Care Home: Woodlands Care Home

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What the care home does well The home gathers good information about people`s personal care and health needs before they move in. This helps to assure people that the home will be able to meet their needs. People are supported to receive the health care they need and those spoken with feel staff treat them well. People are supported to make choices about the activities they participate in and most people are happy with the activities that are arranged. People are confident that any complaints they make will be taken seriously and investigated. The home is generally well maintained and provides a comfortable and safe environment for people. There are enough staff available in the home to meet people`s needs. What has improved since the last inspection? Action has been taken to resolve a persistant unpleasant odour in one area of the home. A shower room has been created and toilets have been refurbished. What the care home could do better: The manager needs to collect more information from people about their social and cultural needs. This will help to plan activities and events that meet people`s needs. Care plans need to contain details of the support people need if they become aggressive. This will give staff information about the actions they need to take to keep people safe. All medication needs to be securely stored and controlled drugs must be stored in an approved controlled drugs cabinet. This will help to ensure that medication is kept safely. The home`s safeguarding procedures need to comply with guidance from Hampshire adult social services. All allegations of abuse within the home must be reported to adult services and the care quality commission. Staff need to receive suitable training to give them the knowledge and skills to meet people`s needs. Evidence of the checks that are carried out on staff before they start work needs to be kept in the home. This will help to demonstrate that staff have been thoroughly checked. The home needs to have an effective quality assurance system. This will help to identify shortfalls in the service provided and plan improvements. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Woodlands Care Home Main Road Sandleheath Fordingbridge Hampshire SP6 1TD     The quality rating for this care home is:   one star adequate 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: Craig Willis     Date: 0 7 0 4 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 27 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 27 Information about the care home Name of care home: Address: Woodlands Care Home Main Road Sandleheath Fordingbridge Hampshire SP6 1TD 01425652710 01425652950 alison@wait2223.freeserve.co.uk 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) : Woodlands House Retirement Ltd care home 30 Number of places (if applicable): Under 65 Over 65 0 30 0 dementia old age, not falling within any other category physical disability Additional conditions: 30 0 30 The maximum number of service users to be accommodated is 30 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Dementia (DE) Physical disability (PD) Date of last inspection Brief description of the care home Woodlands Care Home is located in the village of Sandleheath, a rural area of the New Forest approximately one and a half miles from Fordingbridge. Woodlands Care Home provides accommodation for 30 older people in 24 single and 3 double bedrooms. The house has spacious grounds, which are landscaped and accessible for residents. Fees for the home range from 400 to 450 pounds per week. There are additional Care Homes for Older People Page 4 of 27 Brief description of the care home charges for hairdressing services, chiropody and cost of transport for hospital appointments. Care Homes for Older People Page 5 of 27 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: one star adequate 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 evidence used to write this report was gained from a review of all the information we have received about the service since the last inspection and a visit to the home. The information included an annual quality assurance assessment completed by the manager, incident reports and information from adult social services. A site visit was carried out on 7 April 2009 and lasted approximately seven hours. During the visit we spoke with people who live in the home, a visiting relative, staff members on duty and the manager. Documents relating to the running of the home were inspected and the homes communal rooms were viewed. We received completed surveys from people who live in the home and staff. Care Homes for Older People Page 6 of 27 Care Homes for Older People Page 7 of 27 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 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 8 of 27 Care Homes for Older People Page 9 of 27 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 27 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. There are good systems to assess peoples needs before they move into the home. This helps to assure people that the home will be able to meet their needs. Evidence: The manager reported in the annual quality assurance assessment that peoples needs are assessed before they move into the home and people are able to visit before deciding whether to move in. We inspected the records of four people who live in the home during the visit. All four records contained an assessment of peoples needs that was completed before they moved in. The assessment covers peoples mobility, personal care, pressure care, communication, mental well-being, social and cultural needs, medication, health and nutrition. The information on social and cultural needs had not been completed for two of the records inspected and for the other two people contained vague information, for example a tick indicating they liked to watch television without any specific information about programmes or channels that the Care Homes for Older People Page 11 of 27 Evidence: person preferred. The manager agreed to look at the social and cultural needs assessments and provide more specific information about peoples needs. Where appropriate peoples relatives have been involved in the assessment process. Staff spoken with reported they were confident that the information they receive is accurate. Care Homes for Older People Page 12 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning systems set out most of the needs people have and how they should be met, however there is not enough information on the support required to manage aggression and keep people safe. There are good systems for recording and administering medication, however controlled drugs and medication that needs to be kept in the fridge are not securely stored. Evidence: The manager reported in the annual quality assurance assessment that care plans are written from peoples initial needs assessment and set out how peoples identifed needs should be met, focusing on strengths rather than weaknesses. We inspected five peoples care plans during the visit. Each