Care Home: Woodland Park Nursing Home

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What the care home does well People who use the service and their relatives are given the information they need to decide whether Woodland Park nursing home is the right home to them to move into. The admission procedure is good and shows that staff make sure they can meet the person`s needs before they are admitted. People tell us that the admission process is made easier by the staff at the home. People receive a good standard of personal and nursing care, and communication with healthcare professionals in the community is very good. The care people receive is provided in a safe way and medicines are well-managed by the nursing staff. Staff at the home assure people see healthcare professionals when they need to. Care of the dying is also performed very well with relatives telling us `The personal care and attention we as a family unit received was fantastic. If my dad was to die anywhere other than home it was Woodland Park. The staff are all very professional, caring and attentive to all our needs`. The improved care planning system and documentation at home of good and mean that staff know how to care somebody in a safe and consistent way that meet their individual needs and preferences. People have access to activities and are able to maintain contact with their family and friends. People are supported to maintain their spiritual beliefs and where available people enjoy the activities provided by the home particularly the opportunities to chat and have 1:1 time with staff. People tell us that the food is good at the home. Any issues regarding dietary requirements, preferences or weight issues are 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. Complaints received are used by the home as a way all the home improving standards, and introducing new policies. Recruitment, induction and training is very god at the home and means that vulnerable adults are cared for by a stable group of staff who have had the necessary pre employment checks and training in order to provide care in a safe and effective way. The staff group are popular with people who live in the home who describe the staff as `marvellous` `very kind` and `wonderful`. Thank you cards described the care as `loving` and `devoted`. Woodland Park is a safe and clean place to live and work. Maintenance systems are very well managed and a good level of decor and furnishings is provided at the home. The manager and staff group have suitable qualifications and experience to care for people who require nursing and personal care. The home is well-managed by the manager and supporting team. What has improved since the last inspection? The nursing and personal care of people continues to be good at the home. This has been supported by an improvement in care plans which are now more legible, clear to follow and up to date. This means that communication between staff has improved. The new handover has also improved the morale in the home and the level of information provided for staff. Nutritional and weight management has improved with the home having accurate scales. The provider has also ensured staff have access to sufficient moving and handling equipment. Activities programmes at the home continue to improve with the introduction of a designated member of staff who is responsible for organising a programme and obtaining equipment. Communication with the home has improved with the introduction of the new manager. The new manager is proving to be popular with people, relatives and staff. The awareness, procedures and training in the protection of vulnerable adults, mental capacity act and deprivation of liberties has continued to improve since the last inspection. This means that staff have the knowledge to understand the different types of abuse, restraint and deprivation and know how to prevent or refer if cases are suspected. Maintenance routines and records have improved. In addition to this, the programme of routine maintenance and renewal of the fabric and decoration of the premises had continued since the last inspection. The outside of the home had been painted with the guttering replaced. Many internal communal areas had been refreshed by redecoration, some bedrooms had been refurnished and the garden area had been cleared to provide an attractive place for people to sit. The basement had been cleared to provide a workshop and the floor had been painted to provide cleanable floor areas for food storage. Recruitment is more robust at the home ensuring staff have all the pre employment checks performed before they are able to work with vulnerable people. What the care home could do better: Staff must now ensure the work practices are acceptable to people who live at the home. Staff must ensure the routines are not set and are not organised for the benefit of staff but take into account the wishes and feelings of people who use the service. Staff must also find out more information about the life history, cultural and social preferences of people in the home. This will mean that staff have more information to decide what activities the person may enjoy. This is important for people who are unable to voice their opinion. The activities programme should also be advertised in a way that all people know what is on offer and when this is provided. The manager and provided should also keep staffing levels constantly under review and should look at deployment of staff to reduce the occasions where morning coffee is missed. this will mean that people do not have a long gap between having a drink at breakfast and lunch. Drinks should also be offered and made available within the lounge area at other times. This will prevent dehydration during warm weather and promote well being. People should be offered a lockable facility for their personal items and should also be offered a door lock. A reason for not providing this facility should be recorded within the care plan. Bed rail risk assessments should be improved to include information to show who has been involved in the decision making process for using this form of restraint. This will show that staff have followed good practice guidelines in involving the multidisciplinary team where the person does not have the ability to make this decision for themselves. The storage of medicines and confidential care plans should be improved by ensuring staff remember to lock medicine cabinets and treatment doors when not in use. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Woodland Park Nursing Home Babbacombe Road Torquay Devon TQ1 3SJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Clare Medlock     Date: 1 5 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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 Park Nursing Home Babbacombe Road Torquay Devon TQ1 3SJ 01803313758 01803313046 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Woodland Healthcare Ltd care home 31 Number of places (if applicable): Under 65 Over 65 3 31 old age, not falling within any other category physical disability Additional conditions: Registered for max OP 3 Registered for max PD (E) 31 Registered for max PD 31 Date of last inspection Brief description of the care home 0 31 2 8 1 0 2 0 0 8 Woodland Park nursing home is an established nursing home in the Babbacombe area of Torquay. The home is located approximately 100 yards from Babbacombe Downs with far reaching views over the bay. There is a small shopping area just a short walking distance away. The original Edwardian building has been extended to enable it to accommodate up to 31 people. There are 19 single and 6 double rooms available, some with en suite facilities. The rooms are spread over three levels each being accessed by a centrally located shaft lift. Some rooms have sea views. A stair lift is also provided between the ground and mezzanine floor. The home has been further adapted to meet the needs of the physically disabled people it provides nursing care for. Meals are prepared in a kitchen located in the centre of the home. There are Care Homes for Older People Page 4 of 32 Brief description of the care home accessible bathing facilities on each level and a mobile hoist that can be moved between rooms. The home has car parking to the front and side of the building and a small walled garden area for people to sit in, weather permitting. A Registered Nurse manages the home and Registered Nurses are in charge of each shift, supported by a team of Health Care Assistants. The statements of purpose and service users guide are available in the reception area of the home and on request. The fee levels provided in June 2009 started at four hundred and sixty one pounds and rose to five hundred and one pounds. The actual fee is dependent on the care needs of the person and the room occupied. Additional charges are made for chiropody, hairdressing, newspapers and magazines that the person requests. A breakdown of the fees are recorded within the statement of purpose. 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 2 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 -the findings of these surveys are incorporated into the report. We inspected this service with an expert by experience. The Care quality commission 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. They visited the service and spoke with eight people and two visitors. This helps us get a picture of what it is like to live in or use the service. Care Homes for Older People Page 6 of 32 This key inspection included a visit to the home on Monday the 15th June 2009. During this time we spoke to the registered manager and briefly to the training manager and regional support manager. We spoke at length with nine people who live in the home, two visitors and to five members of staff. 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 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, four staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the recruitment and safeguarding systems work and what this means the people who use the service. During inspection we also watched interactions between staff and people living at the home. Prior to writing the report, the Provider showed us the completed annual quality assurance assessment for inspection (within timescales) prior to posting to the CQC. The AQAA is a self-assessment record that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about 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 Park nursing home. What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 32 The nursing and personal care of people continues to be good at the home. This has been supported by an improvement in care plans which are now more legible, clear to follow and up to date. This means that communication between staff has improved. The new handover has also improved the morale in the home and the level of information provided for staff. Nutritional and weight management has improved with the home having accurate scales. The provider has also ensured staff have access to sufficient moving and handling equipment. Activities programmes at the home continue to improve with the introduction of a designated member of staff who is responsible for organising a programme and obtaining equipment. Communication with the home has improved with the introduction of the new manager. The new manager is proving to be popular with people, relatives and staff. The awareness, procedures and training in the protection of vulnerable adults, mental capacity act and deprivation of liberties has continued to improve since the last inspection. This means that staff have the knowledge to understand the different types of abuse, restraint and deprivation and know how to prevent or refer if cases are suspected. Maintenance routines and records have improved. In addition to this, the programme of routine maintenance and renewal of the fabric and decoration of the premises had continued since the last inspection. The outside of the home had been painted with the guttering replaced. Many internal communal areas had been refreshed by redecoration, some bedrooms had been refurnished and the garden area had been cleared to provide an attractive place for people to sit. The basement had been cleared to provide a workshop and the floor had been painted to provide cleanable floor areas for food storage. Recruitment is more robust at the home ensuring staff have all the pre employment checks performed before they are able to work with vulnerable people. What they could do better: Staff must now ensure the work practices are acceptable to people who live at the home. Staff must ensure the routines are not