Care Home: Woodmead

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What the care home does well People benefit from a clear admission policy and full assessment of their care and support needs before they move in. People benefit from having their care and support needs set out in a plan of care. People have good access to healthcare professionals. Safe systems are in place for managing people`s medicines. People are offered a varied menu with plenty of choice. Staff members make sure that people`s privacy and dignity is a priority. Visitors are encouraged and people are supported to maintain good links with family and friends. Complaints and concerns are taken seriously and people are confident in telling the manager when things go wrong. Staff are confident in reporting any bad practice and referring any concerns about safeguarding people from abuse. People benefit from having sufficient care and support staff members available at times when they need them. Staff members have good access to a relevant training programme. People who use the service are protected from anyone who may be unsuitable to work with them by a robust recruitment process. Mrs Hill is an experienced manager and plans to develop the service further. What has improved since the last inspection? Mrs Hill is now registered as manager. She has worked hard to ensure that staff work as a team, improving the service for people who live there. Much effort has been made to ensure that the care plans are updated with an accurate record of people`s care and support needs. The new care planning format means that staff members can evaluate people`s care and support needs more easily without duplication of information or information being lost. The daily reports show that the care plans direct the care. Where people are assessed as at high risk of developing pressure damage and cannot move without staff support, care plans identify how often they need to be moved. Turn charts are filled out each time staff help someone who is at risk to move. Significant effort has been made to make sure that the home smells fresh and clean. Some commodes have been replaced whilst others have been refurbished so that they are cleaned more easily. People are benefiting from the many improvements and upgrading of the environment. We did not see any of the behaviour we had noted at the last inspection. Mrs Hill told us that she had reviewed the care of those people who were most challenging in their behaviour and they were no longer at the home. What the care home could do better: Whilst food and fluid charts are in place for people whose nutrition and hydration may be compromised, the records should show what amount of fluid should be achieved each day for monitoring purposes. All drinking vessels should be measured so that an accurate amount is recorded rather than recording `half a cup`. If people living with diabetes are monitoring their food intake themselves, this must be recorded in their care plan. All records and any amendments should be dated for monitoring purposes. Staff must always give first aid unless anyone has an Advanced Statement. Any advanced decisions are for the person to arrange with their GP. Relocation of the computer away from the front door to a more private would mean that more people would probably use it. Key inspection report Care homes for older people Name: Address: Woodmead 35 Portway Warminster Wiltshire BA12 8QQ     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: Sally Walker     Date: 3 0 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 37 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 37 Information about the care home Name of care home: Address: Woodmead 35 Portway Warminster Wiltshire BA12 8QQ 01985213477 01985216456 manager.woodmead@osjctwilts.co.uk www.osjct.co.uk The Orders Of St John Care Trust care home 48 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who may be accommodated is 48 The registered person may provide the following category of service only: Care Home providing personal care only (Code PC) to service users of either gender whose primary needs on admission to the home are within the following categories: Old Age, not falling within any other category Dementia over 65 years of age - Code DE(E) maximum of 10 places Date of last inspection Brief description of the care home Woodmead was originally opened in 1962. It is a residential care home, for up to 48 older people, 10 of whom may have a dementia. Originally managed by Wiltshire County Council, the home is now registered to the Orders of St John Care Trust. Mrs Sarah Hill was registered as manager on 7th October 2009. She had been in post since November 2008. Woodmead is situated on a main road close to the centre of Warminster. It is within Care Homes for Older People Page 4 of 37 Over 65 10 48 0 0 Brief description of the care home easy access of the shops, parks and community hospital. There is a small car park and street parking. Peoples bedrooms are located on the ground and first floor. All are single rooms but they do not have en-suite facilities. A passenger lift gives easy access to the first floor. There are comfortable communal areas consisting of a choice of lounge and dining room. There is an integral day service. Staffing levels are maintained at seven care staff members on duty during the morning and six care staff members during the evening. There are four waking night staff. Care Homes for Older People Page 5 of 37 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 quality rating for this service is 2 star. This means the people who use this service experience Good outcomes. This unannounced Key inspection took place on 30th December 2009 between 9:00am and 6:40pm. Mrs Sarah Hill, registered manager, was present during the inspection and received feedback on our findings at the end of the inspection. We looked at the report Mrs Hill sent us to let us know how she had addressed the requirements and recommendation we made at the last Key inspection of 6th January 2009. We spoke to people who use the service, staff and a relative. We looked at care planning documentation, risk management, accident