person had a plan in place that had been reviewed each month and amended where needs have changed. The plans set out how staff should meet peoples needs and also contained an assessment of risks people face. The risk assessments include actions that should be taken to minimise the identified risks. One of the records inspected contained details of an incident in which a resident was punched in the face by another resident. The care plans and risk Care Homes for Older People Page 13 of 27 Evidence: assessments of both residents were inspected and did not contain any details about how to intervene if the person became aggressive or actions to keep people safe. Staff spoken with said they were aware there had been incidents and would intervene verbally to prevent anyone being hit again. People are registered with a local GP and are supported to attend health appointments as necessary. Records are kept of peoples consultations, including any advice from the practitioner. People spoken with during the visit said they were able to see their GP when they need to. We received three surveys completed by residents or on their behalf by their relatives. Two people said they always receive the medical support they need and one person said they usually do. We also received a survey from a social worker who reported that doctors are always called in promptly. The home has medication procedures in place, although these were not inspected during the visit. Most of the medication is stored in a locked trolley in the dining room and is supplied in blister packs to make them easier to administer. The medication administration records for the current month were inspected and had been fully completed. This gave a record of all medication received into the home and administered to people. A separate record was available of medication that had been returned to the pharmacist for disposal. The home does not have a suitable controlled drugs cabinet and was storing Temazepam in the main trolley. The home was also storing insulin and other liquid medication in the kitchen fridge. The manager reported that she is arranging a visit from their supplying pharmacist and plans to obtain a controlled drugs cabinet and a lockable medication fridge. People spoken with during the visit reported that staff treated them well and maintained their privacy and dignity. We received three surveys completed by residents or on their behalf by their relatives. Two people reported that staff listen to them and act on what they say, with one person saying this does not happen as staff appear too busy. The care manager who completed a survey for us reported staff always respect peoples privacy and dignity. Care Homes for Older People Page 14 of 27 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. People are supported to make choices about the activities they participate in and most people are happy with what is arranged. Evidence: The manager reported in the annual quality assurance assessment that people are able to choose how they spend their time and activities are available for those who wish to participate. A specialist entertainer for people with dementia is booked each month and organises activities including reminiscence sessions, a quiz and exercises. The home has a selection of books, puzzles and DVDs for people to use. Most people spoken with during the visit said they were happy with the activities that are available, although one person said they would like the opportunity to do some gardening. The manager said that the homes survey had asked people about the activities that are organised and the replies were generally positive. We received three surveys completed by residents or on their behalf by their relatives. Two said there were sometimes activities arranged that they could take part in and one said there never were. The manager said she was looking at how they could provide more activities for people, including gardening. The care manager who completed a survey for us reported that the home supports people to live the life they choose and responds to Care Homes for Older People Page 15 of 27 Evidence: the different needs of individuals. The home has an open visiting policy and visitors are welcome at any time. The daughter of one resident was spoken with during the visit and reported that they were always made welcome and were positive about the home. People spoken with during the visit said they were able to make choices about what they participate in and how they spend their time. All three people who live in the home or their relatives that completed a survey for us said they always or usually like the food. People spoken with during the visit were very positive about the food and confirmed that alternatives were available to choose from. Details of peoples specific dietary needs are recorded. The lunch time on the day of the visit was observed in one dining area. Food was well presented and there was a relaxed, social atmosphere in the room. The manager reported that a new chef has been employed and they are looking at ways of getting residents more involved in menu planning. Care Homes for Older People Page 16 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has good complaints procedures and people are confident their complaints will be taken seriously, however, the safeguarding procedures do not ensure the correct action is taken in response to allegations of abuse. Evidence: The manager reported in the annual quality assurance assessment that all complaints are dealt with immediately and staff are made aware of the procedure on induction. The manager reported during the visit that no complaints have been received during the last year. We have received one complaint from a relative that we referred to Hampshire adult services under the safeguarding procedures. This issue has not yet been resolved and once we are aware of the outcome we will consider whether any further action is required. During the visit we spoke with four people who live in the home about the complaints procedure. All four said they were aware of the complaints procedures and confident that if they made a complaint it would be taken seriously and investigated. All three residents or their relatives that completed a survey for us said they know how to make a complaint. The home has an adult protection policy in place and information about different types of abuse that people may experience. The adult protection policy states that allegations of abuse must be reported to the senior member of staff on duty and the manager and that the allegation will be investigated and if serious outside agencies will be informed, for example adult services. This contradicts the local authority Care Homes for Older People Page 17 of 27 Evidence: safeguarding procedure, which requires all allegations to be immediately reported to adult services, who will make a decision on what investigations should be undertaken. The manager said she would re-write the homes policy. As reported in the Health and Personal Care section of this report there was an incident in which one resident was hit in the face by