Care Home: Woodland House Nursing Home

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What the care home does well The admission process followed at the home is very good, which means that people and their relatives have the information they need to decide whether Woodland House is the right home for them to move into. Staff perform in-depth pre-admission assessments to ensure they are able to meet the person`s needs, before they are admitted to the home. The health and personal care people receive is good and provided in a safe way. The improved care planning systems and documentation at the home are good, and mean that staff know how to care for somebody in a safe and consistent way, that meets their individual needs and preferences. Medication systems are well managed at the home. Staff at the home ensure people see healthcare professionals when they need to. Relatives tell us they are happy with the care of their relatives received at Woodland House. People have access to an improved activities programme and are able to maintain contact with their family and friends. People appreciate and enjoy the activities provided at the home, particularly the 1 to 1 sessions, and the small pets that visit the home. The food is very good at the home and any issues regarding dietary requirements, preferences or weight issues are effectively and sensitively managed. People who use the service and their relatives can be confident that if they complain their concerns will be listened to and acted on appropriately. Complaints are seen by staff at the home as a way of improving the care and services provided. Staff are aware of how to prevent and report any abuse, and who to report allegations. The use of equipment that can be perceived as restraint is done so only after careful consideration to show that the decision to use such equipment is in the best interest of the person. Recruitment, induction and training is good at the home and means that vulnerable adults are cared for by a stable group of staff who have had the necessary preemployment checks, and training in order to provide care in a safe and effective way. The staff group are popular with people who live at the home, and their relatives. People say the staff work very hard. The improved management structure at the home has had a positive impact on all aspects in the home. The home is a safe and clean place to live and work. Maintenance systems are very well managed and an improved level of decor and furnishings is provided at the home. What has improved since the last inspection? Despite only being eight months since the last inspection, there have been many improvements at Woodland house. The provider has appointed an individual to manage the care home. People living in the home, their relatives and staff appreciate the more stable management structure, and tell us that life in the home has improved and that there are now clearer lines of accountability and leadership at the home. Activities and entertainment at the home has also improved. the home now employ a designated activities coordinator, who has specific hours to provide both general and one to one activities, which are proving to be popular at the home. Attention has also been made to encourage reminiscence of times gone by at the home. A new reminiscence newspaper has been published, and wall displays provide triggers for people to remember things from the past. Mandatory training at the home has also been a major focus of the providers. All staff are up to date with moving and handling training which has included emphasis on ensuring the privacy and dignity of people is protected at all times, especially when being transferred in a hoist. The number of accidents, falls, and complaints have substantially reduced at the home. Many environmental changes have taken place since the last inspection, eight months ago. Specialist beds have been purchased as part of a rolling programme. This means that people receiving nursing care can be nursed in more appropriate beds. A quiet room has been introduced in the home for people to use when receiving visitors, or when a quiet space is needed. Many bedrooms have been redecorated, to include coordinated bedlinen and curtains and the purchase of new furniture. Many new staff have been employed at the home who are enjoying working at Woodland House. Staff morale has improved as has the standard of care. Care plans have continued to improve, and provide a person centred detailed record of care, which has been kept under review and well written. The expert by experience commented `The overall impression (when compared with a visit in August 2009) was that the residents of Woodland House have benefited greatly from the change of management and staff and now enjoy a more stable and peaceful environment and seem secure and contented in their surroundings.` What the care home could do better: The service must continue to use the systems they have introduced to maintain and improve the standards at the home. Attention could be made to improve the content of any future annual quality assurance documents sent to the Care Quality Commission. The planned programme to control odours in a small number of areas of the home should continue. References requested for new members of staff should be requested directly from the home and indicate who the reference is from. The programme of supervision should continue as planned. Key inspection report Care homes for older people Name: Address: Woodland House Nursing Home Middle Warberry Road Torquay Devon TQ1 1RN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Clare Medlock     Date: 0 8 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Woodland House Nursing Home Middle Warberry Road Torquay Devon TQ1 1RN 01803296809 01803380144 woodlandhousemanager@adlcare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Woodland Healthcare Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 30. The registered person may provide the following categorty of service: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia aged 