reports, staff recruitment and training, staffing rotas, menus and medication. Care Homes for Older People Page 6 of 37 We asked the home to complete an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how they were performing. It told us about what has happened during the last year and about their plans for the future. As part of the inspection process we sent survey forms to the home for people who use the service, staff and healthcare professionals to tell us about the service. Comments are found in the relevant part of this report. We looked at information we had received since the last inspection to decide which areas to focus on during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? Mrs Hill is now registered as manager. She has worked hard to ensure that staff work as a team, improving the service for people who live there. Much effort has been made to ensure that the care plans are updated with an accurate record of peoples care and support needs. The new care planning format means that staff members can evaluate peoples care and support needs more easily without duplication of information or information being lost. The daily reports show that the care plans direct the care. Where people are assessed as at high risk of developing pressure damage and cannot move without staff support, care plans identify how often they need to be moved. Turn charts are filled out each time staff help someone who is at risk to move. Significant effort has been made to make sure that the home smells fresh and clean. Some commodes have been replaced whilst others have been refurbished so that they are cleaned more easily. People are benefiting from the many improvements and upgrading of the environment. We did not see any of the behaviour we had noted at the last inspection. Mrs Hill told us that she had reviewed the care of those people who were most challenging in their Care Homes for Older People Page 8 of 37 behaviour and they were no longer at the home. 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 37 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 37 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. People benefit from having a detailed assessment of their care and support needs before they move in. Evidence: New pre-admission assessment documentation had been implemented. Either Mrs Hill or the head of care carried out the assessments with people who were considering moving in. In the AQAA Mrs Hill told us we actively encourage a visit before the move so the resident is familiar with the surroundings and can feel at ease when moving in. One person told us they had come to look around before they moved in. We spoke with one person who used the respite service. They said they had enjoyed their stay and wanted to have a permanent place. In the AQAA Mrs Hill told us the focus on life history has proved invaluable. When going to assess a potential new resident the assessor with leave a life history document for the resident and family to have a look at and complete allowing the Care Homes for Older People Page 11 of 37 Evidence: team to have informed background knowledge of the resident. We were shown starter packs of toiletries which were given to everyone when they moved in. In a survey form one of the relatives told us I am happy I chose the right home for my (relative). Care Homes for Older People Page 12 of 37 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. A new care planning format means that peoples care and support needs are more fully documented and reviewed. Significant effort has been made to make sure the care plans are up to date. Risks are regularly assessed, with more evidence of assessing peoples risk of developing pressure damage, dehydration and malnutrition. People have good access to relevant healthcare professionals. Systems are in place to safely manage peoples medicines. Evidence: A new system for care planning and assessment had been introduced earlier in the month, so that all care and support needs could be assessed, identified and monitored. The pre-admission documentation had also been filled out with those people who already lived at Woodmead, so that the new care plan could be commenced. The records set out how each persons needs were to be met. There were no unclear statements as we had found at the last inspection. Peoples medical as well as social history was identified. There was good detail about how people communicated. Care Homes for Older People Page 13 of 37 Evidence: People could choose the gender of the staff member providing their intimate personal care and this was recorded in their care plan. One lady told us that male staff supported her with personal care. One gentleman told us that it was mainly female staff who supported him with bathing. He told us he had no preference. In the AQAA Mrs Hill told us we do not have any male residents who choose a male carer only for personal care tasks. This information would be gained at the initial assessment and decisions made as to whether the home could meet his need due to most care staff being female. Mrs Hill wrote to us to tell us how she was addressing requirements and recommendations from the last inspection. Mrs Hill told us that care plans for people with a diagnosis of diabetes had been updated following consultation with peoples GP and the nurse advisor on diabetes. She told us that some peoples GP had said that their condition was stable and did not need regular monitoring. She told us that some people were able to monitor their own food intake. We advised that this should be included in their care plan. However we consider that the requirement about detailed care plans is now met. In her report on how she was addressing requirements and recommendations from the last inspection, Mrs Hill told us that advice and training had been obtained from Wiltshire Sensory Team about supporting people with a visual impairment. Some people had had an assessment from the team and equipment ordered for their benefit. The Blind Association was also due to give support to those people identified. Staff told us about the training and different things they had done with the trainer