Care Home: Woodlands Park Care Centre

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What the care home does well There is information available and the opportunity to visit the home to help people decide whether they wish to move to the home. People`s health and social care needs are assessed before they move to the home, to ensure they can be met. The home can meet a diverse range of faith and cultural needs. There is good liaison with the local health care teams and residents see doctor regularly. They are supported to attend hospital appointments if necessary and they receive treatment if they are unwell or have health problems. The home is proactive in seeking specialist nursing advice if needed. Medication is managed well and residents receive the medication they are prescribed regularly and in a safe way. There is a programme of activities which is designed to enable residents to maintain previous interests where they are able. The atmosphere is relaxed and one survey respondent said `there is a warm, caring and friendly atmosphere`. Meals are varied and well presented. Residents are given help discretely if they need it and told us that they enjoyed their meals. The home is clean and well decorated. Infection control standards are good. People told us that they knew how to raise a concern and that these were addressed. The home has copies of the local authority safeguarding policies and procedures to protect older people and had made one appropriate referral, which was handled satisfactorily. There are good staffing levels and staff have access to a comprehensive training programme. Recruitment procedures are thorough and should protect people from unsuitable staff. The manager is experienced and both staff and families said there had been an improvement in the home since her appointment. Care standards are monitored regularly and safety checks are made. Equipment and services are maintained regularly. The home is developing ways in which the views of residents and families can be incorporated into the running and development of the home. What has improved since the last inspection? There has been an ongoing programme of refurbishment. Advice has been taken from the Alzheimer`s Society as to how the environment can be made more helpful and reassuring for people with dementia. There is a garden area and work has been started to create further garden space. Carpets have been replaced and there were no offensive odours in the home. Protective radiator covers have been installed to reduce the risk of burns should a resident fall. Medication management and recording has improved and the medication administration records were up to date and completed in full. Staffing levels have improved and there is now a permanent staff group. Training has been developed and staff have had training in dementia care, helping then to support and understand people who have dementia better. Recruitment procedures have been improved and comprehensive checks are undertaken before a prospective staff member starts work. What the care home could do better: The home should ensure through individual risk assessment that the central stair case is safe for residents. The home should continue to develop the quality assurance programme and seek ways in which residents their families and others can be involved in improving the care and support for residents. Key inspection report Care homes for older people Name: Address: Woodlands Park Care Centre Wendover Road Great Missenden Buckinghamshire HP16 9LS     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: Chris Sidwell     Date: 2 3 0 9 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 26 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 26 Information about the care home Name of care home: Address: Woodlands Park Care Centre Wendover Road Great Missenden Buckinghamshire HP16 9LS 08444725138 08444120620 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Calvercare Ltd care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 40. The registered person may provide the following category/ies 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 categories: Dementia (DE) , Mental disorder, excluding learning disability or dementia (MD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Woodlands Park Residential Home is a large Victorian House, which has been renovated and refurbished, and is set in extensive grounds. The home is situated two miles from the village of Great Missenden. There are no local amenities or public transport facilities close to the home, however Great Missenden has a main line railway station, is served by local bus routes and Care Homes for Older People Page 4 of 26 1 1 1 0 2 0 0 8 40 40 0 Over 65 0 0 40 Brief description of the care home possesses a variety of shops and local amenities. The home is registered to provide personal care for up to forty older people with a dementia type illness. Accommodation is a mixture of single and shared rooms of varying sizes, some of which have en-suite facilities. There are a number of additional bathrooms and toilets throughout the premises. The home has one lounge, two conservatories, one of which is used as a lounge/dining room and the other as a sensory room. There is also separate dining room. Care Homes for Older People Page 5 of 26 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 inspection was conducted over three days and included a review of the information we hold about the service and an unannounced visit to the home of seven hours on the 23rd September 2009 The key standards for older peoples services were assessed. Information received about the home since the last inspection was taken into account in the planning of the visit. The manager completed an annual quality assurance assessment (AQAA) in which she described the way in which the home ensures that the views of people who use the service are included in what they do, the way they ensure equality and diversity is respected, what they do well, the evidence to show it and their plans for improvement. This was completed in full and returned on time. Questionnaires were sent to the home for distribution to residents, staff and visiting professionals. Three residents or their families and two members of staff returned these. Residents and families were spoken to on the day of the unannounced visit. Discussions took place with the manager, the administrator, care and ancillary staff and some records were examined. Feedback was given at the end of the visit. Care Homes for Older People Page 6 of 26 Care practice was observed and the care of four of residents was followed through in detail. The environment and accessibility of the home for people with disabilities was checked. The homes approach to equality and diversity was considered throughout. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? There has been an ongoing programme of refurbishment. Advice has been taken from the Alzheimers Society as to how the environment can be made more helpful and reassuring for people with dementia. There is a garden area and work has been started to create further garden space. Carpets have been replaced and there were no offensive odours in the home. Protective radiator covers have been installed to reduce the risk of burns should a resident fall. Medication management and recording has improved and the medication administration records were up to date and completed in full. Staffing levels have improved and there is now a permanent staff group. Training has been developed and staff have had training in dementia care, helping then to support Care Homes for Older People Page 8 of 26 and understand people who have dementia better. Recruitment procedures have been improved and comprehensive checks are undertaken before a prospective staff member starts work. 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 26 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 26 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 is information available and the opportunity to visit the home to help people decide whether they wish to move to the home. Peoples health and social care needs are assessed before they move to the home, to ensure they can be met. The home can meet a diverse range of faith and cultural needs. Evidence: There is information available to prospective residents in the form of a statement of purpose, which describes the services provided by the home and a home brochure. A pictorial service user guide is available and given to prospective service users. Prospective residents and their families are welcome to visit the home and stay for a trial period before deciding whether the home is for them. The care files of four residents who have moved to the home since the last inspection were checked. The manager or deputy manager had met with them to assess their needs and wishes for care. The assessment documentation prompts staff to take note of peoples faith and cultural wishes as well as their health and social care needs. Care Homes for Older People Page 11 of 26 Evidence: The home does not offer intermediate care for those requiring intensive rehabilitation. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people are met in a way which supports their individual needs. Evidence: The care of four residents was followed through. All had comprehensive care plans which had been updated regularly with them and with their families. Their diverse health care needs were recognised and recorded. The care plans held good information about peoples lifestyles and likes and dislikes, which they may not be able to articulate due to their dementia. Peoples risk of falling had been assessed and appropriate action taken. Peoples nutritional needs were recognised and their weight monitored. There was evidence in all the files to show that residents see a general practitioner and other members of the local primary health care team regularly and are supported to visit hospital outpatient departments when necessary. There are medication policies and procedures in place and the staff spoken to were aware of these. The storage facilities were satisfactory. Records are kept of medication delivered and disposed of by the home. Residents individual medication Care Homes for Older People Page 13 of 26 Evidence: administration records were completed in full and appropriate steps were taken to ensure that supplies were received regularly. None of the residents managed their own medication at the moment although there are policies and procedures in place to support this if residents wish. The staff spoken to said that medication was never given covertly. If a resident did not want to take their medication, this would be recorded. If the medication was essential and the resident continued to refuse the doctor would be informed and a way forward agreed. Controlled drugs were stored and managed correctly. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The routines in the home are flexible and people are supported to undertake activities that they enjoy. Meals are varied and meet peoples nutritional and social needs. Evidence: The atmosphere in the home was relaxed and residents were engaged in activities which reassured them and met their individual needs and abilities. There are a number of sitting areas and residents were seen to move about the home as they wished. There is a safe garden area with seating for residents and rabbits to provide interest. The activities coordinator arranges a programme of activities which are designed to stimulate interest and to help people with dementia maintain their abilities as far as possible. She was very aware of peoples individual strengths and likes and dislikes and had endeavoured to ensure that every one had access to something that they enjoyed. There is a quiet conservatory area with coloured lights and curtains and a small dolls cradle, doll and baby clothes in the corner. One resident was observed to getting satisfaction from holding the doll, others were independently going out to the garden, knitting or attempting a crossword with help. Meals were seen to be a sociable occasion. Tables were well laid in the dining room, with tablecloths, napkins, glasses and flowers on each table. Meals are served two Care Homes for Older People Page 15 of 26 Evidence: sittings in order that those who need more help can receive it. There is a choice of meals and the chef was aware of everyones likes and dislikes. She was also aware of those who required a special diet on health grounds. A pictorial menu is available and used each day to help service users to choose what they would they would like to eat. On the day of the unannounced visit the main meal was roast pork, roast potatoes, parsnips and apple sauce. Carers were seen to help discretely and to take appropriate action when one resident left the table without eating. The residents spoken to said that they always enjoyed their meals. Staff were observed to address people politely and gently. Personal care is given in residents rooms. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are protected from harm and their concerns are listened to and addressed. Evidence: There is a copy of the complaints procedure displayed in the home and it is described in the Service Users Guide. Everyone who returned the surveys said that they knew who to speak to informally if they had a concern and that they knew how to make a formal complaint. People also said that staff listen and act on what they say. Records are kept of complaints which showed that they are responded promptly in a conciliatory manner and that action is taken to address the concerns. One family member commented in the questionnaires that there is always someone to talk to if there is a problem. The home has a copy of the local multi agency policies and procedures to safeguard people living at the home. All staff have had training in safeguarding vulnerable people either during their initial induction programme or during the last year. There are whistle blowing policies and procedures in place and the staff spoken to say that would have no hesitation in reporting any concerns. The home has made one appropriate safeguarding referral to the local authority which is the lead agency in these matters since the last inspection. Care Homes for Older People Page 17 of 26 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 comfortable and has been refurbished with the needs of people with dementia in mind. Evidence: The home is an attractive listed building set in the country side some distance from the main road. There is an ongoing programme of redecoration. The manager said that they had tried to ensure that the environment was helpful for residents and had taken advice from the Alzheimers Society. Objects for residents to touch which may prompt memories are placed at eye level. A chosen photograph and larger font name is placed on residents doors to help them recognise their rooms. The communal areas are warm and well decorated. There are a number of places where residents can choose to sit, on their own or with company. There is a safe garden area at the back of the home. Residents are encouraged to personalise their rooms and many had chosen to do so. The central staircase is open and residents can choose to go up and down at will. One lady was observed to be having difficulty but was assisted by staff. This should be monitored carefully to ensure that residents are not at risk of falling. There are infection control policies and procedures in place and residents rooms have soap and hand towels for the use of carers and visiting healthcare professionals. Care Homes for Older People Page 18 of 26 Evidence: Residents have their own hoist slings and bed sliding sheets if they need them. Staff were observed to wash their hands and to wear gloves appropriately. There were no offensive odours in the home. A requirement was made at the last inspection to fit radiator guards to the radiators to reduce the risk of a residents sustaining a burn should they fall. This has now been done. Care Homes for Older People Page 19 of 26 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. People receive care from kind, well trained staff who can meet their diverse health and care needs in a timely way. Recruitment procedures are thorough protecting residents from unsuitable carers. Evidence: The staffing levels have improved since the last inspection. The manager said that she had been able to recruit good staff and did not now use agency or bank staff. There are six carers on duty in the mornings, fivein the afternoon and evening and three at night. Other members of the staff team help at busy times and at meal times. Those who returned the questionnaires said that they always received the help and support that they needed and commented that there is a warm, caring and friendly atmosphere in the home. Records showed that there is an active training programme. Staff had had training in safe working practices, including moving and handling and first aid. Six of the sixteen carers hold the National Vocational Qualifications in Care at level 2 and a further three will achieve this by the end of the month, meeting the standard that 50 of staff hold this qualification. The manager had led the dementia care training which staff felt gave them the skills and understanding that they needed to care for people with dementia. The recruitment files of two members of staff who had started at the home since the Care Homes for Older People Page 20 of 26 Evidence: last inspection were checked. All had the required documents. There was evidence that the staff members identity had been checked. Criminal Records Bureau disclosures and references had been sought before the staff member started work. The application form showed the staff members work history and interview records were kept. There was evidence that staff had had an induction programme. Staff told us that they were given the opportunity to attend training and one said we have built up a really good team. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed in the interests of residents. Evidence: The manager has been in post for eighteen months. She is an experienced care home manager who holds the National Vocation Qualifications in Care and Management at level 4 and 5. She has completed a Diploma in Dementia Care. Staff said that she had made an impact on the standards of care for residents. Family members commented that the home had improved considerably during the last year. There is a quality assurance programme in place. The manager regularly audits care plans and medication administration. The operations manager of Forest Healthcare, which now manages the home, visits regularly and records of his visit are kept in the home. The manager said that she was working on how to involve residents, families and others in evaluating the standards of care and ways in which they can influence life in the home. This should be further developed. Care Homes for Older People Page 22 of 26 Evidence: The company does not act as an agent for people or manage monies on behalf of residents. A small amount of money may be kept in the homes safe for safe keeping. Records are kept and receipts are given. There are health and safety policies and procedures in place. The annual quality assurance assessment sent to us showed that equipment and services are maintained regularly. Staff have training in safe working practices and regular safety checks of equipment, wheelchairs and fire safety are undertaken. Bed rails are only used where they are integrated into the bed frame, reducing the risk to residents from ill fitting bed rails. Radiators are covered and checks are made on water temperatures to reduce the risk of scalding. The manager has had training on the Deprivation of Liberty Safeguards which have recently been introduced to protect people whose liberty may be curtailed. She has sought the advice of the local authority which is leading on the implementation of these safeguards but has not yet had to make any referrals. Care Homes for Older People Page 23 of 26 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 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 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). 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