another resident. This incident was not reported to adult services and there was no information in the residents care plans about how to keep them safe. Two members of staff were spoken with during the visit. Both said they would take action to stop people if they witnessed one resident hitting another and would report the incident to the manager. The training records indicated that eleven of the seventeen staff that were due to work in the home during the week of the inspection had not completed any safeguarding training. One allegation has been investigated by adult services since the last inspection. This concerned allegations that staff were not always using a pressure relief cushion for a resident who required it. As a result of the investigations staff have been provided with additional pressure care training and there are clear procedures about the action that will be taken if staff do not follow instructions in care plans. Care Homes for Older People Page 18 of 27 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 generally well maintained and provides a comfortable and safe environment for people. Evidence: All of the communal areas of the home were viewed during the visit. All areas were clean and since the last inspection action has been taken to resolve a persistent unpleasant odour in one area of the home. There is a programme of decorations that is being carried out and since the last inspection a shower room and toilets have been refurbished. There are plans to move one of the accessible baths, to provide more room. People spoken with during the visit reported that the home is always kept clean. Of the three residents or relatives that completed a survey for us, one said the home was always kept clean and fresh, with two people saying it was usually clean and fresh. The home has a seperate laundry room in the basement with machines capable of washing soiled clothing. There are infection control procedures place. Care Homes for Older People Page 19 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are employed in sufficient numbers, however, they do not receive suitable training and not all of the evidence of the checks that have been completed in respect of them is kept in the home. Evidence: There are four care staff between 7.30am and 1.30pm, three between 1.30pm and 7.30pm and two overnight. In addition to the care staff there are kitchen, cleaning and laundry staff. Residents and a relative spoken with during the visit reported there were sufficient staff at all times. Of the three residents or their relatives that completed a survey for us, two said there were always staff available when they need them and one said there were usually staff available. Four staff completed a survey for us, two said there were always enough staff to meet peoples individual needs and two said there sometimes were. The manager reported in the annual quality assurance assessment that all necessary checks are made on new employees before they start work. We inspected the records of two new staff members. Both had started work before their full Criminal Records Bureau disclosure had been returned and were working under supervision at all times. The manager reported that she had received confirmation that they were not on the protection of vulnerable adults (POVA) list, although she did not have that confirmation in the home. The application forms for both staff also had gaps in their employment Care Homes for Older People Page 20 of 27 Evidence: history. The manager agreed to ensure the confirmation of the POVA list checks was held in the home and the gaps in employment history were filled in by the staff. The staff training records were inspected during the visit. Staff training is organised in blocks for all staff and last year staff received training in violence and aggression, fire safety, dementia, pressure care and health and safety. The manager reported that approximately half of the care staff have not completed the first aid or the manual handling / use of the hoist training as they have started since the training took place. As reported in the complaints and protection section of this report most of the staff have not completed the safeguarding training as it was last held in August 2006. Six of the eleven care staff have completed the National Vocational Qualification at level 2 or 3. Care Homes for Older People Page 21 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality assurance systems are not effective and have not ensured shortfalls in the service provided are identified and improvements planned. Evidence: The manager has worked at the home for several years and has completed the City and Guilds Advanced Management for Care. Staff spoken with said they receive good support from the manager. The provider works in the home most days and undertakes most of the maintenance issues. There are some quality assurance systems in place, for example a survey of residents and relatives and an annual review of the homes policies and procedures however, these systems have not identified the shortfalls described in this report. Although the provider spends a lot of time in the home there is no formal system for him to assess the quality of the service provided and report to the manager. The home has workplace risk assessments in place that assess the risks to staff and include measures to reduce the risks where necessary. The manager reported these Care Homes for Older People Page 22 of 27 Evidence: are all currently being reviewed. The records for the servicing of the fire alarm, boiler, emergency call system and hoists were inspected during the visit and were up to date. Care Homes for Older People Page 23 of 27 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 24 of 27 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 15 The registered person must 31/05/2009 ensure care plans contain details of the support people require when they become aggressive. This will give staff information about actions they need to take to keep people safe 2 9 13 The registered person must ensure controlled drugs, including Temazepam are stored in a controlled drugs cabinet. This will help to ensure controlled drugs are securely stored. 07/07/2009 3 18 13 The registered person must 31/05/2009 ensure all staff working in the home receive safeguarding training and the homes adult protection policy is amended to reflect the requirements of the local authority procedure. Care Homes for Older People Page 25 of 27 This will help to keep people safe and give staff the information they need to respond to allegations of abuse. 4 33 24 The registered person must ensure there is a formal system for reviewing the quality of care provided and planning improvements. This will enable improvements to be made to the service people receive. 31/05/2009 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 Care Homes for Older People Page 26 of 27 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. 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. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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