so they could appreciate how people with a visual impairment experienced having their care provided. The activities co-ordinator told us that she provided each person in their bedroom with a large print copy of the programme for the week. Staff would then read this to those people with any visual impairment. We said that the website for the Royal National Institute for Blind People gives information about what type of print and backgrounds to use on written information, for easy reading. In her report on how she was addressing requirements and recommendations from the last inspection, Mrs Hill told us that food charts were in place for anyone who experienced weight loss. People were regularly weighed and any significant loss reported to their GP. Mrs Hill told us that following planned training in nutritional assessment in January 2010, the Malnutrition Universal Screening Tool would be implemented. Currently the organisations nutritional assessment tool was being used. Mrs Hill told us that all the milk supplied was now full fat, for peoples improved nutrition. She also told us that fluid charts would only be used if directed by the GP or Care Homes for Older People Page 14 of 37 Evidence: district nurse and would identify specific instructions about fluid consumption. We saw in one persons file a record that the GP had said to push fluids. However their food and fluid chart kept in the office had a line though the section for fluids. We then found that their fluid intake was being recorded on the immediate care chart in their bedroom. This recorded when the persons position in bed was changed. It was clear that staff members were also recording what the person had been given to eat and drink. We said that the record could be further improved if all drinking vessels were measured for more accurate monitoring. Mrs Hill told us that she would ask the GP what was an ideal amount of fluid for the person to achieve each day. There was good evidence that staff members were encouraging the person to maintain a good diet. We saw that those people we visited in their bedrooms had a drink within easy reach and their call bells near them. In her report on how she was addressing requirements and recommendations from the last inspection, Mrs Hill told us that care staff and kitchen staff were fully informed when anyone developed a pressure sore. Measures are put in place at the onset to prevent any skin damage becoming a graded sore. The care plan will reflect how the staff are dealing with the wound including the input from the district nursing team. The head of care told us about one example of where an area of broken skin had been healed recently. The district nurse had been involved immediately, an immediate care chart put in place and the area was healed within 6 days. We saw that a low air loss mattress was in place for one person who was assessed as having a high risk of developing pressure damage. We said that information about the right setting on any dial for this equipment should be gained from the district nurse. This would mean that the support for the person in bed was correct. We saw that some other people had pressure relieving cushions and mattresses in place. Body maps were used to record any marks or wounds, with details of size, colour and whether the skin was broken. Photographs had also been taken of some wounds. We advised that these record should be dated for monitoring purposes. At the last inspection we recommended that there should be evidence of twenty four hour and forty eight hour follow up assessment following a fall. This was so that any previously undetected injuries could be identified. We looked at the accident record to identify whether there had been any recent falls. We looked at one persons care records and found that they had been assessed regularly throughout the two days following the fall. Each entry about the assessment in the daily report had been highlighted. Moving and handling risk assessments were in place together with assessments of peoples risk of falls. One person had moved to a ground floor room to reduce their risk when using the stairs. Care Homes for Older People Page 15 of 37 Evidence: Risk assessments were in place for those people who went out alone or bathed and showered without staff support. Mrs Hill showed us the room which had been allocated as a treatment room for the district nurses. They came on a Monday and Thursday to provide regular treatments either privately in peoples bedrooms or in the treatment room. People were registered with either one of the two local surgeries. One person told us they either went to the surgery for appointments or their GP would visit them at home. Records were kept of the outcome of all medical appointments. Mrs Hill and the care leader with the delegated responsibility for medicines showed us the arrangements. We were told that no one currently administers their own medicines. The care leader said that people were happy to hand over the responsibility to staff members. We spoke with one person who wanted to administer a particular medicine. They said they had administered their own medicines when they were at home. They said they had not discussed the matter with anyone since they moved in a few years ago when were told that it was against company policy. We said they should pursue the matter again with Mrs Hill, the new manager. In her report on how she was addressing requirements and recommendations from the last inspection, Mrs Hill told us that care plans indicate that a resident is prescribed PRN (prescribed to be taken only when needed) medication and detail what it is for and how the resident will receive when required. In addition to the medicine administration record, there was a separate sheet where times were recorded when people took medicines prescribed for only when required. We saw that where people were prescribed variable dose medicines, the medicine administration record showed whether they had taken one or two. Mrs Hill told us that no homely remedies were used; people would be referred to their GP if they experienced coughs and colds. Staff members checked with new peoples GPs