65 years and over on admission - Code DE(E) Mental disorder aged 65 years and over on admission - Code MD(E) Old age, not falling within any other category - Code OP maximum number of places 3 Physical disability aged 65 years and over on admission Code PD(E) maximum number of places 3 Date of last inspection Care Homes for Older People Page 4 of 32 Over 65 30 30 3 3 0 0 0 0 Brief description of the care home Woodland House is a nursing home that provides personal and nursing care to up to 30 people who suffer from dementia type illnesses and/or physical disabilities. The majority people at the home are elderly with dementia type illnesses, sometimes these people have challenging behaviours associated with their illness. The home is located in the quiet suburb of Wellswood, which is approximately one mile from the town centre of Torquay. The home is a large period property with many large rooms. Eighteen 18 bedrooms are single rooms and six 6 shared rooms. Private accommodation is arranged between three floors that are accessible by two shaft lifts. The lower ground floor is a modern extension to the main home. There is a large lounge and a medium sized dining room on the ground floor. The Statement of Purpose can be found in the entrance hallway of the home along with the latest inspection report. Fees are dependant on care needs and range from approximately 504 pounds 574 pounds and do not include chiropody, hairdressing, personal toiletries, and clothing. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. Prior to this inspection we sent surveys to people who use the service (or their relatives if they were unable to complete the survey)-the findings of these surveys are incorporated into the report. We also sent surveys to staff who work at the home, these findings are also incorporated into the report. We inspected this service with an expert by experience. The Care Quality Commission (CQC) consider an expert by experience as a person who either has a shared experience of using services or understands how people in this service communicate. Prior to this inspection we requested and received (within timescales) a completed annual quality assurance assessment (AQAA). The AQAA is a self-assessment record Care Homes for Older People Page 6 of 32 that focuses on how well outcomes are being met for people who use the service. It also gives us some numerical information about the service. This document contained adequate information. The key inspection to the home was performed on Thursday 8th April 2010. Most of the people living at the home were living with advanced dementia so meaningful conversation was virtually impossible although we attempted to speak with fifteen people. Comments within the report are largely based on observation, speaking with four staff, the clinical lead, manager, and talking with three visitors. We case tracked three people who use the service. This means we looked in detail at the care these people receive. We spoke to staff about their care, we looked at records that related to them, and made observations if they were unable to speak to us or provide feedback. We looked at care plans, maintenance records, staff recruitment records, training records and policies and procedures. We also looked at the quality assurance programme performed at the home. We did this because we wanted to understand how well the recruitment, safeguarding and quality systems work and what this means to the people who use the service. All this information helps us to develop a picture of how the home is managed and what it is like to live at Woodland House nursing home. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? Despite only being eight months since the last inspection, there have been many Care Homes for Older People Page 8 of 32 improvements at Woodland house. The provider has appointed an individual to manage the care home. People living in the home, their relatives and staff appreciate the more stable management structure, and tell us that life in the home has improved and that there are now clearer lines of accountability and leadership at the home. Activities and entertainment at the home has also improved. the home now employ a designated activities coordinator, who has specific hours to provide both general and one to one activities, which are proving to be popular at the home. Attention has also been made to encourage reminiscence of times gone by at the home. A new reminiscence newspaper has been published, and wall displays provide triggers for people to remember things from the past. Mandatory training at the home has also been a major focus of the providers. All staff are up to date with moving and handling training which has included emphasis on ensuring the privacy and dignity of people is protected at all times, especially when being transferred in a hoist. The number of accidents, falls, and complaints have substantially reduced at the home. Many environmental changes have taken place since the last inspection, eight months ago. Specialist beds have been purchased as part of a rolling programme. This means that people receiving nursing care can be nursed in more appropriate beds. A quiet room has been introduced in the home for people to use when receiving visitors, or when a quiet space is needed. Many bedrooms have been redecorated, to include coordinated bedlinen and curtains and the purchase of new furniture. Many new staff have been employed at the home who are enjoying working at Woodland House. Staff morale has improved as has the standard of care. Care plans have continued to improve, and provide a person centred detailed record of care, which has been kept under review and well written. The expert by experience commented The overall impression (when compared with a visit in August 2009) was that the residents of Woodland House have benefited greatly from the change of management and staff and now enjoy a more stable and peaceful environment and seem secure and contented in their surroundings. What they could do better: The service must continue to use the systems they have introduced to maintain and improve the standards at the home. Attention could be made to improve the content of any future annual quality assurance documents sent to the Care Quality Commission. The planned programme to control odours in a small number of areas of the home should continue. References requested for new members of staff should be requested directly from the home and indicate who the reference is from. Care Homes for Older People Page 9 of 32 The programme of supervision should continue as planned. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission procedure is good and means that people and their relatives have enough information to decide whether the home is the right place for them to be. The pre-admission process is good which means staff have sufficient information to decide if they are able to meet the needs of the person. Evidence: The AQAA states that We provide an up-to-date comprehensive statement of purpose, which provides information regarding the service on offer. and We undertake a full assessment based on the activities of daily living, but also take into account the mental health specialty. These statements were supported at inspection where we noted that the up-to-date statement of purpose reflected the service provided at the home. The service also offer a photo guide for people to observe, which has been produced by staff and a relative in the home. Care Homes for Older People Page 12 of 32 Evidence: Each person has a full assessment performed before they are admitted to the home. One person had been admitted from another home within the same organisation, however, the manager continued to perform a new assessment on this person. This is seen as good practice. Information from healthcare professionals, social care professionals and relatives is also taken into consideration during this assessment. The admission is then agreed and preparations are made for the person to move into the home. Due to the complex mental health illnesses of people in the home, trial visits are not always appropriate. However, staff stated that if they were appropriate this would be facilitated. Each person is also provided with a contract of residency, when their trial period has finished. Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience 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 people receive is good. The improved care planning systems mean that people have their health needs identified and met in a safe and consistent way. The management of medicines is performed well at the home. Evidence: People we saw were dressed in clean and comfortable clothing and appeared well cared for with attention paid to personal hygiene. We saw examples where necessary clothing changes were encouraged in a sensitive way by staff. We saw women were encouraged to wear jewellery if they chose and were helped to chose colour coordinated clothing. Men were cleanly shaven and smartly presented, whilst reflecting personal characters. Staff successfully used distraction techniques when a patient showed signs of becoming agitated and appeared to engage meaningfully (albeit briefly) with people as they went about their tasks. Care Homes for Older People Page 14 of 32 Evidence: Staff surveys showed us that staff were proud of the level of care they provided. Comments included We give the clients good care, to the best of our ability. We get to know the clients, friends and family very well. Another member of staff wrote We are very good when caring for and preventing pressure sores. Our home rarely has any resident with a pressure saw as they are moved from one position regularly and when they sit, they are always on pressure cushions. People in the home have access to healthcare professionals from the community. Example seen included dietitian, general practitioner, chiropodist, NHS specialists, speech and language therapists, and mental capacity assessors. Each person has two care plans, one is a lifestyle diary which includes information about who the person is, what interests they have and their likes and dislikes. Staff use this information to plan what activities are appropriate for the person. The other care plan is more medical and socially based and contains: pre-admission assessments, risk assessments such as tissue viability, falls assessments weight loss assessments and nutritional screening tools. People are also assessed for moving and handling needs and dependency levels. Records are maintained of specific risk assessments for the person and assessments of health which may indicate referrals to healthcare services. Examples were seen where people had nutritional assessment is made, which indicated a need for referral to the dietitians and speech and language therapists. Records showed weight maintenance and weight increases in these cases. Photographs are used for monitoring pressure sores or skin to show the progress made. The home inform the Care Quality Commission whenever they admit a person with pressure sores and liaise with tissue viability nurses as appropriate. Care plans had improved since the last inspection and showed that care plans are used as working documents to communicate the healthcare needs of people. Each care plan was specifically written for the person, clear to follow and had been reviewed appropriately. Medication storage systems were appropriate, clean and secure. Policies and procedures regarding medication were in place and being followed by staff. Staff were administering medication appropriately and completed medication administration records correctly. The AQAA asked what the home could do better in regards to health and personal care. The AQAA read We could incorporate medication abuse within our Care Homes for Older People Page 15 of 32 Evidence: monthly review system. Relatives were grateful with the care provided at the home.Thank you letters sent from recently bereaved relatives read Words cannot express the gratitude we feel that everything you did for auntie Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The improvements