set and are not organised for the benefit of staff but take into account the wishes and feelings of people who use the service. Staff must also find out more information about the life history, cultural and social preferences of people in the home. This will mean that staff have more information to decide what activities the person may enjoy. This is important for people who are unable to voice their opinion. The activities programme should also be advertised in a way that all people know what is on offer and when this is provided. The manager and provided should also keep staffing levels constantly under review and should look at deployment of staff to reduce the occasions where morning coffee is missed. this will mean that people do not have a long gap between having a drink at breakfast and lunch. Drinks should also be offered and made available within the Care Homes for Older People Page 9 of 32 lounge area at other times. This will prevent dehydration during warm weather and promote well being. People should be offered a lockable facility for their personal items and should also be offered a door lock. A reason for not providing this facility should be recorded within the care plan. Bed rail risk assessments should be improved to include information to show who has been involved in the decision making process for using this form of restraint. This will show that staff have followed good practice guidelines in involving the multidisciplinary team where the person does not have the ability to make this decision for themselves. The storage of medicines and confidential care plans should be improved by ensuring staff remember to lock medicine cabinets and treatment doors when not in use. 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 set out 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 information provided means that people have accurate information about Woodland Park, before they come to the home. The admission procedure is good and means that staff have enough information to decide whether they are able to meet the needs of the person. Evidence: People told us either themselves or their family and friends had an input into deciding whether Woodland Park was the right home for them to move into. One person said Someone else decided this was the best place for me-A friend came and looked around. In addition to this a relative contacted us before the inspection and said one of the senior staff had provided them with detailed and accurate information about the home and the services provided. This relative also told us the member of staff had welcomed them to visit the home whenever was convenient to them. Care Homes for Older People Page 12 of 32 Evidence: The statement of purpose and service user guide had been updated to reflect the changes at the home and the changes within CSCI/CQC. Each person is assessed by staff at the home before they move to the home. Information is obtained from both homes staff and social services and healthcare professionals. Pre admission assessments were well completed, detailed and then used to form the base of the care plan. Each person is now allocated a buddy nurse and several care staff who are responsible for liaising with the person and their family. The role of the buddies is to ensure records are kept up to date and the care reviewed. The home provide intermediate care for people who are needing extra care before going home from hospital and who need care to prevent hospital admission. The home also accept some emergency admissions if they consider they are able to meet that persons needs.The AQAA stated that the home has devised an intermediate care check list to ensure people who come an go quickly still have their needs met. Each person is provided with a contract from the home in addition to a contract from social services if relevant. These contracts contain the room to be occupied, fees charged and other responsibilities of both the home and person. The statement of purpose contains details of a breakdown of the fees charged and what is and is not included within the fee. 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 provided in a respectful way. The improved care planning systems at the home are good and mean people have their health needs identified and met in a safe and consistent way. The management of medicines is generally good and helps protect people from risk. However, individual staff should be reminded about storage and safety to minimise any risk. Evidence: People living at Woodland Park have access to a range of health care services both at the home and in the community. People have access to local and national NHS services and routine screening programmes. Each person has a GP who attends when staff request. GPs are also available for telephone consultations by staff. During the inspection people looked cared with the finer details such as eye care, nail Care Homes for Older People Page 14 of 32 Evidence: care and appropriate foot wear present. People told us they had seen an optician since being at the home. Visiting relatives all said they thought the standard of personal and nursing care was good at the home. One survey read We would not want him to be anywhere else, the care is faultless. People told us They look after me really well and The night staff are marvellous and a visitor said, This is a really nice home, everyone can have a laugh with the girls, it is clean as are the residents. One thank you letter read I just wanted to thank you for the truly excellent care and attention that you and your team gave to my dad during his stay with you. I was very impressed indeed with the way he was looked after, especially when the expected one weeks day turned into three weeks. Whenever he or I had any questions, full explanations were always given and any requests on his or my part were always met if possible. I know dad got on well with all the staff members, and we will have no hesitation in putting him in to Woodland Park whenever I need you to arrange respite care. Health care needs are communicated both verbally between staff and within care plans. Staff said the handover now involves walking around the home to pass on relevant information. Care is also monitored in well written care plans. Care Plans have greatly improved since the last inspection. Each person has a plan, which