when they moved in to ensure they were taking the medicines that they were prescribed. Records were kept of all medicines received into the home and any unused or unwanted medicines returned to the pharmacy. Separate records were kept of administration of controlled medicines. The medicine administration record had flash cards for when medicines were controlled. Controlled medicines were checked each day to ensure the balances were correct. Mrs Hill told us that two senior staff took the lead on managing medicines. They had been trained by the organisation to monitor staff continued competency in administering medicines. In her report on how she was addressing requirements and recommendations from Care Homes for Older People Page 16 of 37 Evidence: the last inspection, Mrs Hill told us we have a qualified person in to train care staff to take blood sugar monitoring safely. He was due to return to capture those staff who did not make the training. There is a list in the medication room of staff competent to undertake this task. The head of care showed us their certificate of training in blood glucose monitoring. They told us that no one currently received insulin injections and in any case these would be given by the district nurse. In the AQAA Mrs Hill told us end of life care plans are being undertaken to give residents the opportunity to make some decisions and choices that they may not be able to make if they became poorly, this will allow the team, families and other professionals to be more person centred when making end of life decisions. Two staff members had completed an extensive course on supporting people who were dying. This was run by a local hospice. We saw in the care planning index, a section on whether people and their GP had made any arrangements for people not to be resuscitated. Mrs Hill told us that the forms had been sent to GPs but none returned. We advised that staff must always give first aid unless anyone had given the home a legal document, often referred to as an Advanced Statement. We advised that any advanced statements were for the person to arrange with their GP and it was not for the home to get involved. Mrs Hill told us that staff had received training in the Mental Capacity Act 2006 and an Independent Mental Capacity Advocate would be sought for any decisions about healthcare for peoples best interests if they could not decide themselves. One of the visiting relatives told us that staff were very, very caring. They are always there when needed. I can read the case notes. They said they would be told about any issue as they arose and dealt with things immediately. In a survey form one of the relatives told us I am very happy my (relative) is in Woodmead. She started in the day centre which was truly good for (her) which catered for her needs outstandingly and now she is a resident permanently. I know I have no worries as to her needs and welfare as they are all met with the greatest of care. Through my experiences with care homes Woodmead is the best. To me Woodmead is a very caring home and I do not think there is anything lacking that could be done better. The home is always clean and the staff are always welcoming and helpful. One of the GPs told us in a survey form: (Does well) Caring hard working staff who make efforts beyond their requirements on a regular basis to ensure patients are safe and happy. (Do better) When patients reviewed accurate and up to date information with current problems and medication accurately recorded or able to be relayed Care Homes for Older People Page 17 of 37 Evidence: verbally. Care Homes for Older People Page 18 of 37 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. Peoples interests and hobbies are known before they move in. A new activity coordinator with more hours means that the variety of different things for people to do is improving. People benefit from regular contact with family and friends. Decision making is encouraged. People enjoy the quality of meals and have a healthy diet. Evidence: Most people chose how they spent their day; others relied on staff for direction. One person told us they went out most days into town and would have a beer in the pub. We asked them if they had a key to the front door. They told us they were happy to ring the bell and for staff members to let them in. They told us they had a key to their bedroom. In the AQAA Mrs Hill told us the home is undertaking an ongoing project of life history work and this is an excellent way of residents maintaining their individuality. It also promotes diversity and ensures that the staff are aware that every resident is treated as an individual with different beliefs, culture and wishes. The ongoing life history work is being directly incorporated in personal plans. This allows staff to meet the social needs of residents especially those with dementia or memory problems. By tailoring daily tasks and activities we are ensuring residents maintain their own Care Homes for Older People Page 19 of 37 Evidence: identity and personality. A new activities co-ordinator had recently been appointed for thirty hours a week. They showed us the weekly activity programme that they were printing out to give to everyone. They told us they had attended training in activities since coming to post and other training was planned for March 2010. They said they geared each sessions for the best outcome for individual people; memory or physical games. They said they would work individually with those people who did not want to join in with the group work. They told us they would chat with the ladies whilst painting their nails. They also said that some of the gentleman enjoyed having hand massages. During the morning we saw that people in one of the sitting rooms were involved in a game throwing bean bags into a slotted board. This board was taken to people where they sat in the room. The activities co-ordinator said they would provide a group session in the mornings; people particularly liked quizzes. Individual sessions took place in the afternoon. They told us they planned to take people out as the weather improved. One person showed us the baby clothes