Care Home: Woodstock Residential Home

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What the care home does well The premises are suitable for the care of residents. Residents are helped to lead an active life. Members of staff receive good training and support from the owner organisation to help them meet the support needs of residents. Care plan records reflect the needs of residents and their aspirations. These contain extensive information about how residents are progressing, aims of care identified by staff and agreed with residents (where this is possible), their health requirements and risks associated with their daily living and activities. Prospective residents receive a pre-admission assessment during which they (or an advocate) receive information about how their support needs can be addressed. Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Procedures in place serve to form the basis for protecting staff from abuse. What has improved since the last inspection? The AQAA outlined how staff awareness of lifestyle issues has been raised through training and staff meetings. The report refers to continue to enhance the internal and external environment for the benefit of residents, staff and visitors, towards aspiring to become a centre of excellence in the provision of dementia care, improving liaison with district nurses and providing further personal development and support for staff. There was evidence that End-of-Life support is being progressed, quality assurance procedures are involving users of the service and notice is being taken of feedback, domestic and catering staff have completed an NVQ qualification as pert of their development and liaison with healthcare and social care professionals is progressing. The improvements to the premises are continuing. What the care home could do better: This report contains no formal requirements or recommendations. The issues regarding the dispersed nature of the premises, two separate accommodation sections serving residents with differing support needs and possible pressure on the six care workers (with an additional team leader associated with each of the two sectors) on duty were discussed with the manager and quality assurance manager. It is possible that a resident, given the above pressures, could fall, sustain serious injury and remain without immediate medical assistance for some time. It would be prudent to recognise these potential issues relating to client safety when assessing staffing levels and providing sufficient personal development for staff to react properly in every circumstance. The Commission believes that these issues are recognised by the service and that, for example, future close co-operation with healthcare agencies will contribute to the aims of the service in this regard. Key inspection report CARE HOMES FOR OLDER PEOPLE Woodstock Residential Home 80 Woodstock Road Sittingbourne Kent ME10 4HN Lead Inspector Eamonn Kelly Key Unannounced Inspection 11:30 23rd June 2009 DS0000065797.V375803.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 2 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 Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodstock Residential Home Address 80 Woodstock Road Sittingbourne Kent ME10 4HN Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01795 420202 01795 477 465 woodstock@nellsar.com Nellsar Ltd Mrs Gail Edey Care Home 60 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: Old age, not falling within any other category (OP) 2. Dementia (DE). The maximum number of service users to be accommodated is 60. Date of last inspection 31st October 2007 Brief Description of the Service: Woodstock provides support for up to sixty older people. There are two separate accommodation areas in the premises. One part (The Lodge) contains bedrooms and communal areas for people with the onset of dementia. Information about services at these premises and elsewhere within the group may be obtained from the website www.nellsar.com. There are two passenger lifts and a third will be installed soon. Most residents have single bedrooms but some shared bedrooms are also available. Information about weekly fees and other charges may be obtained from the manager as can a copy of a resident’s guide that has information about services and facilities. Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Star. This means that people who use the service experience good quality outcomes. The inspection took place on 23rd 2009. It comprised discussions with the manager, care workers on duty and residents at the premises. Care practices were discussed and most parts of the premises were visited. Some records were seen during the visit principally those addressing the personal and healthcare support of residents. The Commission received an annual quality assurance assessment (AQAA) from the manager. This provided good information about how residents are currently supported and how the service is being developed. Information was also received from the home’s activities organiser and from a visiting NVQ Assessor during the inspection and this contributed to this report. The owner organisation’s quality assurance manager also contributed to a number of issues raised during the inspection. The previous report from 2007 and the Commissions annual service review of 2008 were checked as part of this inspection. The evidence of the inspection visit and that contained in the AQAA (annual quality assurance assessment) indicated that significant progress is being made in the interests of resident welfare and comfort and towards meeting the overall objectives of the service. This report contains no recommendations or requirements. What the service does well: The premises are suitable for the care of residents. Residents are helped to lead an active life. Members of staff receive good training and support from the owner organisation to help them meet the support needs of residents. Care plan records reflect the needs of residents and their aspirations. These contain extensive information about how residents are progressing, aims of care identified by staff and agreed with residents (where this is possible), their health requirements and risks associated with their daily living and activities. Prospective residents receive a pre-admission assessment during which they (or an advocate) receive information about how their support needs can be addressed. Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 6 Procedures in place serve to form the basis for protecting staff from abuse. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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. Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1-6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre-admission assessments are made to enable a support programme to be offered and subsequently followed. The service provides residents, relatives and advocates with the information they need to make a decision about entering residential care. EVIDENCE: The AQAA (annual quality assurance assessment) prepared by the manager to assess the current service to residents and to identify areas for improvement stated that efforts are being made to encourage residents to live as independently as possible and to receive the levels of support they need to enable this to continue. This is in line with the aims of the service as outlined in its statement of purpose. Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 9 The information available to potential new residents and their representatives has been updated. Advocates are also able to obtain information about the service and other associated services provided by the group from a website. The AQAA stated that “the home has developed a comprehensive statement of purpose and service user’s guide, which is very specific to the resident group and considers the different styles of accommodation, support, treatment, philosophies and specialist services required to meet the needs of people who use the service. The information is in a format suitable for their and their families’ needs, using, for example, appropriate language, pictures or Braille”. The evidence from resident files seen during the inspection was that careful consideration is given during the time when an admission is being considered. This includes carrying out a range of activities involving the potential resident, advocates, medical practitioners and care managers. Following this, a series of observations is carried out to enable staff to compile a care plan and up-todate risk assessments. From the examples of records seen and individual profiles discussed, these are subject to constant amendment as the needs of the resident are assessed over time and the corresponding care plan and risk assessments are refined. Each resident is provided with a contract that outlines the main aspects of the responsibilities of both parties. The AQAA stated that plans for the future included the availability of information on the Mental Capacity Act and Deprivation of Liberty Safeguards in audio format and large print. A similar easy read style for the resident guide to services and facilities is also planned. Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive good personal and healthcare support. EVIDENCE: The evidence from care plan records and discussion of individual profiles of five residents indicated that residents receive good healthcare support. This includes access to GPs and NHS healthcare facilities. Regular appointments are seen as important and systems are in place to ensure they are not missed. The home arranges for health professionals to visit residents at home when necessary. There is good quality planning and support for residents. The care plans seen during the inspection had good information for carers in the event of having to deal with episodes of various conditions associated with individual residents. Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 11 The Regulation 26 report, in one of the examples case-tracked, indicated that a resident’s apparent deafness could be caused by wax and the support notes stated that district nurses had been asked to address this at their next visit. Support workers have a high level of awareness of resident’s personal and healthcare needs: the manager indicated that each member of staff must have detailed knowledge of identified needs and how these are to be addressed. The staff supervision process, from the examples discussed with the manager, contribute to helping staff in this important area of practice. Records relating to support, care and risk assessments, as working tools for staff, are intended to contribute to this objective. Medication is securely stored and MAR sheets are updated when medicines are administered. Procedures have been reviewed and the manager is confident that current procedures are effective. Residents could keep their own medicines if, as part of a recorded risk assessment subject to review, it was safe for them to do so. Members of staff who deal with any aspect of medication administration have completed an RVQ Certificate in Handling of Medicines. Resident’s individual plans record their personal and healthcare needs and outline how these are being met. The evidence during the inspection was that members of staff ensure that personal support is flexible, consistent and able to meet the changing needs of residents. Examples were observed of how they know and respect resident’s preferences. The home has a detailed policy, procedure and practice guidance to help staff when caring for residents with degenerative or complex physical or mental health conditions. Members of staff receive practical support and advice and have opportunities to discuss any areas of anxiety and concern they may have about how residents are improving or otherwise. Members of staff are obtaining opportunities for gaining meaningful qualifications in resident care and support, for example, RVQ Certificate in Dementia Care, Certificate in Infection Control, Certificate in Administration of Medicines and NVQ Levels 2 and 3. There was evidence that the staff team reviewed all aspects of residents personal and healthcare needs over the past six months. This was evidenced through discussion of three residents profiles. The extensive nature of care plan and healthcare records and AQAA reflections contributed to this conclusion. A Kent County Council contracting officer has liaised with the home’s manager and quality assurance manager recently to enable resident’s support plans to become more valid operational tools as part of normal routines of care and intervention. The AQAA outlined how changes have been made over the past six months to improve medication procedures, a revised medication system that has in the opinion