Care Home: Woodlands Manor

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What the care home does well The management team and staff of Woodlands Manor have a strong commitment and drive in wishing to provide a good service at the home. The home has a number of methods to ensure that people`s needs and wishes are known, recorded and responded to in a `person centered way`. This is undertaken through such methods an an open and engaging management style, one to one support and time spent with those who live at the home talking with them about their care, care planning and review meetings, staff and team meetings are held in order to ensure that all are consulted. There are clear lines of accountability within the home. There is a clear process to ensure that the service is able to meet the assessed care needs of prospective people moving to the home. There is an admission procedure, which is included in the statement of purpose and full assessments of needs were undertaken. The manager ensures that no individual is admitted into the home unless there has been a full assessment of their needs and that the home is confident that they are able to support them to maintain their skills and lead a fulfilling life. The home has a good care planning system, which is holistic, and this specifies how identified needs are to be met. Care plans are regularly reviewed and there is an ongoing assessment and monitoring of individual`s needs and the service is tailored accordingly. Those living at the home said: "I am very happy living here", "Staff here look after me well". Staff have developed sound relationships with those who live at the home and have a clear understanding of the individual needs, wishes and aspirations of those who live at the home. The home is comfortable, homely and well-maintained. The house is well-furnished and those living at the home have personalised their rooms and people showed a sense of pride when showing us their room. Throughout our visit the deputy manager demonstrated good, effective leadership skills that relate to the aims and purposes of the home. It was evident the management and staff are a stable team that supports a commitment to providing quality of care for the benefit of the people living in the home. As well as being organised and skilled in aspects of running the home, the registered manager, actively seeks and values the opinions of staff, residents, relatives and visiting professionals. The manager works closely with staff to establish, maintain and seek to improve communication/relationships and to develop skills, thus supporting the staff group in working together as a cohesive, caring team. What has improved since the last inspection? Since our last visit to the service on 30th September 2009 there have been a number of significant improvements at the home. The management team and staff have worked diligently in order to ensure that the requirements what were set by us during our last visit have been addressed. Since our last visit the home have reviewed medicine records and care plans for people living in the home. This was to ensure that for all medicines prescribed with a direction `when required` or with a variable dose always have clear, up to date and detailed written guidance for staff on how to reach decisions to administer the medicine and at a particular dose, taking into account the provisions of the Mental Capacity Act 2005. This has ensured that people living in the home have received the correct amounts of medication in a consistent way in line with planned actions. All medicines in the home are kept safely so as prevent unauthorised access and are stored within the temperature range specified by the manufacturer or pharmacy. This was to ensure medicines are stored securely and at the right temperature as the manufacturer or pharmacist directs and not be a risk to people living in the home. All Warfarin medication was seen by us to be administered from the correct named boxes for each individual. This ensures legal and safe practices are in place at the home. The medication remains the property of the people it is prescribed for, and allows for clear audit trails to be completed. The lifting hoists have been serviced in accordance with manufacturer instructions and replacement parts have been provided where required. This ensures safe practice when hoists are used. People have been consulted and their needs met with regard to enclosing en-suite facilities. This was undertaken to ensure their privacy and dignity at all times. All areas of the home are kept at a comfortable temperature for people, and this has been monitored. Many radiators within the home have been replaced in order to ensure that they have individual thermostats in place. This ensures that vulnerable people are in comfortable temperatures at all times. The fire risk assessment has been reviewed and advice has been sought from the fire safety officer. This was undertaken by the home at our request in order to ensure that everyone in the home is protected from the effects of a fire. Whilst we were on site at the home fire doors were being replaced in order that they would `self close` upon the activation of the fire alarm. What the care home could do better: The home must maintain a record of food provided including any special diets. This is so that any person inspecting the record can determine whether the diet is satisfactory in relation to nutrition and personal choice. It is recommended that a consistent approach is taken to the use of coding for when PRN medication is not given. A recommendation was made by us at this visit that care plans and pre-admission assessments should demonstrate that individuals mental capacity has been considered. This is in order that people can be supported to make choices where they are able and where they are not able, appropriate support and guidance is sought. Key inspection report Care homes for older people Name: Address: Woodlands Manor Ruffet Road Kendleshire South Glos BS36 1AN     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: Odette Coveney     Date: 2 4 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Woodlands Manor Ruffet Road Kendleshire South Glos BS36 1AN 01454250593 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Woodlands Manor Care Home Ltd Name of registered manager (if applicable) Mrs Cheryl Lynn