they were knitting. Mrs Hill told us there was a manager from the organisation who arranged different inter-home or central entertainments. In the AQAA Mrs Hill told us that outings were planned following comments from people at the residents meetings. The activities co-ordinator told us that there were fundraising events for the amenity fund which paid for activities. They said they found that there was a range of resources to use; including games and art and craft materials. One of the staff members told us that people had recently planted bulbs in tubs for the front entrance and the patio. In the AQAA Mrs Hill told us a gardening and cooking club has been reintroduced to the activity programme and it is evident that more residents now come to the lounge areas during the day to interact with fellow residents rather than choosing to stay in their own rooms. People and their relatives were contributing to life histories both as part of the preadmission assessment and with those people already living at Woodmead. This meant that peoples interests and hobbies were known. There were photographs on notice boards of people being involved in different activities and outings during the last year. There were also albums with photographs of involvement in activities. Mrs Hill told us that these were made available when relatives visited so they could discuss the different things people had done. One of the relatives told us that they joined in with the activities. One person told us about an outing to Boscombe during the summer. They said they Care Homes for Older People Page 20 of 37 Evidence: had really enjoyed it and would like to go on more trips. They said they enjoyed the fish and chip supper on the way home. They said they also went to the local pub recently for a skittles match. They told us I would like to go to the park for a picnic. They told us about going to another home in the organisation for a concert party. Mrs Hill told us that staff members were starting a project following a recent dementia conference held by the organisation. One of the sitting rooms was being transformed into a dedicated activities room and a rummage box would be available for people to access different things to stimulate memory and discussion. Mrs Hill told us that one person who uses the service and was well travelled, gave regular slide shows of places they had visited. There were various bookcases around the home with large print books for people to help themselves to. We asked people whether they used the computer, sited by the front door. No one said they used it. One person said they had not been shown how to use it. Mrs Hill told us that one of the staff was going to do a computer course so that people could be shown how to use it. She also said that a staff member had shown people different pictures and information to be found on the internet. We advised that it was probably not sighted in an accessible or private place, by the front door. Everyone we spoke with made very positive comments about the food. One person said they make lovely custard. You always have a choice. Today its something with onions, which I dont like, so Im having the gammon with green beans and mashed potato. Then Im having a lighter tea. The manager brought my breakfast this morning. I have a boiled egg each morning. Another person told us that there were always two choices for each meal, except for on a Sunday lunchtime when there was a roast dinner. They told us they went to the dining room for breakfast and that staff would bring a meal to their room if there was something they wanted to watch on television. We looked at the menus which showed a cooked breakfast each day, choice at each meal, with vegetarian options and salad. In the AQAA Mrs Hill told us that the chef sought peoples feedback on the meals and made changes to the menus. Mrs Hill showed us the dessert trolley which had been a success with people able to see the range of sweets of offer. We were told that no one needed full assistance to eat their meals at the dining room table. Mrs Hill said that some people might need some initial encouragement. She went on to say that staff would now sit with people when they were supporting them to eat and no staff would support two people at the same time which was what we had seen last time we inspected. The meal was well presented and looked appetising. Care Homes for Older People Page 21 of 37 Evidence: People told us that it was tasty. Wiltshire Council Environmental Health Department had awarded the homes kitchen five stars at their last inspection. In a survey form one person told us that they wanted more activities, soon to be rectified. More use of local activities, library, park, baths. One of the relatives told us in a survey from: My (relative) has Alzheimers and the home gives her excellent care. I have completed the form on her behalf as she is unable to do so. (Do better) An information form with dates of hairdresser, chiropractic etc and who does what in home and setting out the process and rules re taking out your relative and who takes care of doctors appointments etc. Another relative told us that they wanted more places for visitors to sit with their relatives when they visit. More activities in the afternoons. Mum finds it hard to be with large groups, so maybe smaller groups for activities. A further relative told us in answer to the question about what the home could do better Food - choices and fresh foods and vegetables. Care of personal clothing/laundry. Supervision of some residents with dementia with regards to personal goods and space (understandably difficult). Care Homes for Older People Page 22 of 37 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 know that their complaints are taken seriously and fully investigated. Staff members are confident in reporting any abuse or poor practice. Evidence: The organisations complaints procedure was displayed in the entrance hall. Action had been taken to address the recommendation we made that letters to a complainant should state precisely when the person could expect a reply, in accordance with the homes procedure. The complaints log showed