Inspection on 22/04/10 for Willesden Court Care Home

This is the latest available inspection report for this service, carried out on 22nd April 2010.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Willesden Court Care Home 21/07/08

Willesden Court Care Home 04/09/07

Willesden Court Care Home 23/11/06

Willesden Court Care Home 05/12/05

Willesden Court Care Home 26/04/05

Willesden Court Care Home 28/01/05

Willesden Court Care Home 13/07/04

Willesden Court Care Home 22/04/04

Willesden Court Care Home 18/02/04

Willesden Court Care Home 02/01/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Extracts from inspection reports are licensed from CQC, this page was updated on 29/06/2010.

Key inspection report Care homes for older people Name: Address: Willesden Court Care Home 3 Garnet Road Willesden London NW10 9HX     The quality rating for this care home is:   one star adequate 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: Ffion Simmons     Date: 2 2 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 38 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Willesden Court Care Home 3 Garnet Road Willesden London NW10 9HX 02084597958 02084597967 willesdencourt@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Standford Homes Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 60 The registered person may provide the following category of service only: Care Home with nursing - Code N 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 - Code OP (Maximum number of places 18) Dementia -Code DE (E) (maximum number of places 21) Physical disability -Code PD (E) (maximum number of places 39) Date of last inspection Brief description of the care home Willesden Court was first registered in January 2001. It is now owned by Southern Cross Healthcare. Care Homes for Older People Page 4 of 38 Over 65 21 18 39 0 0 0 0 4 0 6 2 0 0 9 Brief description of the care home Willesden Court is situated in one of the many multi-cultural areas of Brent. It is a purpose built 4-storey building found on the corner of Garnet Road and Mayo Road. It is about 3 minutes walk from the main road, which is served by buses. The home has a parking facility at the back and there is also parking on the roads in front and on the side of the home. The home provides care for 60 residents in single and en-suite bedrooms. Accommodation is divided in 3 units, each of which has its own lounge, dining area and kitchenette. The 4th floor is for ancillary services. The ground floor has accommodation for 18 residents. The unit previously only accommodated elderly frail residents requiring personal care, but after a successful application, can now also accommmodate elderly frail residents with nursing needs. The staffing on that unit has also changed as there is now a trained nurse at all times on that floor. The first floor has 21 beds for elderly residents needing nursing care and the second floor can accommodate 21 elderly residents with dementia care needs. The home has a manager and a deputy manager to oversee the overall the running of the home. The manager is not yet registered. The home charges £400-£500 for residents requiring personal care depending on their needs; £500-£650 for residents requiring nursing and £600-£650 for residents requiring dementia care. Care Homes for Older People Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The key inspection took place on the 22nd of April, lasting a total of 10 hours and was undertaken by two inspectors. During the inspection we tracked the care of seven clients and in doing so, we checked their personal records and spent time talking to residents and staff. A number of other records and documentation were examined during the inspection, including care plans and risk assessments, accident records and complaint records, and policies and procedures. As part of the inspection, questionnaires were sent to clients and staff to seek their views about the service. Information within these questionnaires has been used as evidence to inform this report. The Manager took time to complete the Annual Quality Assurance Assessment (AQAA), which has also been used as evidence to inform this report. Care Homes for Older People Page 6 of 38 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 7 of 38 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 38 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 9 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides residents and their representatives with information about the service to enable them to decide whether they would like to live in the home. The needs of residents are assessed before they are admitted to the home, to make sure that the home can meet their needs. Evidence: We were told by the manager and AQAA (Annual Quality Assurance Assessment/pre inspection information) that Willesden Court has documentation and information about the service that it provides to residents. We looked at these records. The statement of purpose and the service user guide were up to date, and included required information about the home. We were informed from records that the service user guide is accessible in audio cassette format. The AQAA told us that the home has an admissions policy and procedure, and that a Care Homes for Older People Page 10 of 38 Evidence: pre-admission assessment of prospective residents needs is carried out generally by the home manager and the deputy manager, but that there are plans to train nursing staff to carry out these initial assessments. We looked at seven care plans. Each care plan included evidence that an initial assessment of peoples needs had been carried out. The assessment information was seen to include a significant amount of information about the persons needs. It was noted that this assessment included communication, sexuality, sensory, eating and drinking, mobility, and death and dying, and other needs. Peoples cultural needs could be better developed in this assessment. A nurse told us that further assessment information is gained from the funding authorities (if the person is not privately funded), and from hospital staff when a person is admitted from hospital. A resident confirmed that she had been asked some questions about her needs prior to and following moving into Willesden Court. A relative also informed us that she had been involved in the assessment of her mothers needs, and had visited the home prior to her mother moving into Willesden Court. We were told by nursing staff that there is ongoing assessment of the persons needs, during their settling in period, prior to permanently living in the care home. We were told that all residents have contracts/statement of terms and conditions. Care Homes for Older People Page 11 of 38 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each individual has a care plan but they are not always used as a working document and do not consistently reflect the care being delivered or their current needs. The homes systems for managing medication are safe. Evidence: During the inspection, we looked at seven care plans. These included the initial assessment information about the person,(including medical, dietary needs and preferences, sight, hearing, preferred form of address, communication, personal care, health, mobility, history of falls), and dependency needs. There was also evidence of some risk assessment, which included