Care Home: Woodlands

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What the care home does well People thinking of moving into the home were given written information and were encouraged to visit, which would help them to decide whether Woodlands was the right place for them. The manager carried out an assessment prior to admitting anyone to the home. This helped to make sure that the person`s needs were understood and could be met by the services and facilities available at Woodlands. The residents we spoke to were satisfied with the care and support they received. One told us they were particularly happy that staff looked after their medication so that they did not have to worry about it. Another said staff looked after them very well, especially if they felt unwell. We found that staff helped people to manage their health care needs. There were prompt referrals to other professionals, such as the GP and district nurse. A member of staff had been nominated as a falls co-ordinator and records showed that the number of falls had recently reduced. Residents made very positive comments about the staff team. They said they were kind, respectful and very willing to help. One person told us, "They never mind coming to help, even in the night." People we spoke to said they were happy with the daily routines in the home. One said, "There are not too many rules." There was a good range of group activities for people to join if they wanted. A resident told us, "There is always something going on; plenty to do." One person who did not join groups said, "They come in and talk to me about things long ago." Residents were provided with a varied diet with a choice at each meal. Everyone we asked made positive comments about the food including, "There`s plenty of food and drink, you can have what you like," and "The food`s marvellous, I have no hesitation in saying that." There was a clear complaints procedure that explained who residents could speak to if they were unhappy. The records showed that all complaints were taken seriously and investigated. The procedures to safeguard residents from harm and abuse were clear, and staff had received appropriate training. This helped to ensure that staff had the skills to recognise and respond to any reports of abuse. New staff had thorough background checks before they started work at the home, which helped to protect residents. They had induction training to ensure that they had the basic skills to understand and meet the needs of the people at the home. Staff told us that opportunities for ongoing training were very good and there was an ongoing staff training programme. This helped to ensure that care was being provided by a well trained and competent staff team. What has improved since the last inspection? After the last inspection we made two requirements and a recommendation to improve the environment. We told the service that they must increase the amount of lounge space on Heather unit. The unit was extended last year to give residents a choice of seating areas and increase their comfort. A member of staff told us that the extension had made a big difference to people on Heather Unit. We also required that the service drew up a firm plan to replace the old, metal windows around the building. All the bedrooms had new windows and there was a plan to replace the remainder in the future. Other improvements to the environment included a new staff call system, which helped staff to monitor people who were at risk of falls. A resident told us that it was much better than the old system because they could speak directly to staff when they pulled the cord instead of having to wait for staff to come to them. Several bedrooms and communal areas had also been redecorated and had new furnishings. There had been several changes of manager since our previous inspection and the home had been without a permanent manager for a number of months, until the appointment of the new manager approximately two months ago. The new manager demonstrated enthusiasm and commitment to improving standards in the home to their previous level. We heard positive comments about the leadership skills of the new manager. What the care home could do better: The standard of care plans and associated records had slipped since our last inspection. There were gaps in care plans, which meant that staff did not have clear directions about the support residents needed. Assessments to monitor risks to residents` health and safety were not kept up to date and plans to control risks were not always sufficient. The new manager had identified most of these shortfalls and was taking steps to address them. There were also some shortfalls in medication records, which meant that we could not be sure that residents were having prescribed creams applied. We found a few other areas of concern during our visit, which were discussed with the manager. We have made recommendations to; carry out risk assessments with regard to the lack of restricted opening on some of the ground floor windows on Heather Unit. Bring the staff training records up to date and address any shortfalls to ensure that all staff have attended mandatory training in health and safety topics. We have also recommended that the records relating to residents` money are improved to show that staff carry out regular checks to safeguard residents. Key inspection report Care homes for older people Name: Address: Woodlands Woodlands Grimston Road Kings Lynn Norfolk PE30 3HH     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: Jane Craig     Date: 0 4 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 31 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 31 Information about the care home Name of care home: Address: Woodlands Woodlands Grimston Road Kings Lynn Norfolk PE30 3HH 01553672076 01553670744 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.norfolk.gov.uk Norfolk County CouncilCommunity Care care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: That Norfolk County Council underatkes a review of the windows with a view to replacement of those which are causing discomfort or present a risk to the Service Users. This review to be completed by end of March 2004. The home can accommodate up to 13 Service Users who are elderly and have dementia. The home can accommodate up to 27 Service Users who are Older People not falling in any other category. The home is to accommodate up to 40 Older People. Date