sets out his or her specific needs. Each plan contains assessments for such issues as falls, nutrition, moving and handling and more general risks. Risk assessments included Waterlow, nutrition, and falls. There is also a risk assessment completed when the use of bed guards (bed rails) has been considered. These assessments are generally reviewed each month or where a change occurs. The maintenance man also conducts weekly physical checks of bed rails and has a gauge to ensure the risk of entrapment is not present. Plans of care were clear to read and well written. They explain how care needs for each person will be met. All records were well written, there were no gaps and all records had been reviewed within the last month. When asked what the home does well one survey read The home think how they can improve the individuals quality of life. Specialist health care professionals are sought for advice and guidance. Progress of the person is recorded in notes made by the staff and also by health care professionals such as chiropodist, physiotherapist and GP. The home also have their own activities sheet to record activities that each person has been involved in and their response to the activity. The management of medications is generally performed well at the home, although on one occasion during the inspection the treatment room door and one medication Care Homes for Older People Page 15 of 32 Evidence: cupboard was left unlocked. Medications are stored in either locked trolleys or locked cupboards. The Registered Nurses are responsible for management of the medication from receipt to disposal. The medication trolleys were clean, tidy and securely stored. Fridge temperatures are recorded daily to ensure correct storage of medications. The records of administration were clear. To aid identification of the person to receive medication the records have photographs of each individual person living at the home who were in receipt of medication. Used medications for disposal are recorded and signed for on collection as per the company and government policy. People were encouraged to move freely around areas of the home if they are able to do so. Walking aids were present for those that required them. Grab rails, ramps, passenger lifts and stair lifts were present throughout the home and ramps were available to reduce risk. We saw staff transfer people from wheelchair to chair using a hoist. This was done safely and sensitively with staff giving explanation and reassurance to the person being transferred. Staff told us there was sufficient moving and handling equipment in the home and scales have now been accessed. People who use the service were treated with respect during the inspection. They were offered choice regarding meals and activities and addressed using their chosen term of address. People seemed to be comfortable at this home and were full of praise for the staff saying, Staff are wonderful, they treat me as if I was their mother, They are all nice, It suits me very well here, Everything you ask for they give you if they can Care of the dying is performed well at the home. Staff use the Liverpool Care Pathway where all health care professionals work together and record together the care that is planned and given to ensure care is continuous and effective. Thank you letters were displayed from grateful residents and their families. One letter read thank you for the sympathy card. We cannot praise highly enough the devoted skill and care afforded to him. We are vastly thankful he did not have to go back to hospital. Woodland Park proved to be a real home from home. Surveys read The personal care and attention we as a family unit received was fantastic. If my dad was to die anywhere other than home it was Woodland Park. The staff are all very professional, caring and attentive to all our needs. 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 routines of daily living not always provided in accordance with the wishes and feelings of people in the home. The satisfactory activities programme could be improved by ensuring staff have a detailed knowledge of the social and cultural histories of people in the home. Evidence: Although all the surveys we received informed us that there were activities to keep people occupied, people we spoke to on the day of inspection were mixed about the activities provided. One person told us that she prefers to stay in her room and one of the entertainers on a Thursday visits her and sings with her. Other people also spoke about the Thursday events but seemed unaware of any other activities. One person told us she particularly enjoyed having her nails painted by one of the staff, the visits from the animals and used to enjoy walking to the local shops until she became more unsteady. Photographs were on display of some of the activities that had occurred since the last inspection. The AQAA stated that staff have produced a newsletter welcoming newcomers to the home. Care Homes for Older People Page 17 of 32 Evidence: Staff told us that one of the care staff had recently had part of her time allocated to activities and is available to spend time with people on a one to one basis or take them out to the surrounding area or nearby shops. An activities agenda was in the process of being introduced but people we spoke with were unclear of this. The comfortable lounge was peaceful as the television was not on. Three people were reading library books. One person said the county library visited the home approximately once a month to exchange the books at the home. We were told that the manager has come to an arrangement with the local Council to improve and make use of an adjacent and previously neglected public garden and is now fund raising to pay for an access ramp. We were told a Cream Tea open to all, with staff and residents dressed in 1940s attire is planned to do this. Some residents were aware of this new facility but others said they were not. The interactions between staff and people in the home were generally very positive. Only two examples of slight poor interaction but noted and these specific incidents were fed back to the manager and regional training manager on the day of inspection. Interactions seen were positive, affectionate and very professional. The staff were seen to display a genuine caring attitude with