risk of falls, use of bed rails, self neglect, nutritional and pressure sore risk. It was noted that this assessment information forms the basis of the care plans, where the needs arising from the initial assessment and/or changing needs are recorded. We saw that there was some written guidance recording the action to be taken by staff to meet each identified need of the person. Some of this guidance was written sometime ago i.e. a risk assessment of a person had guidance dated 23/10/08, and though the records told us that the care plan need with regard to risk of falls had been reviewed monthly, it was not evident that the guidance Care Homes for Older People Page 12 of 38 Evidence: had been updated at all during that time. We noted that for two residents on the first floor that were bed bound, that only basic manual handling risk assessments had been completed. A more detailed manual handling risk assessment proforma was available but had not been completed. A care plan for a residents who is bed bound covered transfers out of bed but did not outline the residents needs with regards to manual handling in bed. Records told us that other reviews are carried out with the resident and family members plus at times a care manager from the funding Local Authority. The information in the care plans was not easily accessible, nor easy to track some information. For example there are risk assessment forms that do not record on them the action to be taken to minimise the risk. This information if available is found in the care plan section of the file. There are also in the care plan files, significant numbers of forms often not dated, and repeating some information. It was not evident that the care plans were person centred. The format of the care plans are written and there was little indication that residents were involved in their care plan. One care plan had recorded that the person using the service was unable to sign, but there was no reference to attempting to involve the resident such as reading the care plan to the person. It also wasnt evident that the care plans were working documents. The manager told us that the nurses write the care plans and review them. The care staff do not have input to the care plans apart from providing verbal information to the nurses about the residents needs. There was no indication that they had read the care plans hence know and understand each persons needs and changing needs. It could be more evident that care staff particularly those that have a key worker role have more access and input into residents care plans. The Manager acknowledges that care plans need to be improved, and since the inspection has facilitated training for staff in person centred planning. The care plans looked at had a map of life document relating to the resident. These had either been partially completed or not at all and there was no guidance re the significance of this information in linking it to the persons plan of care. There was information in the care plans recording whether the resident wished or not to be resuscitated. There were records of daily progress notes for each person, these recorded whether the person had eaten, received personal care etc, but these records were not very personalised. There was little indication in the records looked of the persons mood, or interaction they had with staff or others, nor whether they had been asked how there Care Homes for Older People Page 13 of 38 Evidence: day had been for them for example. We were told that no one had a pressure sore on the 2nd floor unit. One person was spending significant periods of time in bed, and had a pressure ulcer risk assessment which detailed action to be taken by staff to minimise the risk of getting a pressure ulcer, and had an up to date a change of position record. Staff (a care staff worker and registered nurse) who spoke with us were aware of the importance of ensuring that this resident was supported in changing her position regularly and of monitoring the condition of her skin. We tracked the care of two residents who have pressure ulcers on the first floor. Both residents had a care plan in place which highlighted the need for the residents position to be changed on a two hourly basis. The care plan covered guidance on how to transfer the resident out of bed but did not outline the residents needs with regards to manual handling in bed. Change of position charts were in use to record when the residents positions were changed. There were gaps in the recording especially between the hours of 6pm and 10pm and on some occasions there was no evidence that the residents position had been changed between 6am to 10pm. This is of concern especially in view of existing pressure ulcers. The home benefits from the input of Southern Cross Tissue Viability Nurse, whom we met during the inspection. She told us that she visits on a fortnightly basis and is closely monitoring these wounds and providing necessary training and advice to staff. The AQAA told us that the home undertakes weekly tissue tracking and wound audits and provide the equipment necessary for the promotion of tissue viability and treatment of pressure sores. A resident spoke of making some choices, which included choosing her own clothes, and the time she wished to go to bed, and get up in the morning. People were observed to be dressed appropriate to their culture and age. Care plans included evidence that during the initial assessment of their needs that the persons preferences i.e. type of food, times of getting up and going to bed were recorded, but it could be more evident in the care plans that these preferences and choices were acknowledged, and that staff guidance (to meet each of these needs) is incorporated into their plan of care. The AQAA told us that the health and personal care which the resident receives is based on the individuals needs We spoke to people using the service who told us that they are treated with respect, and had support with their personal care needs. The care plans looked at included some guidance in how the residents personal care needs are met by the home. Staff, and visitors told us that people using the service have access to care, and Care Homes for Older People Page 14 of 38 Evidence: treatment from a variety of health professionals, and specialists. These include GP, dentist, optician, dietician and chiropodist. We were told by staff that a GP regularly reviews the needs of residents, and is contacted as and when needed by people using the service. The records of residents health appointments were sometimes difficult to decipher in the care plans. Records of residents contact with GPs was seen and some appointments with the physiotherapist, chiropodist, hospital clinics, and the optician were evident in some care plans, but records of dental checks, were not seen in six of the seven care plans looked at, and there were some care plans with little recording of contact with health professionals apart from the GP. This was discussed with the manager, who told us that residents have the opportunity to see a dentist and option if there was judged to be need or changing need (i.e. the resident has toothache). The home should look at supporting people using the service to have regular preventative health care checks i.e. a regular dental check which might minimise the risk of dental problems arising. