Care Home: Woodland Vale

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What the care home does well Woodland Vale provides people with a purpose built, safe, well maintained and homely environment. The home is kept exceptionally clean and odour free and the domestic staff are commended for their efforts to maintain high standards. Care and support is delivered by a staff team who understand the needs of the people they care for, and comments from relatives include `I think they do an outstanding job. The home has good staff to client ratio, is pleasant and clean and staff are very helpful.` `They care for all equally and ensure that health and safety measures are paramount, whilst keeping a good atmosphere and happy residents.` `Everything is excellent in the home I can`t fault it.` They ensure inclusion, respect and people are treated as individuals.` The home provides an excellent range and choice of meals for people to enjoy and special diets are catered for. People have opportunities to be involved in a range of activities and staff work hard to ensure that activities are geared to meet the needs of people with dementia. The home is well run with good systems in place for ensuring that individuals views are listened to and acted upon. What has improved since the last inspection? The grounds have been improved to include a sensory garden and flower beds and tubs have been kept reported so that people have a pleasant visual garden and outdoor area to enjoy. Activities are being planned that include sensory stimulation such as mood lighting, relaxing music, and plans are in place to include sensory boards around the home that people can touch. What the care home could do better: Although we saw that the homes medications systems are robust and safe we have recommended that any hand written entries to medication records should be double signed. This helps to prevent against any errors. Plans of care could be further improved with including more details about how staff can ensure that preferred daily routines are honored. This helps staff to work in a consistent approach and in a person centered way. Key inspection report Care homes for older people Name: Address: Woodland Vale Woodland Vale Community Care Support Centre New Street Torrington Devon EX38 8DN     The quality rating for this care home is:   three star excellent 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: Joanne Walsh     Date: 0 3 1 2 2 0 0 9 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 25 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Woodland Vale Woodland Vale Community Care Support Centre New Street Torrington Devon EX38 8DN 01805622206 01805622713 thea.stach@devon.gov.uk http/www.devon.gov.uk Devon County Council care home 23 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) : 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: Date of last inspection Brief description of the care home Woodland Vale is a new purpose built home run by Devon County Council, which provides 24-hour care to older people, some of whom may have dementia. The home overlooks the River Torridge and is on the outskirts of Great Torrington. Outside there is a garden. There is level access into the main entrance of the home. There is ample car parking available. Internally, the home is on one level. It is divided into two separate units; each has its own lounge, dining area and conservatory. All bedrooms are ensuite with either a disabled access shower or assisted bath. All of the bedrooms are single. Three are large enough to accommodate couples or people wishing to Care Homes for Older People Page 4 of 25 Over 65 23 23 23 23 0 0 0 0 Brief description of the care home share. The current fees can be obtained from the home. Additional charges are made for hairdressing (dependent upon individual requirements), chiropody, toiletries and newspapers. Care Homes for Older People Page 5 of 25 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place during a week day in December and lasted approximately 6.5 hours. During this time we spoke to 3 people about their experiences of living at Woodland Vale. We spent time observing how care and support was being delivered to people, including the lunchtime period. We also spoke to five care staff, the manager and the cook. We looked at some of the key documents including plans of care, pre admission assessment information, staff recruitment and training files, records relating to medication and individuals monies. This helps us to understand how well the home is run and managed. The home had been notified that a review of the home was due and had been asked to complete and return an AQAA (Annual Quality Assurance Assessment). This shows us how the home has managed the quality of the service provided over the previous year. It also confirms the dates of maintenance of equipment and what policies and procedures are in place. Information from this document was used to write this report. Care Homes for Older People Page 6 of 25 During the inspection 4 people were case tracked. This involves looking at peoples individual plans of care, and speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. As part of the inspection process we try ask as many people as possible for their opinion on how the home is run. We sent questionnaires out to people living at the home; representatives, health and social care professionals (including GPs and care managers) and staff. At the time of writing the report, responses had been received from 9 people living at the home. We also received 3 surveys from social and health care professionals, and four from staff. Their comments and views have been included in this report and helped us to make a judgment about the service provided. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Care Homes for Older People Page 8 of 25 order line 0870 240 7535. Care Homes for Older People Page 9 of 25 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 10 of 25 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. Individuals needs are fully assessed prior to admission to enable the home to ensure they can meet all assessed needs. Evidence: We looked at the pre admission information for one of the newer people to the service and for a person who was having some respite care at the home. We saw that the home obtains the individuals care management shared assessment. This is the information gathered by professionals who are responsible for funding the placement. This gives the home the basic information from which to decide if they can meet an individuals needs. Where possible a senior member of the team will also complete a pre admission assessment to ensure that the home are aware of any preferred runtiness, likes and dislikes and what interests and possible diverse needs the individual may have. Care Homes for Older People Page 11 of 25 Evidence: We spoke with staff on duty who confirmed that the pre admission information is available to them and helps them to plan for the individuals care and support. None of the people we spoke to who live at the home could tell us if they had been involved in the pre admission assessment, however some of the surveys we sent had been completed by relatives on individuals behalf. These confirmed that they were involved in the admission process. Care Homes for Older People Page 12 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal and health care needs are very well met. Evidence: We looked at the plans of care for two people who had lived at the home for a while and two who were newer to the service. One individual was fully mobile but could present with some challenges in their behaviours and one person was less physically able and needed more complex physical care and support. The people we case tracked gave us a good picture of how the service meets the diverse needs of the people who live at the home. We saw that plans of care give staff a good picture of what the person can do for themselves, what they need support in and the home are now looking at including more detail about how staff should support people to honour their daily routines. This will ensure that care and support is delivered consistently and in a person centered way. Some plans have what the home call individual action plans, which are used to give Care Homes for Older People Page 13 of 25 Evidence: staff a better indication of a personalized morning and evening routines. We agreed that these should be expanded and rolled out to everyones plan. Daily records show that staff monitor and record individuals personal care, health and their emotional well being. The home have a weekly meeting with a member of the community nurse team. We sat in on this meeting and heard that staff highlight any health care concerns and improvements for each person they care for. The community nurse confirmed to us that the home have always been very good at alerting the nurse team to any potential health issues and appear vigilant in respect of ensuring that people do not develop pressure areas. We reviewed a survey back from a health care professional who said This is a well run unit with a great understanding of patients needs. All staff are informative and give us clear information. We also received 7 surveys back from people who live at the home. Most of these had been completed by family members on behalf of their relative at the home. These were extremely complimentary about the care and support and included comments such as I think they do an outstanding job. The home has s good staff to client ratio, is pleasant and clean and staff are very helpful. They care for all equally and ensure that health and safety measures are paramount, whilst keeping a good atmosphere and happy residents. Everything is excellent in the home I cant fault it. They ensure inclusion, respect and people are treated as individuals. We observed good practices throughout the day with staff ensuring that individuals were given a choice in drinks, snacks and in staff spending a few minutes with people to ensure they were comfortable, or needing a little reassurance. One person wanted to dance and staff did a waltz with them and said that they could do some more dancing later when the entertainer came in. The atmosphere of each unit was relaxed and calm. Staff were decorating the rooms for Christmas and chatting with people as they did this. We checked the storage and records relating to the administering of medications. The system of storage and recording appeared robust and meets the current requirements. We would however recommend that any hand written entires should be double signed to help prevent against errors occurring. Care Homes for Older People Page 14 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals social and diverse needs are well met Evidence: We saw that the home offers a variety of activities throughout the day, including group and one to one sessions. Some staff expressed concern that they were currently undergoing staff re-evaluations and they had lost their activities coordinator. The registered manager said that they were looking at ways that would ensure that activities are planned in each day and that they had recently purchased some sensory equipment, such as special relaxing lighting in one unit. They are also working on having tactile boards and visual displays for people to interact with. We saw that staff knew the people they care for well and they tried to keep them engaged at different times during the day. Staff have good skills at interacting with people, drawing them away from being challenging in their behaviours. We saw that staff spoke gently to someone who was distressed and danced with someone who wanted to get up and be active. One relative commented They try to keep people occupied with books games and chatting. Another said They keep people untested in their environment, this is the Care Homes for Older People Page 15 of 25 Evidence: best home. Relatives who completes surveys said that they were always made welcome and could visit at any time. We were told by staff that some people had visitors daily and some less frequently, but that everyone was welcome to stay for as long as they liked. Meal times are relaxed and a good choice and range is offered to people. We saw that the menus are planned around known likes and dislikes and people are offered alternatives and special diets are catered for. People who needed assistance with eating their meals were supported in a sensitive and respectful way. The staffing levels are a little low at times during meal times. We saw on one of the units that for an hour over the lunchtime period, there was only one staff member on duty. This meant that people were waiting for drinks and