in the activities programme and extra activity time provide people with meaningful stimulation and entertainment. the routines of daily living and activities are flexible and varied and people have access to a wholesome appealing balanced diet. Evidence: On arrival at the home, some people were still in bed, whilst others had been up for some time. Staff explained that staff worked around the routines of people and gave examples where some people rose early such as 5am whilst others were having a lie in until 10.30am. Staff were seen and heard to knock on bedroom doors and wait before entering and were sensitive when assisting people with personal care such as clothing changes, attending the bathroom and the use of hoists. At 10.30a.m. seven people were in the dining room taking breakfast at a leisurely pace. One person chose to remain in the dining room all morning. A couple of people were being given breakfast in the lounge whilst another had returned to her bedroom where she sat enjoying classical music on the radio until lunchtime. Care Homes for Older People Page 17 of 32 Evidence: An in-house activities organiser has been appointed for 22 hours per week but was on leave at the time of the visit. The AQAA stated The hours of the activities support worker has been under review and in place to allow for more attention and less diversion. A couple of outside professional activity people also visit with a variety of musical options and small animals to be held. According to the published monthly plan, mornings are dedicated to one to one activities with a selection of Balloon games, Puzzles, Drawing, Manicures and a Feel and Touch box etc. in the afternoons. A new activities board displays photographs of past activities, along with the activities programme for the months ahead. The AQAA stated our social program has improved despite the limitations of our clients. There is more focus on leisure and freedom of individuals. The activities focus on leisure and the therapies noted through best practice to impact on the level of dimension suffered by our clients. We have less incidents of aggression and more family support. We have developed our existing documents to include a project which focuses on well-being. Throughout the inspection staff spoke about a program called remember me which has been introduced by the organisation to improve the care of people with dementia. The only religious opportunities appeared to be listening to a Service on the radio on Sunday morning and watching Songs of Praise on the television on Sunday evening. The secure patio area has not yet been brought into use due to inclement weather. A visitor expressed the wish that her husband could be taken out into the garden for fresh air and change of surroundings, and explained he was very much an outdoor person when at home. At the time of writing this report, the manager telephoned us and happened to mention that many people in the home had been enjoying sitting out in the garden enjoying the recent sunshine. During the morning a carer spent a little time tossing a ball with a gent but most people were sleeping or resting with their eyes closed. The television was not on and the lounge was very peaceful. Visitors said they are always made to feel welcome by the Manager and staff. This was obvious throughout the inspection with the unannounced arrival of visitors. One person was encouraged to join their relative for lunch. Care Homes for Older People Page 18 of 32 Evidence: The cook advised that she procures fresh meat, vegetables and fish from trusted local sources with dry goods coming from a national wholesaler. She told us that she was satisfied with the quality of the available items. Lunch (from 12.30p.m.) consisted of a choice of either roast belly pork or sausages with broccoli, carrots and jacket potatoes or chips followed by a dessert of homemade egg custard with or without cream. A choice of hot drink was then available. The food was wholesome and served on varying sizes of dinner or soup plate to accommodate the manual dexterity of the person. Several people had pureed meals served on compartmentalised plates so the different colours, tastes and textures could be experienced. More than half of the people we saw needed some assistance and this was given by carers (or in one case a visiting relative) seated alongside engaging with the person. The teatime meal was to be soup, buffet and banana mousse. Some people remained in the lounge for lunch but the majority moved (with assistance) to the dining room. One person was eating a sandwich which staff said was offered as he was not eating his lunch.One person who had not been well took lunch in his bedroom. A visitor commented, Dad has not lost any weight and therefore must be eating enough. The cook advised that the Night staff have access to snacks for residents and the staff have the option of eating the same meals as the residents at a cost of £10 per month deducted from wages. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that complaints will be well managed at the home. Staff knowledge and training helps to protect people from abuse and documentation clearly shows why forms of restraint have been made. Evidence: The Care Quality Commission have not received any complaints regarding the home since the last inspection. The manager stated that the home had not received any complaints either. Staff surveys informed us that staff are aware of how to handle complaints. The statement of purpose and service user guide contained a complaints procedure, and relatives are encouraged to leave feedback and express concerns through the use of questionnaires. Care plans contained evidence that the mental capacity of people had been assessed and that some people had been designated an independent mental capacity assessor representative when necessary. During the inspection we did not see any evidence of any deprivation of liberties and saw two instances where people were being cared for in tilted chairs and bean bags. Records showed that the decision to use these pieces of