full investigations, action taken and responses to complainants. In the AQAA Mrs Hill told us the number of complaints has gone down this year. This may be due to the fact hat the home deals with small issues before they become cause for concern resulting in a complaint. Communication has improved with the families and they feel comfortable in passing on any concern they may have with confidence. One person told us about a complaint they had made. They said it was dealt with by Mrs Hill and the event had not happened since. The person told us that they could talk to Mrs Hill at anytime and that they were confident in putting any complaints to her. One of the visiting relatives told us they answer concern promptly. Theyve always done it when I asked. The staff are very approachable and Sarah (Mrs Hill) keeps her door open. They told us that they were able to look at the records kept of the money held for their relative so that they knew what it was spent on. Care Homes for Older People Page 23 of 37 Evidence: We did not see any of the behaviour we had noted at the last inspection. Mrs Hill told us that she had reviewed the care of those people who were most challenging in their behaviour and they were no longer at the home. In the AQAA Mrs Hill told us over the past year a number of residents have moved to alternative accommodation as a result of changing need the home constantly reviews needs and will actively ensure that all needs can be met. We looked at the recording arrangements for people to keep small amounts of money in the safe. At the last inspection we recommended that receipts should reflect the transactions made with peoples money. We saw that handwritten receipts identified each transaction and shopping receipts automatically identified purchases. The balance sheets had records of what had been purchased. We asked staff about the local safeguarding procedures. They were quick to tell us how they would report any allegations or observations of abuse. They also told us that they would report directly to the safeguarding unit or care manager if senior management was not available. Mrs Hill gave us examples of staff using the whistle blowing process which resulted in people being protected by unsuitable staff. The contact details of the safeguarding unit were prominently displayed on the office notice board. Mrs Hill told us that potential staff were asked questions about safeguarding people at interview. Staff members told us they had received training in safeguarding vulnerable people from the police at the local safeguarding unit. Care Homes for Older People Page 24 of 37 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. Significant effort has been made to upgrade the environment for peoples benefit. One significant improvement has been eliminating unpleasant odours. Further improvements are planned. People benefit from a clean, well maintained and more comfortable home. Evidence: All of the bedrooms are singles, although none of them have ensuite facilities. Bathrooms and toilets were nearby. People had personalised their bedrooms with small items of furniture and pictures. One person said they were waiting for shelves to be put up so they could display their ornaments. In her report on how she was addressing requirements and recommendations from the last inspection, Mrs Hill told us many carpets have been replaced along with either refurbishment or renewal of many commodes. We now have a full compliment of housekeepers led by a head housekeeper. This ensures that all areas are kept clean and odour free. Any odours that occur are dealt with without delay on an ongoing basis. When we first arrived at the home and indeed throughout the inspection, we did not notice any unpleasant odours in any part of the building. Mrs Hill told us that having a head housekeeper meant that checks were made on different parts of the building to make sure they were clean and fresh. She said that one staff member had the delegated responsibility for continence management and had ensured that people Care Homes for Older People Page 25 of 37 Evidence: had been reassessed to make sure they had the correct continence aids. Bins were available in some bedrooms and all toilets and bathrooms for disposal of continence pads. The housekeepers and care support staff helped with bed making. In her report on how she was addressing requirements and recommendations from the last inspection, Mrs Hill told us new commodes have been bought with procedures in place to ensure they are emptied as soon as possible after use. We spoke with one person who confirmed that their commode was emptied when they had used it. They told us the staff dont mind emptying it. I just ring this. Mrs Hill also told us the refurbishment of commodes has taken place enabling the care team to keep them clean in line with infection control guidelines. Rooms are checked by care staff and housekeepers to ensure residents who change their own continence pads in their rooms are removed as soon as possible. Small pad bins with liners are provided for their use to minimise any odours. Mrs Hill told us that she had decided not to implement our recommendation from the last inspection about installing a washer disinfector for commode buckets. She said she had found that only one or two buckets could be put through the machine at a time and the operation was time consuming. She said she concluded that this was not efficient for the homes needs. As a consequence, Mrs Hill had purchased new buckets and commodes and arranged a cleaning schedule which meant that the commodes were emptied and cleaned individually soon after use and returned directly to the person. We looked at commode buckets in some of the rooms and confirmed that they were cleaned to a satisfactory standard. In her report on how she was addressing requirements and recommendations from the last inspection, Mrs Hill told us care staff and housekeeping staff are aware that all linen must be clean. Some residents make their own beds and are not always aware that sheets may be soiled. Staff are aware who these residents are and discretely check to ensure the linen is fresh. We saw that