suitable laughter and light banter. Staff providing care behind closed doors were heard to continue with positive interactions speaking to people in a respectful way and providing orientation information on the day of week, weather and current news stories. Staff at the home were seen to encourage the involvement of people in daily activities at the home. An example included one of the residents serving biscuits with a morning coffee round and acting as messenger for other people. Staff were seen and heard to knock on bedrooms doors and wait before entering. No evidence was seen of personal care being given with doors open. The staff we spoke with were very knowledgeable about the physical and health needs of people in the home but were less knowledgeable about the life history of the person and what social history was relevant to them. Care plans and life stories were incomplete in relation to the marital status of some people at the home and staff knowledge of previous occupation was not always accurate. Staff informed us that obtaining a religious minister to visit the home had been difficult but a local church had agreed to visit the home. One person said she is taken to her nearby Church each Sunday morning and that some people visit on an irregular basis from the local Baptist Church. Care Homes for Older People Page 18 of 32 Evidence: People told us the staff were very kind and wonderful. Thank you cards described the care as loving and devoted. People told us they appreciated the care that given. One person said they really appreciated that staff do not take over and allow me to be as independent as I can. However, some people told us the routines were not always of their choosing. Several people told us they were woken up by staff earlier in the morning (e.g. 5.30am, 6am or 6.30am) than they would have chosen themselves. One person told us bed times depends which night staff is on duty, if I go to bed too early I do not sleep. All people we spoke with were complimentary about the food one saying, it has improved with the arrival of the new manager and new chef. Several people told us that the chef had visited them recently seeking details of their food likes and dislikes promising to see what I can do. One visitor told us that her relative had requested kippers for breakfast and was told that this should be possible and several others had made the same request. Another visitor told us that their relative had put on weight since admission and was eating and enjoying different food than they had in the past. One person described the food as Pleasant homely meals. On the day of the inspection the main meal was a choice between toad in the hole with gravy, mash potato and cabbage or pasta bake with cabbage. The plated food was freshly cooked, hot and looked appetising. Alternatives were available to order and one resident enjoyed an omelette with mash and cabbage. For dessert the choice was apple sponge and custard or ice cream with or without chocolate sauce. Jugs of orange juice were on tables laid with tablecloths and linen napkins. Five people were served lunch at the two round tables in the light and airy dining room with eight covers. About nine people chose to eat in the lounge where they were given trays and paper napkins. One person was seen to need assistance; this was provided in a sensitive unhurried manner. People were not all complimentary about drinks available at the home. One person said my only gripe is that we dont always have a drink to hand in the lounge and its a long time from 7 AM until lunch, especially when occasionally staff have forgotten coffee rounds when they are busy. On the day of inspection person who uses the service was seen to prompt staff serving morning drinks. 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. The improved processes, training, and staff knowledge followed at the home helps to protect people from abuse. However, minor improvements to some documents would show how some decisions about restraint issues have been made. Evidence: Everyone we spoke with said they felt safe living at home. People told us the staff were very kind and very caring. Several people told us the staff felt more like family rather than carers. Since the last inspection the manager has compiled an abuse folder with information leaflets, contact details and details of local guidance. All staff knew how to correctly report any allegations of abuse including how to do this externally. The staff recruitment process helps to protect people by ensuring that criminal records bureau checks (police checks) and protection of vulnerable adults checks are performed on more staff. Where staff have declared a minor criminal record records are kept to show how the decision has been made to continue with the employment of that person, and what action is taken to protect the vulnerable people within the home. This risk assessment process is seen as good practice. Care Homes for Older People Page 20 of 32 Evidence: Staff had received training on protection of vulnerable adults. The manager had also attended training on the deprivation of liberties and mental capacity act. The regional training manager informed us that training had been provided on the deprivation of liberties and this information will be cascaded to staff. The notice board within the office contained relevant information for staff access. During our inspection we found no examples were people were having their liberties deprived. During the inspection we saw no examples of people being restrained. Some people were being cared for in bed using bed rails. In these cases people had been assessed that the suitability of bed rails and a full risk assessment had been performed to ensure the safety of this equipment. The maintenance man also conducts weekly physical checks of bed rails and has a gauge to ensure the risk of entrapment is not present. Although risk assessments were detailed, they did not show evidence of who had been involved in making the decision to use bed rails. The complaints process is clearly displayed within the home, on notice boards and within statement of purpose. The manager has compiled a complaints register to show how any complaints are managed and actions. The manager had treated the three minor issues as complaints. These issues were recorded to show that they had been acted upon promptly and appropriately. People told us they knew how to complain. One person said they would speak with the manager in the first instance if they needed to complain. Surveys confirmed that people in the home and their relatives knew who to speak with if they were unhappy. The care quality commission has received no complaints regarding Woodlands Park since the last inspection. People told us that staff do not handle their financial affairs. One person told us this is done by solicitor and friend. 