stated that the GP visits the home weekly and that there is a record of visits and decisions made regarding the care of those residents seen. This record was seen by us. In addition, the case records that we examined showed us that residents have access to other healthcare professionals such as the psychiatrist, chiropodist, psychologist, dentist and optician. Individual care plans are in place for all residents. We found, from a sample of five care plans, that they are on the whole well-prepared, and that they address the holistic needs of each resident. Care plans have been updated and contain details of action that need to be taken to meet the health, personal, and social care needs of residents. We saw a number of appropriate health-care entries within residents’ records. For instance, details of the oral-hygiene support provided to individuals are recorded. Nutritional care plans, fluid charts and monitoring forms were in use where appropriate. The records of a resident assessed as being at risk of developing pressure sores similarly contained an appropriate pressure-area care plan. Management indicated that staff have been vigilant in ensuring that residents do not develop pressure sores. There was documented evidence of monthly care reviews carried out by care staff for each resident. Management stated that regularly checks of this are undertaken. This is good practice and ensures that the care provided for residents is appropriate and takes into account any changes in their condition. There was also evidence that residents or their representatives had been consulted and had signed the care plans. This ensures that they are aware of the care plans and agree with them. We saw that care plans contain evidence that the cultural needs of residents have been assessed and action has been taken to respond to them. Details of specific dietary and religious requirements are documented. We interviewed relatives of two residents from an ethnic minority. They confirmed that cultural and religious needs are responded to. We met and interviewed three visiting healthcare professionals. They were generally positive regarding the care provided at the home. They indicated that they and their departments maintain close liaison with the home. Appropriate risks assessments are in place for residents. These assessments include strategies for minimising risks of falls, wandering and pressure sores. Management and staff who were interviewed were found to be knowledgeable and aware of potential risks faced by residents and how these risks can be minimised. We noted that two residents at risk of falls had been provided with hip protectors purchased by their relatives. This was discussed with management who stated that relatives had been asked to purchase them. As residents in this home are placed there under a block contract with the health authority, such items should normally be provided by the home or the health Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 14 authority. In view of this, a requirement is made for the funding of hip protectors to be reviewed with the placing authorities. Three of the case records examined contained photos of the residents concerned. Two however did not. This was discussed with management, who explained that these residents had recently been admitted. We noted that one of the residents concerned was admitted more than two months ago. Photos must be provided to ensure that residents can be easily identified by staff attending to their needs, including new staff. Medication charts of residents were examined on both floors of the home. These indicated that medication is administered as prescribed. The temperature records of the room where medication is stored are recorded daily. These were satisfactory and no higher than 25°C. We saw staff treating residents very respectfully. For instance, we saw staff gently awake one resident for lunch, another knock at bedroom door before entering, another trying to offer choice of drinks, and a fourth responding to the quiet call of a resident on the other side of the room. We received strong feedback from relatives about the attitude and ability of staff, one person stating for instance that “Staff have people skills, which you can’t teach, and know when to approach and when not to.” The manager told us that much work has taken place with specialist dementia agencies, for instance through reading their literature, to improve the services provided to people in the home. They had also visited other homes to look at what they had done. This has resulted for instance in many items being hung up in corridors, for instance cooking implements, handbags, hats, specific pictures, and other items from yesteryear, which residents can use and take as they wish. Woodland Hall DS0000063588.V369888.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. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. The daily life, meal arrangements and routines of residents are on the whole well-organised and take into account residents’ preferences and cultural wishes. Residents are able to maintain important family relationships through the home’s approach to visitors. Residents are very well supported to gain greater independence and have control over their lives where possible. EVIDENCE: The home had a varied and comprehensive programme of weekly social and therapeutic activities. This programme was on display along the corridor on the ground floor. Activities provided include entertainment sessions, singing, outings, garden parties, birthday parties, barbecues, and art & craft sessions. The home’s full-time activity organiser recently resigned from her post. She has been replaced by two part-time activity co-ordinators who have previously worked in the home as carers. Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 16 Staff told us that some residents have recently attended a show at a local school. We were also informed that religious services and holy days such as Diwali, Hanukah and Christmas were celebrated at the home, and that religious leaders from various religious orders have held services at the home. A list of these special days is also on display along the corridor. Pre-inspection paperwork stated that residents had been involved in the local Harrow horticultural show. This included baking bread and cakes, and growing fruits and vegetables. Nine residents won awards at this show. During the inspection, residents were noted to be participating in board games with staff. Management stated that the doors to the back garden are left open to enable residents access to the garden. Residents’ representatives interviewed were satisfied with the activities organised. A healthcare professional indicated that there were communication problems between staff and residents and this had resulted in residents not been assisted to be as independent as possible. This was however not evident from the feedback received from either relatives or residents. Comments made by them indicated that they are satisfied with the care provided and they expressed no concerns. Staff feedback included that they encourage residents to do as much as they can for themselves. The care plans examined indicate that residents are encouraged to remain as independent as possible. The manager provided an example of good practice in which a resident with dementia who was dependent on a wheelchair has made significant progress and could now walk on her own. In another case, a resident who had challenging behaviour and was uncooperative regarding his care is now cooperative and for instance makes drinks for himself. Documented evidence of this progress was seen within the computerised case records. The menu examined was varied and balanced. There was a choice of main dish at meal times. Residents and relatives indicated to us that they are generally satisfied with the meals provided. One resident and a relative from an ethnic minority indicated that their dietary preferences have been responded to. The relative stated that the home had made special effort in this respect. Another relative told us that “staff check people’s nourishment, and feed people is needed. No one is forgotten.” Woodland Hall DS0000063588.V369888.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use this service experience an excellent outcome in this area. This judgement has been made using available evidence including a visit to this service. The ethos of the home is that it welcomes complaints and suggestions about the service, uses these positively and learns from them. People can therefore be very confident that any concerns raised will be taken seriously and acted upon. The procedures and training provided at the home also ensure that residents are protected from abuse. EVIDENCE: We received very strong feedback about complaints processes from surveys and during the visit. All seven people who filled in the residents’ survey stated that they always know who to speak to if they are not happy. The health professional survey stated that, “in discussing a concern with the manager, she acted upon my concern and suggestion.” Feedback from relatives during the visits similarly found that they experience staff and the manager as willing to listen to concerns, ideas, and things that are wrong, and to take action. We found that the complaints procedure was on display in the entrance foyer, the main corridor, and clearly within some people’s bedrooms. Training records showed that virtually all staff have completed a customer care course. The induction record of one newer employee showed that they had undertaken this course within their first few days of working at the home. The manager stated that this training has helped to prevent minor issues from escalating into Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 18 formal complaints. We found only one formal complaint since the last inspection. The record of it showed that to investigate the issue raised by a relative, the manager had consulted with both a health professional and the resident themselves. There were detailed records of the agreed actions arising from the complaint. These records, and feedback from the manager, showed that the complaint had been considered very much from the perspective of the resident whilst still considering care obligations. We note that there have been no complaints raised directly with us about this home since the last inspection. We also briefly looked through a bulky compliments book. A typical comment from it was, “We were impressed from the outset with the warmth of the staff as they went about their duties. Nothing was too much trouble.” The manager noted that there have been twelve such compliments in the last year, and showed us the award provided by Care UK in 2007 to this home for compliments about the service. This was in competition with 55 other homes in the region. The manager told us that she values abuse prevention very highly. For instance, when meeting new people at the home, she lets them know that she is available should they have any concerns about anything they observe whilst in the home. Feedback from relatives, as per complaints, corroborates the manager’s openness to feedback. There have been two incidents reported to us, about residents assaulting one another, since the last inspection. These notifications have been timely, reasonable in the actions taken to safeguard people, and included the appropriate referral to the local Social Services department in respect of following the London Borough of Harrow’s safeguarding procedures. The manager stated that there have been no other such incidents since the last inspection, which she explained was in parts due to the staff picking up on signals from residents before issues escalate. Additionally, the issue for one resident has been resolved through placing a specific picture on their bedroom door, and writing their name there in a large font, to help them recognise their bedroom. We received positive feedback from people about how care staff handle any residents who become aggressive. Relatives noted that care staff know residents well and as individual people, and hence are generally able to proactively and calmly diffuse situations