of the quality assurance Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 12 manager reduced the likelihood of errors and contains more frequent medication audits and a tracking system for use of PRN. Part of this tracking system was discussed during the inspection. The AQAA refers to how risk assessments have been updated and to how they form part of the individual care plans. Information is outlined on how staff training in health matters and individual health action plans are now seen to be giving residents more control over their own health with the support they need. Discussion with the manager and quality assurance manager about the background to adult protection referrals suggested that procedures are being adopted to lesson the chances of resident’s injuries from falls. An outcome is that risk assessments are being updated and GP/hospital assistance is obtained immediately. The AQAA stated that the service is “highly efficient when caring for residents who are terminally ill or dying. The wishes of individual’s about dying and terminal care and the arrangements they want after death are openly and sensitively discussed during the development of a person centred plan of care. Members of staff are proactive and are sensitive to the particular religious or cultural needs of the individual or their family. These are clearly recorded, respected and known to the staff delivering the care. The home has a detailed policy, procedure and practice guidance to help staff when caring for residents with degenerative conditions, terminal care and death. All carers receive inhouse training and practical advice and have continuous support and opportunities to discuss any areas of anxiety and concern … We have encouraged relatives to work with staff in signing End-of-Life care plans and we are starting to look at care options at End-of-Life stages where residents have dementia”. In relation to provision of meals, the AQAA stated that “We have listened to our residents and have expanded choice and preferences at mealtimes… Staff are starting their training of Certificate of Personal Exercise and Nutrition and implementing appropriate exercise programmes for the individual resident”. During the inspection, kitchen staff showed how they publish the planned meals for the day for residents to read easily, how they obtain each resident’s choice of meal that day and how residents receive the meal they requested. The activities organiser conducts a “guess your weight” competition regularly and this contributes towards the process of recording weight loss/gain and any subsequent health outcome to be considered. Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive support in keeping physically and mentally active. EVIDENCE: A fulltime activities organiser conducts a variety of activities for the benefit of residents. There are individual activities (puzzles, board games), small group sessions (reminiscences, arts and crafts, and outings) and one-to-one discussions. The service has access to a 14-seater vehicle for outings. Examples of outings planned were shown on notice boards and there is good take-up on events. Some residents prefer to spend a greater deal of their time in their own rooms. On this occasion, there were many activities underway including use of extensive garden facilities. Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 14 Residents have access to newspapers, magazines and large print library books and many have audio/TV facilities in their rooms. A number of visitors met their relatives in the premises and in the garden. Relatives say that they are made welcome when they visit. In relation to provision of meals, the AQAA stated that “We have listened to our residents and have expanded choice and preferences at mealtimes… Staff are starting their training of Certificate of Personal Exercise and Nutrition and implementing appropriate exercise programmes for the individual resident”. During the inspection, kitchen staff showed how they publish the planned meals for the day for residents to read easily, how they obtain each resident’s choice of meal that day and how residents receive the meal they requested. The activities organiser conducts a “guess your weight” competition regularly and this contributes towards the process of recording weight loss/gain and any subsequent health outcome to be considered. The AQAA stated that “routines, activities and plans are person-centred, individualised and reflect diverse needs within six strands of diversity: gender (including gender identity), age, sexual orientation, race, religion or belief, and disability. They are regularly reviewed, and are very responsive to individuals changing needs, choices and wishes… the service actively encourages and provides imaginative and varied opportunities for people using the service to develop and maintain social, emotional, communication and some independent living skills. The service has strong and highly effective methods, which focus on involving residents in all areas of their life, actively promoting the rights of individuals to make informed choices and providing links to specialist support when needed. This includes developing and maintaining family and personal relationships”. The evidence of the inspection that these statements are being realised through the activities and personalised support referred to above. Whilst the service provides two separate sectors within the premises for supporting residents with differing support needs (ie. The Lodge/Woodstock), residents are not closely confined within the sections. A resident, for example, could have a bedroom in the Woodstock sector but spend most of his/her time in The Lodge sector. Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16-18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are protected from abuse. The service asks people (residents, visitors and advocates) for their views, listens to the responses and acts on these where necessary. EVIDENCE: The service has a complaints procedure and residents are encouraged to express any views they have. The AQAA stated the home “encourages service users and their relatives to express their views, comments, complaints and suggestions, in order to enhance the service. It has notice boards …throughout the home… regular meetings with service users and their representatives to discuss issues are held…”. Examples discussed with the quality assurance manager suggested that careful consideration is given to outcomes of direct contact with users of the service. Discussion with the manager and quality assurance manager about the background to adult protection referrals suggested that procedures are being adopted to lesson the chances of resident’s injuries from falls. An outcome is that risk assessments are being updated and GP/hospital assistance is obtained immediately. One such outcome is that concentrated efforts are being made to Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 16 enable liaison with District Nurses to be optimised for the benefit of staff and residents. Policies and procedures for safeguarding adults are available to all members of staff and these give specific guidance to those using them. Staff working at the service said they know when incidents need external input and who to refer the incident to for guidance. The manager and quality assurance manager are confident that support workers and team leaders understand local authority procedures for Safeguarding Adults. The Commission is notified of incidents that occurred and reflection on these is reportedly used as part of quality assurance measures for the protection of residents. The recruitment procedure contains the checks (including CRB checks) necessary to help contribute to the protection of residents and all members of staff receive training for their responsibilities under current POVA arrangements. The AQAA stated that all members of staff are aware of the rights of residents and of how their interests must be identified and promoted. It outlined how the companys quality assurance system focuses on issues consistent with current care standards with emphasis on making residents quality of life progressively better. It also highlighted the fact that current stable management conditions have had a positive effect on residents and on the staff team and the evidence of the inspection supports that conclusion. Reference was also made to staff guidance on relevant aspects of the Mental Capacity Act and how essential procedures might be affected as these measures come into being more fully. The quality assurance manager implements measures across all homes in the group to obtain feedback from users of services. Results are made available to individual managers. Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 People using the 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 premises are suitable for the care and support of residents. EVIDENCE: Renovation and improvements to upgrade the premises are continuing. Flotex-type flooring to communal areas and bedrooms is being fitted to enhance infection control. Wall colouring in some bedrooms and bathrooms are being changed as part of general upkeep and also as part of efforts of improving visual recognition for residents with the onset of dementia. Two lounges have been decorated with new curtains and new lighting. A 2nd Sluice room has been added to minimise the need to walk through the home with clinical waste. New door opening devices have been fitted to most bedroom Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 18 and communal area doors. New signs for bathroom doors are being fitted and up-to-date photographs set in frames have been prepared for bedroom doors. The AQAA stated that, as a result of consultation and reflection, the following improvements have taken place: • • • • • • • • • Planting in the rear garden to include seasonal colours. Large notice board in the dining area to display daily menu in large print. Raised flower beds to allow residents to plant flower beds for the summer. 18 sets of bedroom furniture purchased to enhance resident’s bedrooms. New flat screened television with Freeview fitted in lounge for those residents who like the sport channels. New large wooden gazebo purchased for the garden to further enhance the seating areas and allow wheelchair access. All toilet and bathrooms equipped with red pull cords for the light switches for increased visual awareness. New parker bath installed. Improved lighting in toilets, bathrooms, corridors and lounges to assist with visual awareness. The AQAA outlined planned improvements over the next year as, for example: 1. General areas of the premises to be refurbished. 2. An additional two bedrooms to be refurbished that will include en-suite facilities. 3. Upgrading of communal lighting to enhance visual perception. 4. Further refurbishment of the section of premises where most people with dementia are accommodated. This area is recognised as currently in need of such upkeep. 5. Red toilet seats installed throughout the premises to aid visual perception and 5. Installation of a third passenger lift. The premises were free from offensive odours and the evidence was that close attention is given towards keeping all the premises clean and tidy at all times. At the time of the inspection visit, the manager undertook to rearrange the storage of food from an area that was unsuitable. The service has excellent laundry facilities. The external facilities provide many options for staff, residents and visitors and these facilities were being extensively used at the time of the inspection visit. Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are in the care of members of staff that are skilled in meeting their support needs because of the personal development support they receive and the way they are recruited. EVIDENCE: All new members of staff have suitable induction and foundation training based on standards recommended by Skills for Care. According to the AQAA, most care workers are trained to NVQ Level 2 or above and others are completing NVQ training. An NVQ assessor who is currently assisting 8 members of staff to achieve an NVQ qualification was carrying out observations at the time of the inspection visit. The assessor observed activities associated with infection control and she suggested that all staff seen were carrying out the activities in the correct way. There was evidence on this occasion that a stable management system is in place and that the staff team is addressing the needs of residents as defined in support plans and information from reviews. Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 20 From two examples of staff files seen, it was evident that the manager and team leaders undertake formal supervision in a planned way with all members of staff. The stated purpose is to identify practice standards relevant to the needs of residents and staff and to progress the objectives of the staff team and aims of the group. The AQAA included an analysis of the effectiveness of recruitment and staff development procedures. From the documents seen, it is possible to conclude that all relevant checks are carried out and support workers receive good guidance and on-going support. The AQAA, for example, stated that in addition to the statutory training provided for every member of staff specific training to meet the needs of each resident is given. Examples of the knowledge and skill levels needed by staff were discussed during the inspection and it was clear that all staff receive specialist training as needed according to the changing needs of residents. Inspection of staff files showed that the required checks including criminal records bureau (CRB), two (sometimes three) written references and follow-up telephone checks are made. A training matrix and staff files contain good evidence of current level of training. Previous references are contained in this report to how all members of staff receive support for the type of job they do. The AQAA contains a good account of the policy of the owner organisation and managers have both the autonomy and the eventual responsibility in ensuring that all staff have the proper support. For example, the quality assurance manager was able to declare that the training programme for staff undertaking medicine administration had led to efficient and consistently safe procedures that benefit both staff and residents. The manager has autonomy within fairly tight guidelines to vary staffing numbers so that the needs of clients are effectively addressed. Apart from the manager, two team leaders and six carers were on duty to support 45 residents. A significant proportion of residents have high support needs (dementia, physical disability, mental health challenges) and the premises are dispersed over a large area. There have been reports via Adult Protection referrals of pressure on staff when, for example, residents fell and sustained head injuries. The manager and quality assurance manager have addressed these concerns and changes such as better liaison with district nurses are being implemented. A KCC contracting officer has also assisted the service in refining support plans so they are accurate and useful operational tools for staff. According to the AQAA, plans are underway to upgrade the recruitment procedure by incorporating ISA (independent safeguarding authority) proposals, continuing team meetings to identify “an holistic and individualised Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 21 training programme for staff”, continuing the NVQ 2 and 3 staff development programme, developing all aspects of the staff development plans, new technology to check the authenticity of documents relevant to recruitment and implementing revised measures for common induction standards. Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 38. People using the 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 and continues to be run in the best interests of the residents. EVIDENCE: The AQAA stated that policies are gradually all being updated with more accessible formats being introduced. Quality assurance questionnaires have been developed and are completed by residents, their families and health/social care professionals with reports compiled from the results. The quality assurance manager said that managers in branches of the organisation Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 23 and the registered responsible person for the overall service make assessments of this feedback and use it to progress the quality of the service. Other procedures include reviews of care plans, staff meetings and regular 1-1 supervision. The service has a development plan and environmental risk assessments were regularly conducted to contribute to the safety of users of the service. Risk assessments for individuals form a key part of support in place for residents. The AQAA referred to how key workers take a special interest in, for example, keeping care plans updated and individual residents involved in this. The medication system has been thoroughly reviewed by the manager and improvements made for the safety of residents and benefit of staff. This includes how some residents could keep their own medication subject to recorded risk assessments. During the inspection visit, the manager described how consideration is given to carrying out health and safety procedures affecting the safety of premises and individuals. The manager is working to improve services and to provide an ever-improving quality of life for residents and is aware of current developments both nationally and by CQC. Care plan and healthcare records seen indicated that there are developing procedures for meeting the needs of respective residents. KCC contracting staff are advising on and monitoring aspects of these procedures. Declarations are included in the AQAA about the required checks to premises and associated procedures and safety certificates. The manager has the experience and qualifications to run the care home in line with current legislation and standards. The AQAA outlined how this experience is being deployed for the benefit of residents. An example is that the service is equipped to liaise with Social Services on issues relating to assessments relevant to the Mental Capacity Act and Deprivation of Liberty Safeguards (MCA/DOLS). From evidence seen during the inspection and from references in the AQAA, the use of a person centred approach is improving the lives of residents and giving support workers an effective framework to carry out their work professionally. The provision of the service by the manager and staff team is complemented by the support received from other parts of the company and from the registered responsible person for the wider service. Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 x x 3 Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Woodstock Residential Home DS0000065797.V375803.R01.S.doc Version 5.2 Page 26 Care Quality Commission South East The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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. 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