the staff member was very busy. We were told that on the other unit, there are at least four people who need assistance with eating and that although during the day of the inspection there was three staff available, that more often there is two. This would be very difficult for staff to ensure that people got the right level of support and assistance during meal times with only two staff available. We discussed this with the manager and said that we would recommend that staffing levels be reviewed at meal times to ensure people can be assisted safely and in good time. Care Homes for Older People Page 16 of 25 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. Individuals views are listened to and acted upon. Evidence: All 7 surveys we received back had ticked yes to the question is there someone you can speak to informally if you are not happy and also to the question do you know how to make a formal complaint? These had been completed by a relatives and we were unable to find out from speaking to people who live at the home whether they knew how to make a complaint. We did see however that the manager had detailed even small issues and concerns that individuals and relatives had voiced to staff. We saw that these issues had been taken seriously and had been responded to with an action as to what had been done to resolve any concerns raised. Most of these were minor, but showed that the staff and manager did listen to what people said. Staff we spoke to appeared to have a good understanding of what they should do if they suspected abuse and the training matrix showed that staff either have had or training is planned to help them understand safeguarding issues and be aware of potential abuse. Care Homes for Older People Page 17 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and provides people with a homely warm and clean environment to enjoy. Evidence: During this inspection we look at all communal areas and some of the individual bedrooms. We saw that the whole home is kept clean to a high standard and the staff are commended for their efforts in keeping the home clean and odour free. We saw that bedrooms are spacious, have en suite facilities and individuals are encouraged to personalize their own space. The lounge and dinning room areas are warm and homely and people appeared comfortable and relaxed in their environment. As the home is purpose built corridors are wide and spacious and the space has been divided into two units to allow smaller group living. The home have good policies and procedures in place for infection control and staff appeared to understand what this meant and were observed to follow good basic hygiene procedures. Care Homes for Older People Page 18 of 25 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. Staff are well trained and supported to do their jobs. Evidence: The staffing levels are sufficient for the number and needs of the current group of people that live at the home, although we have identified that in order to provide good support during lunchtime periods the staffing levels should be increased. We saw that in one unit for example for a period of an hour over lunchtime there was only one member of staff present. This meant that they were very busy and individuals did not always get attention and support when they requested it. People had to wait for drinks and two staff are needed. The other unit have more people who need assistance and they do require at least three staff members to enable them to do this safely and so that people can all eat together. Sometimes this unit only has two members of staff at lunch times, which is not sufficient. Staff told us that they were in a consultation period and staff levels and roles were being evaluated. They are concerned that numbers of care staff will decrease. We saw that the home have good recruitment processes in place. We checked three recruitment files and saw that all relevant checks and references are obtained before someone is offered a post. This ensures that only people who have be checked to be suitable to work with vulnerable people get offered jobs. Care Homes for Older People Page 19 of 25 Evidence: Staff we spoke to and those who returned surveys said that they had lots of opportunities for training and were given regular one to one support from their senior management team. Care Homes for Older People Page 20 of 25 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 home is well managed and run in the best interests of the people who live there Evidence: The manager is currently in the process of registered with CQC. She has been a registered manager for another service has has experience, knowledge and qualification to ensure that the home continues to be well managed. Staff that we spoke to said that they have some concerns about the consultation process and regrading of some roles. Their main concern is that they do not want to loose care staff numbers. They said that they understood that the new manager was not responsible for these changes and they said that they felt they could discuss any concerns they have with her. There are good systems in place for ensuring that individuals views are heard, including key worker one to one time, resident meetings and staff meetings. The manager showed us how she had been collating even small concerns expressed as Care Homes for Older People Page 21 of 25 Evidence: part of their complaints. Each concern had been actioned and dealt with appropriately. The AQAA also gives us information to show how the home ensures safe working practices via training and policies and procedures. We saw that all new staff have an induction programme that meets national standards. We checked the system in place for ensuring that any personal monies kept is safe and accountable, and found that a good audit trail is available and records well maintained. Care Homes for Older People Page 22 of 25 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 23 of 25 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 9 The home should ensure that any handwritten entires or alterations to medication records are always double signed to help prevent against errors. Care Homes for Older People Page 24 of 25 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. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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