before they escalate. As a couple of relatives put it, “Staff are very patient” and “Have never seen anything untoward.” This matched survey feedback in this area, notably from a health professional who stated that the home does well at “finding ways to deal with challenging behaviour.” It also matched our observations of consistently respectful behaviour from staff to residents. The manager explained that any mark found on a resident must be reported as an incident, whilst any injury witnessed is recorded as an accident. We saw numerous records in these respects, and of the manager’s analysis where Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 19 needed. She explained for instance, that for one resident who has had a number of falls at night, staff were now undertaking half-hourly checks which are helping to reduce the frequency of falls. One relative independently confirmed to us that there are “lots of checks at night.” We checked the home’s internal policy on abuse, and found it appropriate. It now includes actions to take in cases of one resident assaulting another. We also saw records to confirm that all staff have fully completed training on abuse-prevention. Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24, 25 and 26. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a safe environment that is in need of some refurbishment but which has started to be redecorated and renewed. Resident’s own rooms are kept personalised and meet needs. The home is kept clean and hygienic. EVIDENCE: A few people made comments to us that the environment should be improved on, such as “the unit is tired and in need of redecoration.” One relative put this in good context, explaining that whilst the environment was in need of some improvements, it is the excellent care provided that is most important. The manager was open with us that the environmental work was taking time to get completed, however she stated that full budgets have now been granted to address all requirements from the previous inspection. We were shown documents that confirmed this. External contractors were working during our Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 21 visits, and we saw that one corridor of the six has been redecorated, with a second being worked on. The manager explained that flooring would be replaced, and new furnishings brought in, once redecoration work has finished. The manager agreed to provide us with a written monthly update on this extensive work, so that we can monitor the requirement to bring furnishings and décor up to an appropriate standard. We checked four randomly-chosen bedrooms across the home. All were pleasantly decorated, comfortable and clean. All had window-restrictors in place. Each had an en-suite toilet. Each showed signs of personalisation, for instance, magazines, rosary-beads, and photos, plus in one room a sign about the sort of music that the resident likes. This all suggests that the individual aspects of each resident’s personality are respected. The manager explained what has happened about bedroom doors to make them more individual. All will be repainted in a colour of each resident’s or relative’s choice, which for some people should help them remember their room. However many doors have already had a memory box securely attached to them. These boxes, attractively-styled, contain items that the resident likes or is used to, which in some cases is helping them to locate their room. We saw for instance paint boxes, pasta, pictures, and cotton reels in various memory boxes. We saw that the area in front of the home has now been redeveloped into a pleasant garden with raised flowerbeds and seating. The manager explained that the various different plants at each border represent a different sensory aspect, and that staff support residents to use the area. A relative noted positively that a few residents eat the food that is grown there. A newsletter sent to people involved in the home similarly confirmed that residents were involved in setting up the garden. The home has one passenger lift between floors. The manager clarified that it has a 24-hour call-out contract, and that any faults have always been fixed within 24 hours. We found appropriate standards of hygiene and cleanliness in the areas of the home that we checked. The home has a team of domestic workers for this purpose. Kitchenettes were found to have a ready supply of anti-bacterial hand-foam. We also noted the floors in most kitchenettes have occasional cracks and stains, which would benefit from replacement to help uphold hygiene standards. Feedback from residents’ surveys found that three people felt the home is always fresh and clean. Three people rated this as ‘usually’, one person noting that any continence accidents are “cleaned up straight away and carpets shampooed.” One person rated this as ‘never’. The latter noted that the “unit always smells of urine.” We however found no lingering offensive odours within either the large and small lounges or the corridors of the home, all of which we Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 22 checked. The manager noted in the pre-inspection paperwork that, “We have eliminated certain odours by implementing a more effective urine neutraliser,” which shows attention to the issue. We looked at the laundry area. It was clean and tidy, and contained four industrial machines, two for washing and two for drying. A sample check of clean clothing returning to people found it labelled and ironed. The manager showed records of monitoring all cases of any residents having an infection of any sort, which are analysed and sent to a specialist within the organization. She also explained that all staff have undertaken training on infection control, which records confirmed. We saw records of monthly audits by the company’s Clinical Governance Team, which for this year included a laundry audit. We also saw on a company newsletter for August 2008 that infection control audits were now going to start taking place within homes. The manager confirmed by email after the inspection that the audit would be taking place in November 2008 for this home. We also received praise from one relative about how the home handles infection control within a personal care context. Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. People who use this service experience an excellent outcome in this area. This judgement has been made using available evidence including a visit to this service. Staff have the skills to communicate effectively with all residents. There are sufficient staff provided at all times to meet residents’ collective needs. The service ensures that all staff within its organisation receive relevant training that is targeted and focused on improving outcomes for residents. Recruitment processes support and protect residents. EVIDENCE: Six of the seven resident surveys we received stated that staff are always available when needed. The other person stated, “Obviously staff may be dealing with someone else when you need them, but as soon as reasonably possible they make themselves available to you.” The manager noted that there have been no changes to staffing levels, despite there being more vacancies in the home than at the last inspection. Some relatives met with during the visits confirmed this, noting that staff are “very good, responsive and patient.” We noted very low use of agency staff by the home, gaps in the roster being covered by the home’s bank staff whom the manager told us are trained to similar standards as permanent staff. We also noted relatively low staff turnover, which suggests a positive working environment. Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 24 We received very strong overall praise about the staff team. All resident surveys we received stated that staff always listen to and act on what is said to them. One person commented, “The staff are very attentive and always quick to sort out any queries”, whilst another stated that staff are “A1 and nothing is too much trouble for them.” We also saw very positive interactions from staff towards residents, and found no cause for concern in anything we saw. One person noted by survey that, “It is evident that staff have been given much more training than when my relative initially came into the home as it shows in their handling of the residents.” Feedback from staff showed that they receive good training support, which training matrix records of the whole team confirmed. The manager told us that although a number of care staff have completed a National Vocational Qualification (NVQ) course in care, some certificates have not yet been delivered. This has contributed to the company changing training provider, who additionally allow work on the company’s ‘EL-Box’ computer system to count towards the qualification. The manager estimated that there are 15 care staff with certificates, 6 waiting for them, and 10 working at the qualification currently. Additionally, a member of the kitchen staff has a relevant NVQ qualification. We see all this as satisfactory support to reach the National Minimum Standard of 50 of the care staff team having the NVQ qualification. We additionally saw a list of nursing staff that showed that their nursing qualifications were being kept up-to-date, and records to show that they have also all received training on caring for people who have mental health needs. We checked the recruitment files of two newer staff, and found all documents to be in place and appropriate. These included Criminal Record Bureau (CRB) disclosures, two written references, identification details, application forms with employment histories, and documentation showing entitlement to work in the UK where needed. There were also records of interviewing these staff, and of equal opportunities monitoring. The start dates of these people showed that all this documentation including CRB disclosure was acquired beforehand, which is appropriate to make sure that residents are not put at risk. We saw records of the nationally-recognised Common Induction Standards being worked through for new staff. This included a reflective journal in one case, showing that the new carer was being encouraged to think through what they had been taught, a sign of good staff support. We also saw, for a worker who had only been in post a few days, that they had already completed the company’s courses on Customer Care, Manual Handling, Activity Work with Residents, and Fire Prevention. The manager explained that the activity course, in many ways a day’s shadowing of activity workers, ties in with the philosophy of care the home. It clearly shows that interaction with residents is valued at this home. The manager also said that all new staff work their first five days as supernumerary, to help support them into the work. Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People who use this service experience an excellent outcome in this area. This judgement has been made using available evidence including a visit to this service. The home is led by a knowledgeable and experienced manager. The ethos of the home is open and transparent. The views of residents, relatives and staff are listened to and valued. The home has efficient systems to ensure effective safeguarding and management of residents’ money and valuables. Staff receive effective support and supervision. The health and safety systems in the home generally protect people. EVIDENCE: The manager has many years’ experience of working in this field, having qualified as a general nurse and then a mental-health nurse over twenty years ago. She upholds her nursing qualification, and is continuing to work towards Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 26 the registered manager’s award. She has worked at the home almost since it opened thirteen years ago, and has been the registered manager since 2006. Discussions with the manager, and the paperwork supplied by her, confirm that she is very capable and focussed in the role, for instance showing elements of good care and management practice, and being able to answer all questions knowledgably. Feedback from people about the manager was positive, for instance from relatives that she is