of last inspection Brief description of the care home The home, first built in 1963 and extended since then, is a two-storey care home on the outskirts of Kings Lynn. There is a passenger lift and a stair lift. The home has a Care Homes for Older People Page 4 of 31 Over 65 0 27 13 0 Brief description of the care home ramp to the front entrance, which provides good access for wheelchair users. There are large grounds to the front and the rear and there is a secure garden area for service users from Heather Unit. All of the 40 bedrooms are used for single occupancy only and there are communal areas, including dining areas and lounges, throughout the home. Information about the home, including the last inspection report and the current fees, is available from the manager. Care Homes for Older People Page 5 of 31 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 last key inspection on this service was completed on 23rd January 2007. This key (main) inspection includes information gathered since the last inspection and an unannounced visit to the home. The visit was carried out on 4th December 2009 by one regulatory inspector. We met with a number of people who use the service and where possible asked about their views of Woodlands. We spent time observing daily routines in the home and how staff interacted with residents. Three residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. We talked to the acting manager, visitors to the home and members of the staff team. We looked around the home and viewed a number of documents and records. Care Homes for Older People Page 6 of 31 As part of the key inspection, surveys were sent out to a random selection of people living and working at Woodlands but none had been received at the time of writing this report. The report also includes information from the annual quality assurance assessment (AQAA), which is a self-assessment report that the manager has to fill in and send to the Commission every year. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? After the last inspection we made two requirements and a recommendation to improve the environment. We told the service that they must increase the amount of lounge space on Heather unit. The unit was extended last year to give residents a choice of seating areas and increase their comfort. A member of staff told us that the extension had made a big difference to people on Heather Unit. We also required that the service drew up a firm plan to replace the old, metal windows around the building. All the bedrooms had new windows and there was a plan to replace the remainder in the future. Other improvements to the environment included a new staff call system, which Care Homes for Older People Page 8 of 31 helped staff to monitor people who were at risk of falls. A resident told us that it was much better than the old system because they could speak directly to staff when they pulled the cord instead of having to wait for staff to come to them. Several bedrooms and communal areas had also been redecorated and had new furnishings. There had been several changes of manager since our previous inspection and the home had been without a permanent manager for a number of months, until the appointment of the new manager approximately two months ago. The new manager demonstrated enthusiasm and commitment to improving standards in the home to their previous level. We heard positive comments about the leadership skills of the new manager. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 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 process ensures peoples needs are understood before they are offered a place at the home. Evidence: Information given to people thinking of moving into the home was not completely up to date. The manager told us that the statement of purpose and service users guide were being revised to make the documents more relevant to the service. New residents were provided with an information pack on admission, this included various leaflets published by Norfolk County Council about issues affecting people in receipt of care. People thinking of moving into the home were encouraged to visit in order to assist them to make a choice and new residents were admitted for a trial period to allow them time to reflect on their decision. The AQAA told us that anyone who moves into the home receives a copy of the service agreement with Norfolk County Council, which Care Homes for Older People Page 11 of 31 Evidence: advises them about funding arrangements. People were assessed by social care professionals before being referred to the home. The manager also carried out a pre-admission assessment to ensure that the services and facilities provided at Woodlands could appropriately meet the persons needs. The assessments we saw identified the persons daily living, physical and mental health needs. However, there was little information about their abilities, preferences and usual routines. This could result in staff having difficulty in drawing up person centred care plans, especially if the person was not able to discuss this information with staff. Each assessment contained an outcome statement that the persons needs could be met at Woodlands and told staff of any special arrangements or equipment that needed to be obtained before the person came in. The AQAA told us that the manager is planning to improve the admission process by identifying a key worker for the new resident and including them in the pre-admission visit. The key worker would be on duty when the new person arrived, ensuring that they would always see a familiar face and have someone to help them to settle in. Care Homes for Older People Page 12 of 31 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. Despite some shortfalls in care records, residents current health and personal care needs were met. Evidence: Plans to assist residents to meet their personal care needs generally described how the person preferred to be supported and included directions to promote their independence and personal choice. We saw examples of care plans to support people with needs associated with dementia. These were also person centred and gave staff good directions. Three of the staff were trained in dementia care mapping. There was some mapping planned in the near future to assist staff to identify triggers for complex behaviour and also to help to identify whether changes were needed to care plans. In addition to their