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. Providing lockable facilities would allow people to feel secure about their personal items. Evidence: A tour of the home showed that the environment was a safe and well maintained place to live and work. The programme of routine maintenance and renewal of the fabric and decoration of the premises had continued since the last inspection. The outside of the home had been painted with the guttering replaced. Many internal communal areas had been refreshed by redecoration, some bedrooms had been refurnished and the garden area had been cleared to provide an attractive place for people to sit. The basement had been cleared to provide a workshop and the floor had been painted to provide cleanable floor areas for food storage. The AQAA stated new carpet has been fitted and a new TV and adjustable beds have been provided. In addition to the the AQAA also stated that the nurse call system. All areas of the home were clean tidy and free from obvious risks. Furnishings throughout the home were of a good standard. All bedrooms visited were clean, tidy and contained varying amounts of personal memorabilia and furniture. Care Homes for Older People Page 22 of 32 Evidence: The home employ a maintenance man on a part time basis. Apart from ad hoc day to day repairs, routine safety checks are performed. Examples of checks performed included water temperature records, fire safety checks, emergency lighting, call bell systems, wheelchair checks and bed rail risk assessments. All records kept by the maintenance man were meticulous and should be commended. One person told us that although they felt safe living at the home also said A while ago another resident came into my room uninvited on three occasions, I think that he was unwell. They pointed out that their bedroom door did not have a lock nor did they have a lockable place to put any valuables. On feeding this issue back to the manager a lockable drawer was immediately sourced and reassurances given that the new bedroom furniture would be fitted with locks. Discussion was held with the manager about the need to ask people if they would like to be able to lock their bedroom door and the need for risk assessment in this situation. Discussions were held regarding the bathroom that is out use at present. The manager told us that she had obtained three quotes and had been given authorisation to continue to change the used bathroom into a wet room. Laundry facilities were well organised and contained equipment suitable for washing items of foul laundry. Sheets, duvet covers, towels and flannels are sent to an outside contractor for cleaning. Personal items are washed in the home. One person told us they were satisfied with the laundry service and often receive items the same day. A recent quality assurance survey performed by the home showed that people thought the laundry was satisfactory. The manager confirmed she was considering ways to find why this was just satisfactory rather than good. Gloves, aprons and hand washing facilities were located throughout the home. The majority of staff had received infection control training. Remaining staff were booked to attend the next session. Examples of good practice were seen. These included disinfecting hand gels, dissolvable linen bags and use of appropriate protective clothing. 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. The staff group are popular with people in the home. The robust recruitment, induction and training programmes mean that people are cared for by staff who are suitable to work with vulnerable adults and up to date with their skills and knowledge. Monitoring staffing levels will continue to show that people have their needs met. Evidence: Everyone we spoke with were very complimentary about the staff at the home. Comments we received included They are all nice, The night staff are marvellous and everyone can have a laugh with the girls. People told us that there were not enough staff, with comments such as Staff dont have time for their breaks, They are overworked, its not fair on them, They have too much on their hands and They work their hands to the bone. One person commented, At night there are only two staff on and they have too much work. Staff spoken to said they felt there were enough staff on duty unless staff went off sick but then support is provided by the existing team. The manager confirmed staffing numbers depended upon the numbers of people in the home at any time. The AQAA stated that the general stability of the home has improved thereby Care Homes for Older People Page 24 of 32 Evidence: providing more security for clients. The workforce has stabilised to a nil staff turnover, thus relieving staff who are familiar with client needs and the risk of errors lower. People told us call bell response times were good within five minutes usually and call bells are answered quickly unless they are very busy. People said they had their medications given to them on time and meals were always served on time, with the exception of morning coffee which had been forgotten occasionally. The AQAA stated that the home has improved the recruitment procedures to tighten up the pre employment checks, thereby protecting our clients. This was evident at the inspection. Recruitment processes were consistent at the home. Each person completes and application form with the necessary information such as next of kin and employment history. Staff undergo criminal records bureau checks (police checks) and protection of vulnerable adults checks before employment. Where staff have declared a minor criminal record records are kept to show how the decision has been made to continue with the employment of that person, and what action is taken to protect the vulnerable people within the home. This risk