equipment was in the best Care Homes for Older People Page 20 of 32 Evidence: interest of the person, and had been fully risk assessed and agreed with healthcare professionals and relatives where appropriate. Bed rails are used in the home following substantial risk assessments and relative/health care professional involvement. Staff spoken to knew what to do if they suspected allegations of abuse. The manager was aware of local reporting procedures, and contact details of the local safeguarding team, Care Quality Commission and police were displayed within the office area. The home have made one safeguaring adult alert and were authorised to investigate internally. Records showed that this process was managed appropriately. Systems were in place to ensure that people were not placed at risk of financial abuse. The manager explained that there is a policy that in the home not to handle personal money on behalf of people. She explained that any transactions for hairdressing or chiropody were invoiced to relatives or the person responsible for financial management of the person. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is a pleasant, clean, and safe place to live and work. Continuing plans will help reduce isolated odours. Evidence: The premises appeared well maintained both internally and externally. the home employ a permanent maintenance man who works on schedule and ad hoc repairs in the home. All the areas visited were very clean and tidy. Bathrooms and toilets were hygienically clean, and bedrooms were tidy and clean. Staff were especially proud of the tidy wardrobes and drawers which are the responsibility of designated housekeepers employed at the home. Laundry areas are well organised and contained the necessary equipment. Personal protective equipment was being used appropriately by staff and hand soap and towels were available in bathrooms and toilets areas. The AQAA contained information of service records regarding gas, electricity, lifts maintenance, moving and handling maintenance, and waste management. A recent environmental health inspection required: temperature records to be maintained on meat deliveries, temperature records to be maintained on fridges, a replacement thermometer to be introduced along with a new fan, maintenance of some equipment, and cleaning fly screens. Evidence was invited to show all of these requirements have Care Homes for Older People Page 22 of 32 Evidence: been met, with systems introduced to ensure cleaning programmes are ongoing. Since the last inspection, Gates have been installed by the front door, to enable people to enjoy the garden whilst being kept safe. A new quiet room has been introduced, where people can sit and listen to music, or receive their relatives in private. The garden has been cleared in areas, and a shed has been relocated to make one of the rooms appear lighter. The lounge has been redecorated with new stenciling, new curtains and cushions. New signs have been displayed to assist people find the dining areas and bathrooms. Attractive reminiscence displays have been introduced. The dining area had old advertising signs for food products, and the hall area had photographs of royalty. The bedrooms have been personalised to greater or lesser degrees depending on the wishes and illness of the person and in some cases, their relatives. Many rooms have been redecorated and re furbished with coordinated bed linen, new pictures and new furniture. The manager explained that this is an ongoing process. One survey read we are extremely pleased with the room change for her and the wonderful effort made for her -- this was for her and not a request from the family. A thank you card in the home read with grateful thanks for all your hard work with her new room. There were no malodours in the common areas. Staff were able to explain the reasons for some malodours in specific areas of the home and described ongoing action to minimise this when it occurred. Records were seen of monthly building audits performed for the organisation. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are cared for by staff who have had appropriate preemployment checks, induction and training performed. Continuing to monitor staffing levels would ensure people have their needs met. Evidence: Throughout the inspection staff were seen to be busy but with time to engage meaningfully (albeit briefly) with people as they went about their tasks. The carers gave the impression that they were happy in their work with many smiles, some quiet singing, and appropriate physical contact. Care was taken to ensure that there was always at least one carer on duty in the lounge. Staff we spoke with were new to the home and said they were enjoying working at Woodland House. One member of staff had made a major career change and was enjoying caring for people with dementia. Relatives who completed surveys on behalf of people in the home were grateful for the staff group. One person wrote The staff are always patient and caring and make us feel welcome when we visit. They never complained when we phoned the home on a daily basis. They seemed to be always trying to improve the care given and the home environment. Care Homes for Older People Page 24 of 32 Evidence: Although for many of the staff, English is not a first language they were all very fluent and no communication difficulties were witnessed during the visit. Staffing levels were stable. We were told that for the twenty people in the home, four carers, one registered nurse and an activities coordinator are generally on duty during the morning. During the afternoon and early evening there are three carers and one registered nurse, whilst at night there are two care staff and one registered nurse. Off duty records confirmed this. A couple of visitors expressed concern over the workload of the manager, clinical nurse manager and activity organiser saying, They seem to be always on the go without respite and, We know some of the staff are still trainees. Staff surveys indicated that there were usually or sometimes enough