main care plans, each resident had a summarised action plan to tell staff, at a glance, whether the resident needed assistance with particular tasks of daily living. These were particularly helpful for new or temporary staff. The action plans were kept up to date but the corresponding care plans, which gave staff more Care Homes for Older People Page 13 of 31 Evidence: detailed directions about the care they needed to provide, were not always current. This could be confusing for staff and prevent them supporting people in a consistent way. There were shortfalls in some of the other care records we looked at. There were no plans for end of life care for a resident whose general health was deteriorating significantly. No-one had a risk assessment relating to pressure sores, despite a preadmission assessment for one of the residents stating that one should be done on admission. A resident who was receiving treatment from the district nurses for a pressure sore did not have a care plan relating to skin integrity. Despite the lack of plans, staff were assisting the person to change position in bed and this was being recorded. One resident had bedrails in place. They were an integral part of the bed but there was no initial assessment to show that bedrails were safe for this particular resident. There was no record to show that the mattress had been checked to ensure that it was appropriate for the type of bed and rails. There were detailed assessments and plans for manual handling and we observed staff using the appropriate equipment to transfer residents. However, the corresponding care plans were not always updated. Two out of the three people we case tracked had nutritional assessments, which had been reviewed. Falls risk assessments did not identify the particular factors that contributed to the risk. This meant that the plan to control the risk did not focus on the reasons why the resident may be falling. The manager told us that there were plans to review the assessments. There were some good practice issues with regard to the prevention of falls. The service worked closely with the local falls team. A senior member of staff had been nominated to collect and interpret information with regard to falls and there was the scope to refer individual residents to the falls team for advice. The records we looked at showed that the number of falls had dropped over recent months. Assistive technology was being put into place. Bed sensors were being introduced. These would alert staff if residents, who were at risk of falls, were getting up in the night. High risk residents, who chose to continue to move around without staff help, were to be given falls sensors to alert staff if they should fall. Everyone would have an individual call pendent linked to the staff call system. Some of the staff we spoke to were aware that the care records were not all up to date. One told us that they had struggled a bit with keeping documents up to date through recent staff shortages and one told us that plans had, lapsed a bit. Records confirmed that care plans had not been reviewed consistently. Another member of Care Homes for Older People Page 14 of 31 Evidence: staff told us that even if information was not in the care plan that they discussed everyones care during the handover at each shift change. The manager had already identified that the care records needed to be improved and had taken steps to address this. She had nominated a senior member of staff to take the lead in this and had arranged for staff to have supernumerary time to do the work. Despite some shortfalls in care records, residents told us they received the care and support they needed. They were referred to health professionals whenever necessary and staff ensured that advice and treatment was carried out. Several staff were dignity champions. This meant that they took the lead in ensuring that the principles of promoting dignity and other core values were always practiced by staff. Dignity awareness was raised in staff and residents meetings. Two of the residents had also attended a presentation on dignity in care, so that they had some awareness of the principles staff should be working to. Throughout the course of the visit staff were heard speaking to residents politely and respectfully. A resident told us that staff respected their privacy and always knocked on their door even if it was open. Others told us that staff were, kind, and considerate. Several care plans made reference to respecting the residents privacy and dignity when carrying out personal care. The manager ensured that any nursing or medical examinations were carried out in the residents own room. We had received a number of notifications in the past six months about shortfalls in medicines management. The manager told us that she had identified problems with medication when she was first in post and was taking steps to improve issues. She had carried out work based supervision sessions with staff who handled medication, which had identified if any had further training needs. Medication audits had been increased to help to identify areas of good practice, as well as areas that needed to be improved. Staff who handled medication had received appropriate training, including training in administration of insulin. Most medication was administered from a monitored dose system (MDS). There were records of medicines received, disposed of and of any stocks of medicines carried over from the previous month, which meant there was an audit trail and medication was ordered as necessary. We checked a small sample of medicines and found that the stock matched the records. This was a good indication that residents were receiving their oral medication as it was prescribed. There were no gaps on the medication administration record (MAR) charts. Appropriate codes and notes were generally used when medicines were omitted. However, MAR charts for recording prescribed creams were kept in residents own rooms. These were not being signed regularly. It was not clear whether this was because residents were not having Care Homes for Older People Page 15 of 31 Evidence: cream applied or whether staff were forgetting to sign charts. There were a number of handwritten entries on MAR charts. There was no evidence that these were witnessed to reduce the risk of transcribing errors, which could lead to serious errors. Where medicines were prescribed with a variable dose, staff recorded