Lawrence Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 40 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admissison to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Woodlands Manor is a part converted and part purpose built home registered in November 2004 by Woodlands Manor Care Limited and operated by the directors Mr and Mrs Jenkins. Mrs Jenkins is the Responsible Individual (RI) for the Home. The home is situated in a rural location, but is on a local bus route to Bristol and Yate, and is accessible to local shops and amenities by bus or car. Communal areas are provided by way of a dining room, lounges and large conservatory areas. There is level Care Homes for Older People Page 4 of 31 Over 65 40 0 3 0 0 9 2 0 0 9 Brief description of the care home access throughout the home and all areas of the home are accessible via a lift. There are a number of bathrooms and toilets with adaptations to meet most of the care needs of people living in the home. Some bedrooms have ensuite toilet facilites. Appropriate equipment can be provided for individual use based on assessed or identified needs. All rooms have a call bell system. The home is set in its own grounds, which are beautifully maintained and accessible to people. Car parking is available for several cars. Visitors are welcome to the home at any time. In house activities and entertainments are provided. The fees charged at the home are available upon request, additional charges are made for Chiropody, hairdressing, newspapers and private telephones. 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: This unannounced key inspection took place at the home and was completed in seven hours by two inspectors. The registered manager was not present during the inspection. The deputy manager assisted us and fully participated and engaged in the process. Evidence for our opinion about the service and the quality of care provided was gained from a whole range of different sources, including talking with people who use the service, talking with staff who are employed at the home. And a review of records seen by us at the home and discussions with two of the directors and the deputy manager. The purpose of the visit was to establish if the service provided at Woodlands Manor is meeting the National Minimum Standards and the requirements of the Care Standards Act 2000 and to review the quality of the care provision for the individuals who use the service. Care Homes for Older People Page 6 of 31 We also spoke with one of the directors about the new Health and Social Care Act 2008 and the responsibilities of the service. Information was left with the service about the forthcoming registration process to compliment the information they already had. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Since our last visit to the service on 30th September 2009 there have been a number Care Homes for Older People Page 8 of 31 of significant improvements at the home. The management team and staff have worked diligently in order to ensure that the requirements what were set by us during our last visit have been addressed. Since our last visit the home have reviewed medicine records and care plans for people living in the home. This was to ensure that for all medicines prescribed with a direction when required or with a variable dose always have clear, up to date and detailed written guidance for staff on how to reach decisions to administer the medicine and at a particular dose, taking into account the provisions of the Mental Capacity Act 2005. This has ensured that people living in the home have received the correct amounts of medication in a consistent way in line with planned actions. All medicines in the home are kept safely so as prevent unauthorised access and are stored within the temperature range specified by the manufacturer or pharmacy. This was to ensure medicines are stored securely and at the right temperature as the manufacturer or pharmacist directs and not be a risk to people living in the home. All Warfarin medication was seen by us to be administered from the correct named boxes for each individual. This ensures legal and safe practices are in place at the home. The medication remains the property of the people it is prescribed for, and allows for clear audit trails to be completed. The lifting hoists have been serviced in accordance with manufacturer instructions and replacement parts have been provided where required. This ensures safe practice when hoists are used. People have been consulted and their needs met with regard to enclosing en-suite facilities. This was undertaken to ensure their privacy and dignity at all times. All areas of the home are kept at a comfortable temperature for people, and this has been monitored. Many radiators within the home have been replaced in order to ensure that they have individual thermostats in place. This ensures that vulnerable people are in comfortable temperatures at all times. The fire risk assessment has been reviewed and advice has been sought from the fire safety officer. This was undertaken by the home at our request in order to ensure that everyone in the home is protected from the effects of a fire. Whilst we were on site at the home fire doors were being replaced in order that they would self close upon the activation of the fire alarm. What they could do better: The home must maintain a record of food provided including any special diets. This is so that any person inspecting the record can determine whether the diet is satisfactory in relation to nutrition and personal choice. It is recommended that a consistent approach is taken to the use of coding for when PRN medication is not given. A recommendation was made by us at this visit that care plans and pre-admission Care Homes for Older People Page 9 of 31 assessments should demonstrate that individuals mental capacity has been considered. This is in order that people can be supported to make choices where they are able and where they are not able, appropriate support and guidance is sought. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 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 11 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 homes assessment processes and the information available about the home ensures that placement is offered to those people whose needs they can meet. Evidence: Woodlands Manor is a care home registered with the Care Quality Commission to provide personal care, nursing support and accommodation for up to 40 persons, male or female. The home has in place a detailed, well-written Statement of Purpose. We saw that information was included within this document about the rights of those who live at Woodlands Manor. People would be respected in relation to their rights, ensuring they will be treated with dignity and respect, with their right to privacy and maintaining their civil rights being upheld. The Statement of Purpose also detailed the staffing arrangements for the home, the range of services, which can be provided, and how individuals will be supported with their health, personal care, social and emotional Care Homes for Older People Page 12 of 31 Evidence: aspects of their life. The information within this document was fairly comprehensive and contained clear information for residents and their relatives about the services and facilities provided at the home. Furthermore, this document contained information about the admission process into the home and how to raise issues of concern and showed to the reader how these would be responded to. The manager of the home carries out its own care needs assessment for all referrals recieved by visiting the new service user prior to the service starting. Evidence was seen of these assessments in both of the files examined at the home for the two people who were recently admitted into the home. Contracts for people, which outline the terms and conditions of the placement were not reviewed by us during this visit. Intermediate care is not provided at this home. Care Homes for Older People Page 13 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. Individuals personal and health care needs are being met. Individuals Living at Woodlands Manor are generally protected by the homes medication practices and procedures. Evidence: Individuals care records for four of the people who live at the home were reviewed by us at this visit and it was found that the plans in place had been generated from a care management assessment and the homes own detailed assessment. Information contained within care records included: Information about the reason for the placement being required, health care support services involved, next of kin, family contact details, power of attorney arrangements and medical history. The home has a good care planning system, which is holistic, and this specifies how identified needs are to be met. The care plans we saw evidence that a person centered approach had been incorporated evidencing (where possible) the involvement of the service user in order that their wishes and choice are known. We Care Homes for Older People Page 14 of 31 Evidence: saw that care plans are regularly reviewed and there is an ongoing assessment and monitoring of individuals needs and the service is tailored accordingly. The care plans give detailed information about the needs and wishes of the service users and clearly state the actions that staff need to take to meet the assessed needs. We also found that the sensitive nature of some of the comments made by staff showed a respect for the dignity of the person. These were commented on by us. The person is charge stated that she tests the credibility of care plans by anonymising them and asking senior staff to review them and identify the person the plan relates to. This is good practice. Each person also had risk assessments, records of health professionals visiting, daily records of individuals routines, medication information and a care plan. The care plan identified the areas in which the individual required support and detailed how staff intervention and support would be provided, the support and the situation is evaluated and dated. When examining the care plans it was evident that staff from the home had spent time with the individuals discussing their wishes and choices. We also saw that senior staff within the home review individuals care plans in order that the information recorded within them is correct. Within peoples notes we saw that staff monitor peoples wellbeing on a daily basis, people are supported well, ensuring that they were receiving the care and support needed as outlined within their plan of care. Care workers are encouraged to report any changes to service users needs to their supervisor and this will initiate the updating of care plans more frequently. The deputy manager confirmed that staff contribute to the review of care plans and are able to feedback information to the office and know that it will be actioned. There are people who live at the home who have a diagnosis of a dementia, we spoke to the deputy manager about the rights and choices that people make and spoke in length about the Mental Capacity Act 2005. The deputy manager was able to demonstrate a good understanding in this area. We did note that the home has obtained information from relatives who have Power of Attorney arrangements to act on behalf of their relatives best interests and this is in line with current good practice. We did feel that more information should be recorded within individuals care plan and pre-admission assessments in order to demonstrate that individuals mental capacity to make decisions had been fully considered. We also found that peoples emotional and mental health support requirements were Care Homes for Older People Page 15 of 31 Evidence: well recorded and how staff should support people in this sensitive area. Staff were aware of their responsibility in respect of confidentiality and respecting individuals right and privacy, these are underpinned by the homes policies and procedures in this area. During our last visit to the service in September 2009 we recorded some concerns over the privacy for people in respect of the en-suite facilities within peoples rooms. Please see the environmental section of this report for further information about this. Medication is kept in locked cupboards within a designated room in the home. At the last visit to the home the temperature of the room was noted to be excessive and since then the owners have installed an air condition unit that has reduced the temperature considerably. At this visit we reviewed the arrangements for controlled medication. These controlled drugs are required to be kept in line with specific storage