staff to meet the individual needs of people in the home. Comments included: I think an extra staff member in the afternoons would be of great help. There is a great deal of work to be done in the afternoons, an extra staff member would be beneficial between the times of one and seven. Another member of staff wrote: More staff would always be better, but we are always within the guidelines. If there was more time, staff could spend a little more time reading to the clients, writing in lifestyle diaries, so they could get to know the individuals better. The manager told us that staffing levels are continually kept under review and are being adjusted accordingly. Staff told us they had received clinical supervision and thought they were due again for more sessions. Records confirmed that supervision sessions were due. The AQAA stated the training files demonstrate our commitment to training and development. It also shows that 70 of the staff are qualified in some area of NVQ or above. Many staff at the home are new since the last inspection. We inspected three staff files which all contained photograph, application form, two written references, forms of identification, criminal records check and independent safeguarding authority checks. Staff files also contained intervew notes, induction record, medical declaration, contract and job description. One file however contained two references from people who had written generic references and one file contained a reference from friend rather than previous employer. However, the manager had obtained three references Care Homes for Older People Page 25 of 32 Evidence: in this case. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The clear lines of management have had a positive impact on all aspects in the home. Evidence: Safety appeared to be a priority at the home. On arrival we met the Manager and were given fire evacuation instructions and informed that they were not expecting a fire drill. First aid boxes were located in areas of the home, and records showed that to be incident and accidents have reduced in the home since the last inspection. We noted that staff training records had improved since the last inspection. Virtually all staff had received moving and handling training. We noted that the transfer hoist was used correctly with confidence and without distress being caused to the person. One person fell to the floor during the inspection and staff were seen to sensitively, but safely encourage the person to their feet after examination by the registered nurse. Staff training records and discussion with staff confirmed that the amount of Care Homes for Older People Page 27 of 32 Evidence: mandatory training in the home has increased since the last inspection. The staff were aware when they were due for updates. Training records showed gaps for three members of staff, but further discussion confirmed that these staff were no longer working at the home. Visitors commented on the positive changes since the appointment of the current manager saying, There are more staff than previously and they are better than the ones they replaced, Its all so much better and I am very happy with the changes. A longstanding staff member volunteered, Its so much better now we have a proper manager who knows her job and is fully trained and a visitor told us The manager and staff are much more approachable now. The new manager has been in post since the last inspection. She holds a professional nursing qualification (state enrolled nurse specialising in mental psychiatry). She has the Registered Managers Award (RMA) and an NVQ two in dementia care. She has worked within nursing home settings since 1989 and in a management capacity since 2005. She also has experience in a regional quality role for the organisation. An application to become registered with the Care Quality Commission has been submitted. The manager is supported by a clinical lead who manages the nursing and healthcare side of the home. She is also a registered nurse and popular with people in the home. Regular staff meetings are held where staff are able to provide feedback. Meetings are for both trained and care staff. The AQAA stated that the service continue to listen to the views of people who use the service, and states that this is done by Holding meetings with relatives or advocates in order to seek feedback regarding our services. We also instigate and hold regular individual care reviews with interested parties to allow for for used to be expressed. As a result of listening to people, the AQAA states that the following changes were prompted: More communication and dialogue with relatives was requested, and a more frequent and regular programme. The AQAA also stated that Better care plan auditing was needed to focus around to care reviews and relatives involvement. Regular provider visits are made to the home by representatives within the organisation. These can be other care home managers within the organisation, the Provider or independent consultants. On the morning of the inspection an independent consultant had been at the home performing an audit of the home. No major issues had been found. Care Homes for Older People Page 28 of 32 Evidence: Relatives and visitors at the home are encouraged to provide feedback. Feedback forms are located in the entrance hall, and the newsletter even offers a prize for people who make suggestions, comments or niggles. Care Homes for Older People Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 19 27 The planned programme to minimise and keep odours under control should continue. The manager should ensure that staffing numbers are constantly kept under review and change to ensure the needs of people continue to be met The manager should ensure references are requested specifically from the service and identify where they are from The manager should continue with the supervision programme 3 29 4 36 Care Homes for Older People Page 31 of 32 Helpline: 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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