how much they had administered. This helped staff to be able to evaluate the effects of the medication and prevent residents receiving too much medication. Some residents were prescribed medication to be given when required, which meant that it was at the discretion of staff whether the resident needed the medicine. There was insufficient guidance to tell staff when particular residents needed medication with a sedating effect. This could potentially lead to residents being over or under medicated. We were shown evidence that Norfolk County Council were reviewing the overall use of this type of medication. Controlled drugs were stored, administered and recorded in accordance with legislation and good practice guidance. Care Homes for Older People Page 16 of 31 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. Daily routines and meals suited the majority of people living at the home and people were supported to meet their social and recreational needs. Evidence: Most of the care records we saw included information relating to the residents past social and family history. A member of staff who worked on Heather unit told us that this information provided them with ideas for activities and also topics for conversation. Each resident had an activity profile, plan and risk assessment. These were maintained by the activity co-ordinator who told us that they were changed as the residents needs changed. There was a programme of activities, which was flexible to fit in with what the residents wanted. For example, on the day of our visit residents were invited to join a morning activity at the day centre next door. Consequently noone was very interested in doing anything in the afternoon, so the activity coordinator came back into work after tea to organise a game of bingo. Staff working on Heather unit also organised daily activities and residents could choose whether to remain there or join in with the main unit. Staff we spoke to had a very positive attitude about activities and stimulation and saw it as an integral part of the care they provided. On the day of our visit a group of residents were occupied with a word game. There was also one to one time for residents who did not wish to, or were not Care Homes for Older People Page 17 of 31 Evidence: able to join in groups. One resident told us they were not really able to join activities but she was very pleased that staff came in to talk to her about years gone by. Residents we spoke to were happy with the level of social stimulation. One told us, There is plenty to do, and another said, There is always someone about, they stop and have a chat. It is better than living on your own. Residents said they had choices in most aspects of their daily lives. One person told us there were not many rules and everyone we spoke to said they could get up and go to bed when they wanted to. Residents preferred routines, likes and dislikes were recorded on their care assessments. Not all of these were up to date but a member of staff who worked on Heather unit told us the information helped them to provide residents with meaningful choices. One member of staff said, Some residents cant name things so we give them a visual choice. Staff said that even if they knew the residents likes and dislikes very well they are still asked. Cultural and spiritual needs were identified on social care plans. The AQAA told us that a multi faith service was held at the home every month and individual spiritual support was provided whenever it was required. Residents had links with the local community. Activities were regularly shared with the day centre next door. There were links with the local church and schools. One resident went out to the pub. A number of people went into town on shopping trips and there were group outings on regular basis. One resident told us that they thoroughly enjoyed a recent trip to Newmarket. There was open visiting, which helped residents to maintain contact with their family and friends. The AQAA told us that residents had a varied diet with a good choice of food each day. Meals were always discussed in the residents meetings and suggestions were acted upon. For example, staff had suggested more culturally appropriate meals for one resident and this was being explored. People we spoke to were happy with the meals. One said, The food is marvellous, I have no hesitation in saying that. Another told us, There is always a choice of meals and you can have seconds if you want. On the day of our visit the main choices looked appetising and residents said they enjoyed lunch. Residents could choose whether to have their meals in the main dining room or in their bedrooms. We observed the lunchtime meal on Heather unit. Residents were given a choice of whether they wanted to wear protective clothing. Staff were attentive throughout, offering people condiments and a choice of drinks. Staff on duty at the time of our visit were skilled at assisting people to eat, whilst maintaining the social atmosphere of lunchtime. Care Homes for Older People Page 18 of 31 Evidence: There were cold drink dispensers in each of the lounges. The AQQA told us that the manager was planning to introduce a 24 hour buffet system. This meant that residents would be able to help themselves to snacks throughout the day and night. A chiller cabinet had been purchased to enable this to go ahead after the Christmas period. Care Homes for Older People Page 19 of 31 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. Complaints were dealt with appropriately and procedures and training were in place to help to ensure that people were safeguarded from abuse. Evidence: The complaints procedure was included in the, Tell Us What You Think booklet produced by Norfolk County Council. It was given out to all new residents and there were copies in the home for anyone to take away. The procedure was quite detailed and told people exactly how complaints would be dealt with. The booklet could be made available in different formats but, at the time of our visit, this did not include a format aimed specifically toward people with dementia. The AQAA told us that there had been 14 complaints made directly to the home in the past year. The records showed that these were a mixture of minor complaints, such as, how a bed had been made, to more serious issues about care practices. They had all been investigated by the manager in post at the time and 13 were found to be true. Some