arrangements. We found that these are kept securely in this room and no concerns in respect of this were found by us. Balances of controlled drugs held in the home were found to correspond with the relevant records. Having taken advice given by us at our last visit, the home now stores topical medication separately form that to be given orally. Medication is taken around the home by the use of trolleys designed for the easy storage and administration of medication. A monitored dosage system is used for the routine administration of medication and this is overseen by the supervising Pharmacy. The Pharmacy recently completed their own audit of the storage recording, administration of medication supplied to the home. We viewed their report and saw that no errors or concerns were noted and no recommendations were made. Regular medication reviews are conducted by the GP responsible for prescribing medication. The administration of medication on a routine basis was found to be satisfactory with the exception of the record for one person on one day when medication was not in the dosage cassette and the record had been not signed. The manager has agreed to find out what happened on this occasion and report back to us. Prior to this report being completed the manager investigated and provided us with clear information why the medication had not been recorded and has taken appropriate action to ensure that this does not happen again. There is some medication that is prescribed for administration as and when required Care Homes for Older People Page 16 of 31 Evidence: (PRN). It was noted that there is inconsistent use of the codes given for when medication is refused etc. It is recommended that staff are reminded of their responsibility in this area and that a consistent recording approach is adopted. It was noted that a member of staff had administered Paracetamol from the homely remedies stock and the remaining tablets were left on top of one of the medication trolleys. This type of medication should be returned to the correct storage area to avoid confusion. The manager tracked who had been responsible for this and spoke to the staff member concerned to remind them of their responsibility in this area. Care Homes for Older People Page 17 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. Those living at Woodlands Manor are enabled to maintain contact with families, friends and local communities. Choices are provided to people in respect of meals and mealtimes. The home provides those who live there with structured and meaningful activities and they are able to choose whether they wish to participate or not. Evidence: The dining room is at the centre of the home and tables were laid with table cloths and floral decorations. This room was pleasant and people told us they enjoyed dining in this area. There is a two week menu that changes on a monthly basis to account for seasonal changes and to accommodate the preferences of residents. Breakfast offers a choice of cereal, fruit or juice and cooked alternatives including a full English breakfast on Saturday. Lunch is a choice of two main dishes with a range of alternatives including Omlette or Salad. On the day of the visit there was Meat Loaf Care Homes for Older People Page 18 of 31 Evidence: with Creamed Potatoes and mixed vegetables or Gala Pie served with Salad followed by a choice of Plum Crumble with Custard, Sorbet or Fresh Fruit. It was noted that one person had chosen fried egg with chipped potatoes and another person confirmed that they were to have Omlette as a preference over the choices offered. The kitchen prepares special meals for those requiring a soft diet and for those with Diabetes. There was no requirement for any other special,diets being prepared on that day.The evening meal is usually a choice of soup, sandwiches or a dish such as Kedgeree, Pizza, Pate or Salad. There are three deliveries each week to ensure that food delivered to the home is fresh. To ensure the safety of those that live in the home and in line with food safety requirements, hot food is probed to ensure that it is of a safe temperature. The Activity Organisers spend time with residents on a one to one basis, during the early part of the day. They serve morning drinks at a leisurely pace to ensure this is a social time and following this, engage in an exercise session. These sessions are carried out in the lounge and have been introduced at the specific request of some residents. After lunch there is an organised activity and on the day of the visit some residents participated in Bingo games. Due to the good staffing levels at the home the routines of daily living and activities are flexible and varied to suit the expectations, preferences and abilities of individuals. people who live at the home told us that staff knew what help and support they needed and that staff are very kind, they also told us that staff responded quickly to their requests for assistance Individuals are encouraged to continue with any activities outside of the home. Those that are able to, can go out as they wish and there are no restrictions made on their movements People we spoke with at Woodlands Manor, told us that they enjoyed the entertainment provided at the home and in particular enjoyed it when entertainers visited and sing-alongs were held. People living at the home confirmed they are able to participate, or not, in activities as per their choice. Local clergy visit the home and provide a religious service for those who wish to participate. We were told that the home has a relaxed policy related to people seeing their friends or family at the home. Individuals are able to see their visitors in private and are able Care Homes for Older People Page 19 of 31 Evidence: to choose whom they wish to see and not see. The visitors book evidenced that there are many people who visit the home and visitors were seen by us during our time at the home. People living at the home told us that staff make their visitors welcome and always offer a cup of tea. A Hairdresser is available in the home on Monday of each week and to coincide with this staff offer pampering sessions that include hand massage and nail care. Residents birthdays are celebrated with a celebratory cake being provided by the home. On the day before our visit there were two celebrations. One person chose to have their party in the