peoples beds were made with clean sheets. Large flat screen televisions had been installed on the walls in the sitting rooms so that everyone could see the screen. Peoples names and pictures of things they were interested in were displayed on individual bedroom doors. Large signage was also displayed around the home so people could know where things were. We saw that new pictures had been put up around the home, making the environment more interesting. We thought that some of the pictures should be re-hung at eye level Care Homes for Older People Page 26 of 37 Evidence: for peoples benefit. New seating had been purchased for the sitting rooms. We saw that laundry carts were available to housekeepers. This meant that laundry was now sorted at source and not in the laundry room. People who we spoke with told us they were pleased with the laundry service. The home now had a member of staff employed to undertake laundry. The housekeepers had been provided with cleaning carts with a removable bin liner section and space for brushes, cleaning liquids and other cleaning equipment. There were disposable gloves and aprons available. Mrs Hill told us that the sluices were due to be upgraded over the coming months. The organisations property department had assessed the bathrooms and toilets for gradual replacement and upgrade. We saw one of the bathrooms which had recently been refitted with a specialist bath and the new accessible shower room. New windows would be included in the refurbishment plan. There was a hairdressing salon with a professional hairdresser visiting on Mondays and Wednesdays. One person was very pleased to show us that they had had their hair cut and styled that morning. The old style fitted wardrobes were gradually being removed. Vanity units, freestanding modern wardrobes and chests of drawers had been made available in the bedrooms. There were plans to move the medicine storage room which would then be fitted out as a small kitchen, where people could be provided with tea and coffee making facilities. There was a servery in the annex where meals were served and people could make hot drinks. A quiet room was planned where people could meet with visitors and have hot drinks. Care Homes for Older People Page 27 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff members are available at times when people need them. Staff have good access to relevant training. A robust recruitment process protects people from anyone who is unsuitable to work with vulnerable people. Staff have established good relationships with people who use the service. Evidence: The care staffing rota showed that there was a minimum of six care staff members with a care leader during the mornings. During the evenings there were five care staff and a care leader. Two care staff members were allocated to work with the nine people who lived in the annex. There were four waking night staff. The day service was separately staffed. There was a cook, a kitchen assistant, one housekeeper and handyman on duty. The head of care told us that one of the housekeepers was on sick leave and cover had not been found. There was a housekeeper due in for the afternoon shift. A head of care had the delegated responsibility of managing the day to day care and support for people who use the service. Mrs Hill told us that the post was temporary until one of the four care leaders retired in the new year. Mrs Hill told us that two care support staff had been appointed. This role was in carrying out bed making, help with meals and light cleaning. These staff members did not provide personal care. Care Homes for Older People Page 28 of 37 Evidence: Two staff members told us they had received a good induction into their roles. We saw from staffing records that all the information and documents required by regulation were obtained when recruiting new staff. Mrs Hill kept a record of when she had checked all the documents needed when applying for a Criminal Records Bureau certificate. No one started working until checks on their suitability to work with vulnerable people was established by a negative Criminal Records Bureau certificate. One person told us you never get the same service from agency staff. We asked whether there was a lot of agency staff use. They told us that only when staff were extremely pushed or understaffed. In the AQAA Mrs Hill told us that following permanent appointments there was less use of agency staff. She told us that the aim was to stop using agency staff altogether. Mrs Hill told us that all of the care and support staff had completed the organisations dementia training. She went on to say that the organisation was now looking at a more advanced training programme in association with the Alzheimers Society. In the AQAA Mrs Hill told us that five staff had attended the organisations recent dementia conference. One of the staff is the homes dementia champion and meets with other staff in the organisation to discuss dementia care. Mrs Hill told us that eleven staff members were undertaking NVQ Level 2. There was a computer available for staff members to access the e-learning programmes provided by the organisation. One staff member told us about the recent training they had undertaken including: infection control, moving and handling, blood glucose monitoring, dual sensory loss, stoma care, death dying and bereavement and fire safety. They told us that some of the training was via a DVD and questionnaire or from an outsourced specialist. The head of care was qualified to teach moving and handling. They told us they had the delegated responsibility for doing some in house training. They also discussed each staff members training need during supervision. There was a training matrix which showed mandatory course and when updates were due. The organisations training lead also sent a list of which courses were available month by month. Senior staff had been trained in leadership skills. In the AQAA Mrs Hill told us staff have training on equality and diversity and work hard to ensure individuals are not discriminated against. The organisation has provided a counselling service for staff. Everyone we spoke with made very positive comments about the staff. One person described the staff as very friendly. They were not aware of having a keyworker when we asked them. They said they were looked after by everyone. In a survey Care Homes for Older People Page 29 of 37 Evidence: form one person told us Friendly and cheerful staff. We saw that staff members engaged with people, some spending time sitting and chatting. We saw that staff members knocked on peoples bedroom doors before being invited to enter. One of the visiting relatives told us staff are marvellous, fun, they have time for mum. There are more staff now. In a survey form one of the relatives told us When we visit at the weekend there never seems sufficient staff on duty to care for all the residents. Sometimes there is no help in the lounge. A warm and friendly home. Excellent staff who work hard. Always someone to speak to if I need information about my mother who has dementia. Care Homes for Older People Page 30 of 37 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. People benefit from having a manager who has improved the service over the last year. The home is run in peoples best interests. Staff benefit from regular supervision. Everyones health and safety are well managed. Evidence: Mrs Hill had managed the home since November 2008, when she moved from managing another home in the organisation. She had four years in her role as a manager in three different homes run by the organisation. Mrs Hill is the second manager to be appointed in the last three years. Mrs Hill was registered as manager for Woodmead on 7th October 2009. Mrs Hill had the Registered Managers Award and NVQ Level 4 in management and care. She told us that she had decided not to commence any further qualification at the moment, so she could concentrate on further improvements for the home. Mrs Hill said she continued to seek training and had recently undertaken training in: deprivation of liberty safeguarding standards, the Mental Capacity Act 2005, first aid, train the trainer and recruitment and selection. Care Homes for Older People Page 31 of 37 Evidence: Mrs Hill was supported by an administrator from a nearby home as her administrator was on long term sick leave. One person told us about the monthly residents meetings. They said they talked about the meals and activities. They also said the trouble is, some people dont speak up. We asked them whether they had contributed to the organisations annual survey questionnaire. They had no recollection of filling out a questionnaire. They went on to say that the home was improving greatly since Mrs Hill came to post. Minutes of the meeting were posted on notice boards around the home. The organisation carried out the annual quality audit of the home. Questionnaires were sent to people who used the service and other stakeholders. The organisation then completed an action plan which was sent to Mrs Hill. In the AQAA Mrs Hill told us the action plan is shared with all of the team so they are aware of views and opinions of our residents. As the manager I walk around the home on a daily basis. This has made me accessible to the residents and opened another forum for dialogue enabling residents to share thoughts or off the cuff comments about the service we provide. The home produces a regular newsletter that is distributed to residents. We saw from the AQAA that the unannounced monthly visits under Regulation 26 were carried out by an employee from another home, rather than senior management in the organisation. We thought that other managers may not be as critical as senior management when carrying out these visits. Staff told us that they received regular supervision. Mrs Hill kept a plan of when the sessions took place throughout the year. Records were kept of supervision in staff members personal files. Mrs Hill showed us the records she kept of falls monitoring each month. She showed us the board in the office where staff recorded any falls and when peoples families were informed. We also saw the highlighted record in the daily reports where people were monitored after a fall. Mrs Hill told us that the handyman had the delegated responsibility to carry out and review the environmental risk assessments. He had been trained to do this. There were generic risk assessments provided by the organisation, with individual risk assessments relating specifically to the home, tasks that staff were involved in or events in the locality. In a survey form one of the staff told us Improvements are there to see and feel with our new manager. I am proud to work at Woodmead. I think the manager is doing an outstanding job for the needs of the residents and staff. Another staff member told us Although greatly improving there is still times when communication is not at its best. Care Homes for Older People Page 32 of 37 Evidence: I believe Woodmead has greatly improved over the past months. Care Homes for Older People Page 33 of 37 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 34 of 37 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 When people living with diabetes are monitoring their food intake themselves, this must be recorded in their care plan. Enabling people to maintain choice and control. 01/03/2010 2 8 13 Staff must always give first aid unless anyone has an Advanced Statement. Any advanced decisions are for the person to arrange with their GP. Ensuring people wishes are recorded and followed. 01/03/2010 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 8 Fluid charts should indicate the amount of fluid to be achieved each day, for monitoring purposes. All drinking vessels should be measured so that an accurate amount is recorded rather than recording half a cup. Page 35 of 37 Care Homes for Older People 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 2 13 Consideration should be given to moving the computer from the front entrance to a more private and accessible space, so that people are more likely to use it. All records and any amendments should be dated for monitoring purposes. 3 37 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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