records clearly showed what actions had been put into place to prevent the situation arising again but others did not. The Commission received one complaint about the service, which centred around poor staffing levels. The manager at the time was asked to investigate the complaint and respond to the complainant. This was done within the agreed timescale. There have been no complaints since the current manager took up post. She is in the Care Homes for Older People Page 20 of 31 Evidence: process of arranging for all staff to receive training in responding to complaints, which may help to prevent minor grumbles from escalating. She also intends to audit any complaints she receives to ensure that any patterns or trends are identified. Staff received training in safeguarding adults during their induction and NVQ training. Several staff had also received refresher training. Staff we spoke to said they were confident they would be able to recognise any signs that a resident may be a victim of abuse and said they would report it straight away. One said, I wouldnt let it rest. They were also aware of the need to respond appropriately if a resident was being abused by another resident. The Norfolk County Council adult protection procedure was available for reference. There was also an updated procedure to guide staff on how to respond to a safeguarding concern. Staff had received training about the Mental Capacity Act and Deprivation of Liberty Safeguards. The aim of the training is to ensure that staff understand and promote the rights of people who lack capacity to make their own decisions. There were notes on the file of one resident to show that some decisions had been made on their behalf. However, there was no evidence that the process of assessing the residents capacity about these particular decisions had been followed. The new manager had not been made aware of the reasons for this and confirmed that she would investigate and ensure that the residents rights had been upheld. Care Homes for Older People Page 21 of 31 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 was clean and well maintained and the standard of decor and furnishings provided people with a safe, comfortable and homely place to live. Evidence: From looking around the building we could see that the home was accessible and well maintained. A requirement from the last inspection to improve the communal space for people on Heather unit had been met. There was a large extension, which was partitioned to provide 2 smaller areas. On the day of the inspection one was being used for a group activity and the other as a quiet area. A member of staff told us that the extension had made a big difference for people on Heather unit. The other requirement with regard to replacing the metal windows had also been actioned. All bedroom windows had been replaced and the others were on the improvement plan. All windows on the upper floor had restricted opening but not all those on the ground floor. The manager said she would look into this in order to protect the safety and security of the residents. Some of the lighting in the home was quite low, which caused some areas to be dimly lit. The manager had been trialling various types of lighting around the home and she had received approval to begin a programme of replacement. This would help residents who liked to read in their bedrooms. Residents whom she spoke to about this were pleased with the news. A new staff call system had been installed. Used with Care Homes for Older People Page 22 of 31 Evidence: sensors, it enabled staff to monitor residents at risk of falls more closely. A resident told us that when he pulled the cord he could speak to staff. He said this was much better than the old bell because staff could tell people how long they would be. All areas of the home were decorated and furnished in a homely way and to a good standard. There was an ongoing plan of redecoration and renewal. Heather unit had been decorated with a view to assisting people with dementia to find their way around. For example, toilet doors were all painted a bold colour to make them stand out, whereas areas where residents were discouraged from going, such as the medication room, were painted the same colour as the walls to help them to blend in. There were discreet signs around and pictures on residents doors were meaningful to them, which assisted recognition. All bedrooms were above average size for single occupancy. They were personalised with ornaments, pictures and furniture. Residents we spoke to were happy with their rooms. One told us that the only thing missing was an en-suite. There were sufficient bathrooms and toilets around the home. Most had assisted bathing facilities. Staff had tried to make the bathrooms feel less clinical but there were large waste bins in some, which detracted from the homely feel. On the day of our visit all areas of the home were clean and fresh smelling. A resident told us that it was always, spotlessly clean. The AQAA told us that there was a best practice plan in place for the prevention and control of infection and staff had received training. There were disposable gloves in bathrooms and appropriate hand washing facilities around the home. We observed good practices to control the spread of infection. For example, at lunchtime we saw that staff always remembered to take their dining room tabards off if they needed to help a resident with personal care. Care Homes for Older People Page 23 of 31 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. Recruitment practices provided safeguards and there were sufficient staff with appropriate training to meet the needs of the current residents. Evidence: Residents and staff told us that the home had gone through a period of being short staffed. We were told that this had impacted negatively on a number of areas in the home. For example, there was a high use of agency staff, which could affect the consistency of care, the care records were not kept up to date, staff did not have as much time to spend with residents in a social capacity and staff morale was low. The manager had commenced a recruitment drive since taking up post and all but two of the vacant posts had been filled. There was also a bank of relief staff to cover holidays and unplanned absence. This helped to ensure that residents always received care from staff they recognised. A resident told us that they thought staffing had been