garden that involved a cream tea for relatives and other guests. Daily newspapers are delivered to the home. The home produces a monthly newsletter to advise residents and visitors of forthcoming events in the home and to celebrate achievements. The newsletter for June 2010 records information about the World Cup sweep stake, recent French Day and forthcoming trip to Weston super Mare. In addition there is information about the purchase of new games for use in the home and news. Care Homes for Older People Page 20 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. There are sound and robust complaints and adult protection protocols in place at the home. Individuals can be assured that any complaints they have will be listened to and acted upon and that they will be safeguarded from harm. Evidence: The complaints policy and procedure shows a clear timeline and action to be taken in event of a complaint. It also directs the complainant to the Care Quality Commission and South Gloucestershires Social Services and Housing Department. A copy is made available to service users and relatives should they request it. The Commission has received no recent complaints about the home. We spoke to people who live at the home and asked them what they would do if they had any problems or complaints. One person told us; I have never had cause to make a complaint, the staff are wonderful. If I had a problem I would speak to the manager and I am confident that it would be dealt with efficiently. The home has in place a complaints logbook. This is in place in order to record what complaints are recieved and to evidence how issues of concern have been responded to. We reviewed the information contained within this and saw that issues had been responded to in a professional and timely manner. Care Homes for Older People Page 21 of 31 Evidence: Minor accidents and incidents were recorded and more serious accidents and incidents affecting the well-being of people who live at the home had been reported to the Commission. Care Homes for Older People Page 22 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. Those who live at Woodlands Manor live in a home that is safe and the quality of furnishings are of a high standard and suitable for those who live there. Evidence: The home is set in extensive, mature, landscaped gardens with features to provide a focus of interest. There is a large pond at the rear of the home that has a wide array of fish. Around the garden walkway there are handrails to aide mobility and various seating areas offer privacy during the warmer weather. On the day of the visit there were residents and their families utilising these spaces. The gardens are home to Peacocks that roam freely and provide a talking point for those that live in and visit the home. There were Contractors on the premises at the time of the visit upgrading the fire alarm system. There was a notice affixed to the front door of the home advising of the need to take care and of the nature of the work being carried out. The work being done was to enable each bedroom door to be connected to the fire alarm system to enable them to close automatically on activation of the fire bell. This improvement is the direct action of the home following our previous visit when it was noted that some door were held open with door wedges. Care Homes for Older People Page 23 of 31 Evidence: A further improvement that has been carried out follows the last visit and comments made during the winter months about the temperature of the building. The heating system has been upgraded with additional and replacement radiators installed. The replacement radiators carry a larger capacity, are independently controlled, provide additional heat and are of the cool surface type. All areas of the home were noted to be clean and tidy with the exception of the carpet in one room that was badly stained. This was attended to during the visit. The kitchen and food stores were clean and orderly. The Chef confirmed that a new cooker and microwave oven is to be provided in the near future. Fridge and freezer temperatures are recorded as required. All of the laundry is carried out on the premises. There is sufficient equipment to carry out laundry tasks and whilst space is limited the area is well organised.There is a system in place to ensure that personal clothing is returned to its owner and staff take care with delicate items as a demonstration of pride in their work. There are separate facilities for the laundering of items related to catering. There are adaptations in place throughout the Home and specialist equipment including hoists, bathing aids, mobility aids, sensory aids and handrails. All equipment is serviced and checked for safety as required in order that it is fit for use Toilets are situated in readily accessible parts of the Home near to communal areas and bedrooms. The bathrooms and toilets were clean, and were well stocked with hand towels and soap to help minimize risk from cross infection in the Home. The home has an ensuite facility incorproated within some of the residents rooms. This consists of a hand basin and WC and are reached through an archway into the facility. The facility is complimented by a mirror and storage facilities. Following the last visit it was recorded that there was concern about the openness of the arrangement and a requriement was made for the home to consult with residents about this. In response the home conducted a survey of residents specifically related to privacy and dignity. Care Homes for Older People Page 24 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. Individuals are cared for by sufficient numbers of competent staff that are provided with training to fulfill their roles and responsibilities. Safe vetting and recruitment procedures are in place. Evidence: Staff records were examined for a newly recruited staff member as well as for some of those who had been working at the home for a long period. It was evident that there had been improvement in the standard of practice, over time, with the new person having the most comprehensive documentary evidence including full employment details, two written references(including one from the most recent employer) and evidence of identity along with ISA (Independent Safeguarding Authority) and CRB (Criminal Records Bureau) checks. The staff consulted as part of