responsive to issues raised. A health professional also told us, “The manager has a strict attitude towards any inappropriate or disrespectful action from staff members.” We saw records to confirm these high standards of resident-focussed care, and it is evident that the home has made significant improvements in a number of areas. Relatives told us that there are 3-monthly meetings, for themselves and residents, to discuss with home management about all aspects of the home. We saw the minutes of one such meeting from earlier this year, which came across as both informative and supportive. We also viewed the minutes of the last Friends meeting, which showed that this organization continues to play an important role in the home. We were provided with a copy of the ‘customer satisfaction survey for relatives and friends’ dating from September 2007. It noted that seven people responded, and showed overall good levels of satisfaction whilst noting where improvements are needed. We were also told that a 2008 consultation process was about to start. Checks of how the service looks after residents’ money found continued good standards. Money is kept securely in the home. For a sample resident, their money was found to balance with the records kept in a ledger. Similarly, the ledger tallied with records of withdrawals from their bank account. Separate and individual bank account records are kept on the computer system, backed by copies of monthly records sent by the bank. We also found that there is a ‘slush’ fund that is used for when anyone’s money in the home temporarily runs out, so that they can still buy items pending further money of theirs becoming available. Finally, we were told that residents and their nominated representatives can view all these records on request. Staff generally fedback positively about the support they receive in the home. We checked the supervision records of one person and found that she received supervision both in July and August. The manager keeps a supervision grid of all staff, to check that supervision meetings take place frequently. The grid for 2008 was up-to-date. Samples of supervision records showed appropriate detail in terms of providing support and training. We also checked the minutes of the last carers’ and nurses’ meetings. They came across as clarifying standards of care appropriate such as in terms of Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 27 medication and health & safety, and providing support and information, with staff able to raise issues for discussion. We also viewed a sample of internal health and safety checks. These were upto-date for weekly checks of all fire points, the temperature of hot-water outlets, and the staff-call buzzers in the rooms of people considered capable of using them. These records included details of the occasional issue that needed remedial action, and that these were addressed. We checked the water temperature of the hot tap in one bedroom, and found water to come through at a safe temperature. The manager confirmed that all taps have temperature-control thermostats in place. We checked a sample of professional safety inspection documents. Everything was valid and up-to-date, including for gas safety, portable electrical appliances, fire extinguishers, mobile hoists, and the passenger lift. We found a detailed fire-safety risk assessment, undertaken by professional contractors, dating from 2007. We saw that the fire authority’s last visit to the home was three years ago. We also saw that the home has a detailed emergency plan that is available to view in the entrance hall. A record of the local environmental health department’s last visit, from February 2007, was on display in the main corridor. It rated the home as 4star from a possible 5, which is a strong rating. The kitchen was inspected on the first day of the inspection visit. A record of daily fridge and freezer temperatures had been kept until the end of the previous month. These were on the whole, satisfactory. The freezer temperatures had not been recorded since the beginning of the month. This was discussed with management who agreed to ensure that they are monitored and recorded. In addition, the freezer temperature for one of the freezers was not satisfactory on two recent occasions, as –10°C & -16°C is not sufficiently cold. The temperature of the freezer must be kept at least at -18°C. This is necessary to ensure that food is stored safely. This deficiency was brought to the attention of management who agreed to contact the maintenance department and arrange for it to be adjusted to the right temperature range. Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 28 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 3 X 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 2 3 X 3 3 3 3 3 STAFFING Standard No Score 27 4 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X 4 4 X 2 Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 17(1)(a) s3 pt2 Requirement Photos of consenting residents must be provided in the case records. This is to help ensure that residents can be easily identified by staff attending to them. The funding of hip protectors for residents must be reviewed with the placing authorities. This is to help ensure the health and welfare of residents. The ongoing refurbishment of the home, in terms of redecoration, reflooring, and refurnishing, must be duly completed, so as to minimise any disruptions for residents and enable them to have a better standard of living. The temperature of all freezers in must be monitored daily and maintained at -18°C or colder. This is necessary to ensure that food is stored safely. Timescale for action 15/09/08 2 OP8 12(1) 05/10/08 3 OP19 23(2)(b, d) 24/12/08 4 OP38 13(4)(c) 05/09/08 Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 30 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 OP19 Good Practice Recommendations Kitchenette floorings should be replaced, to help uphold hygiene standards. Woodland Hall DS0000063588.V369888.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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