assessment process is seen as good practice. The AQAA stated that the manager is looking at ways to involve people who use the service in the interview process of new staff. Two written references are obtained and proof of identity checked by looking at birth certificate, passport, driving licence and utility bills. Health checks are performed and equal opportunity checks are performed to show the process is fair to all. Staff have an induction to ensure they are provided with the relevant information. Staff are provided with a uniform and copy of the contract of employment. Staff told us the organisational training manager provides mandatory training on a rolling programme and reminders are given to attend this. Staff are also supported to do NVQ training and extra training sessions. Care Homes for Older People Page 25 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 new manager has made a positive impact on standards at the home. Evidence: Everyone spoken with said they liked the new manager commenting, She is a case, You can have a laugh with her, I get on with the manager exceptionally well, She is very good at her job, and I get on well with her. People who prefer to remain in their bedrooms said they see the manager 3 or 4 times a day. We were told that the current manager invited relatives to a briefing to introduce herself when she started at the home. We were also told that a Relatives meeting and social event with cheese and wine had been booked later in June. Staff were also complimentary about the manager saying She knows her stuff and she is supportive whilst making sure we do our jobs to a good standard. Staff said Care Homes for Older People Page 26 of 32 Evidence: they found the regular staff meetings useful but new ideas and advice could be requested at any time on an informal basis. Staff said they now receive regular supervision sessions and find these useful and informative. Staff said morale was good at the home with the staff working as a real team for the first time in a long time. One member of staff said she thought this was because of the new manager. The new manager has now been in post for approximately one year and is awaiting a medical report before submitting the application to become registered manager with the CQC (Care Quality Commission). Communication between the CQC and manager has been good and notifications being sent promptly. The AQAA had been completed by the manager but had not been processed by CQC at the time of writing this report. Health and safety is taken seriously by the manager and maintenance man at the home. This was the first time the inspector and expert by experience had been offered and given fire evacuation instructions upon arrival at the home. Accidents are recorded well with any incidents being reviewed by the manager before filing in the persons notes. The home is well maintained. Meticulous records are kept showing what safety checks are performed by the maintenance man. Examples of checks performed included water temperature records, fire safety checks, emergency lighting, call bell systems, wheelchair checks and bed rail risk assessments. All records kept by the maintenance man were meticulous and should be commended. Outside contractors are used for larger system checks. Records were provided for lift servicing, moving and handling equipment, fire safety, gas safety and electrical safety checks. Waste is managed by an outside contractor. Valid insurance certificates were seen and were not due to expire until September 2009. With the exception of one member of staff all care staff said they had received training in moving and handling, health and safety, infection control, fire safety and first aid. Staff told us the organisation has a training manager who visits the home on a rolling programme to renew training. The member of staff who had not received training had been booked on the upcoming training sessions. Staff files showed certificates for mandatory training are stored with an overview training matrix to highlight who is due for training. Care Homes for Older People Page 27 of 32 Evidence: Quality assurance surveys have been performed since the last inspection. The manager told us the response had been good but the quality of information received could be improved next time. The results for the environment, catering, housekeeping, care, and staff were all good. The laundry came out as satisfactory. The manager said she was looking into how she could find why this result was only satisfactory and was considering asking people and their relatives at the forthcoming cheese and wine evening. A detailed annual diagnostic business plan has also been performed. This document looks at information produced in the Regulation 26 visits, business plan, improvement pan sent following the last inspection and information on budgets. Care Homes for Older People Page 28 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 29 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 1 12 12 The Manager must ensure routines are not task orientated or routine based. This will ensure people have choice and control over their lives and routines of daily living 13/01/2010 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 9 12 Staff should be reminded to keep the treatment door locked at all times when not in use. Systems should be introduced to ensure staff are aware of the social, cultural, and leisure history of people to ensure activities offered meet those peoples needs and preferences. The manager should raise the profile of activities to ensure people are aware of what is on offer Systems should be in place to ensure people do not miss a morning drink because of lack of staff and 3 4 12 15 Care Homes for Older People Page 30 of 32 drinks should be available for people to access in the communal lounge. 5 18 Evidence should be provided to show who had been involved in the decision making process when using bed rails. The manager should ensure people have access to a lockable space for their valuables and should have an opportunity to have a lock on their bedroom door. Reasons for not providing this should be recorded in the care plans. 6 24 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or 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. 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