the inspection were positive about the work they were taken on to do and welcomed the opportunity to take on alternative duties. Staff we spoke with demonstrated a pride in their work and a commitment to the work of the home. Training is provided for staff and there were records to demonstrate that staff had completed training in fire awareness, moving and handling and adult abuse. In Care Homes for Older People Page 25 of 31 Evidence: addition some staff have attended sessions concerned with infection control, first aid and changes to the law relating to Mental Capacity/Deprivation of Liberty Safeguards. Some of the training is carried out by senior staff from the home or alternatively by visiting training providers or the local Council. Since commencing employment in the home as a Kitchen Assistant, the Chef has completed NVQ (National Vocational Qualification) training in Catering. The senior staff in the home provide Clinical Supervision for nursing staff. This is underpinned by Aims and Objectives and an accompanying list of supervision topics. There is a format for recording supervision sessions. Discussion with the person in charge during the visit considered the benefits of extending formal supervision meetings to all care and support staff. We considered how this could link in to the Key Worker (named staff) system, benefit residents by focusing on changing care needs and how it can assist staff in the achievement of NVQ (National Vocation Qualification). Whilst at the home we observed staff and they were seen to be supportive to people who live at the home. It was noted that staff were very patient and asked people who live in the home questions and encouraged them to make decisions, rather that deciding for them and encouraged individuals to make choices. We spent some time throughout the day talking to staff and observing them carrying out their duties and assisting residents. Staff were respectful, warm in manner, good humored and sensitive towards the residents within a relaxed, calm environment. All staff demonstrated a very caring, committed attitude to their roles and responsibilities in ensuring they provide quality of care to the people living at Woodlands Manor. Care Homes for Older People Page 26 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. The Home benefits from good leadership and management, its practices have offered protection to the health and safety of residents. However, some improvements are needed to ensure that records are maintained of what residents have eaten. The home is run in the best interests of the residents. The home is well managed ensuring that individuals interests and rights are promoted and protected by a committed staff team. Evidence: During our visit the deputy manager demonstrated a commitment to the provision of good quality individualised care packages in the home. The deputy manager is well known to the staff team and has a high visibility in the home and gives strong leadership and direction. The home has a number of methods in which to monitor and review the quality of service provided at the home and to also establish the levels of satisfaction for the people who live at the home, these include residents and staff meetings, care planning reviews, staff supervision and training. Care Homes for Older People Page 27 of 31 Evidence: A recent survey relating to privacy and dignity was conducted by the Activities Organisers to maintain a distance from the management of the home. A minority of residents stated that they did not like being able to see the facility but did not have significant concerns about this. Recorded comments from residents included; The staff are very caring, What I expect is always done, The girls are considerate. When we spoke to people who live at the home and asked them about how they were supported we were told; Staff are always polite and respectful to me, I dont know what the problem is about the en-suite, I have never had a problem with it. Policies and procedures are in place at the home and all are of the standard expected. We saw that staff are familiarised with these as part of their induction programme with a more in depth approach to such policies as the whistle blowing procedure and adult protection. The standard of record keeping is very good. Files examined at the inspection were well-presented and easy to follow and written in appropriate language. We did note food preferences are recorded by the kitchen as a means of identifying what is to be served to individuals. However, this does not fulfill the requirements of the legislation and it is required that a record of food supplied to each resident is maintained. When we reviewed the information contained within the homes fire logbook, we saw that the home is completing all of the daily, weekly and monthly tests as required. Records of fire drills and staff training were clear and well recorded. We reviewed accidents and incidents which had occurred at the home, those seen by us were situations that could be expected to occur. Accident reports had been well written and showed what had happened, what injuries had been sustained and what the home had done to support the person involved and recorded the measures that had been taken in order to try to prevent recurrence. Care Homes for Older People Page 28 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 29 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 37 17 The Registered Person must ensure that a record of the food provided to service users is maintained. This is to enable any person inspecting the records to determine whether the diet is satisfactory in relation to nutrition and special diets prepared for individual service users. 08/07/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Care plans and pre admission assessments should demonstrate that individuals mental capacity has been considered. This is in order that people can be supported to make choices where they are able and where they are not able appropriate support and guidance is sought. A clear and consistent approach must be in place in respect of medication to be given as and when required. This will evidence that medication is being given when needed and as prescribed. Page 30 of 31 2 9 Care Homes for Older People 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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