better over the last few weeks and a member of staff said they had not had to work short handed for a full shift for a while. Staff agreed that when there was a full compliment of staff there were enough to meet the needs of the current residents. We looked a duty rosters for the last month. They showed consistent staffing levels and there was only one day where agency staff were used. Staff were recruited in accordance with the robust procedures of Norfolk County Council and with regard to equal opportunities. Everyone had the required preCare Homes for Older People Page 24 of 31 Evidence: employment checks. The manager shortlisted and interviewed staff, which ensured that she had the right skill mix to meet the needs of the residents. New staff completed a thorough induction training programme, which covered the standards of the national training organisation. The programme was delivered through a mix of taught sessions, self study and shadowing, which helped to make sure that staff had opportunities to discuss the training and clarify any issues. New staff who already had an NVQ completed a shorter version of the induction training. Staff had supervision meetings during their induction training to check on their progress and ensure the programme was meeting their needs. The central training record was not completely up to date but the manager said that she had checked individual records and found that most staff had received training in the mandatory topics. Further training was planned. Staff we spoke to said the opportunities for training were good. Everyone who worked with people with dementia had received training to various levels, from awareness courses to dementia care mapping. One member of staff we spoke with had experience of previous courses and said the training she had at Woodlands was good. Over half of the care staff held a national vocational qualification (NVQ) in health and social care. Care Homes for Older People Page 25 of 31 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. Residents and staff benefited from a safe and well managed home. There was a good level of consultation which meant that residents were able to contribute to service development. Evidence: The home has had three different managers since our last inspection. At the time of our visit the current manager had only been in post for two months. She was aware of the need to apply for registration. The manager told us that she was aware that some issues had slipped since our last inspection and had identified that one of the main causes was staff vacancies and concentrated on that straight away. She had also begun to address shortfalls in care records, medication, staff training and supervision. Throughout the inspection the manager demonstrated a commitment to improving standards. She was enthusiastic and a member of staff told us, The manager has some very good ideas and I am sure she will see them through. A resident said, She has not been here that long but she seems to be good; she listens. Care Homes for Older People Page 26 of 31 Evidence: There had been a recent quality survey but the results had not been collated or published at the time of our visit. The manager told us that residents comments were positive but some of the comments from staff showed that morale had been low. There were regular resident meetings, where people were encouraged to share ideas and voice their preferences. In addition to staff meetings, staff had regular supervision with their line manager and an annual appraisal. Audits had been carried out on a number of practices. The manager and senior staff planned to have an away day to look at areas that needed improvement and draw up action plans. The AQAA told us that there were a number of Norfolk county council policies that had not been reviewed for some time. It was not clear whether they still reflected current legislation and best practice. Most residents were assisted to manage their finances by family members. A number of residents had small amounts of money held at the home for safekeeping. There were secure facilities and individual records were kept of any financial transactions. We audited a small sample and found them to be correct. However, some records were not signed by staff and a high number were not witnessed to show that staff were carrying out checks when handling money. All staff had received fire safety training. Fire alarms were tested regularly and other fire safety equipment had been serviced. The AQQA showed that the maintenance and servicing of other equipment and installations were up to date, which helped to protect the health and safety of people living and working in the home. Care Homes for Older People Page 27 of 31 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 28 of 31 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 7 13 Risks to residents health 31/03/2010 and safety must be assessed and care plans drawn up to reduce risks. These would include risks associated with bed rails and developing pressure sores. To promote residents health and safety. 2 7 15 Care plans must address all health and personal care needs, including end of life care. Care plans must be reviewed and kept up to date. To ensure that staff have clear and accurate directions about the support they need to provide. 31/03/2010 3 9 13 There must be accurate records of all prescribed medication, including creams, administered to residents. 31/01/2010 Care Homes for Older People Page 29 of 31 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 This is to ensure residents are receiving all their medication as it is prescribed. 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 Handwritten MAR charts should be witnessed to reduce the risk of transcribing errors. Residents who are prescribed medication to be given when required should have a plan in place to ensure that staff are clear about when to administer the medication. 2 19 There should be a risk assessment to support the lack of window restrictors on some ground floor windows on Heather Unit. The central training records should be brought up to date and any shortfalls in training should be addressed. To increase safeguards for residents, all records of financial transactions should be witnessed by a second member of staff. 3 4 30 35 Care Homes for Older People Page 30 of 31 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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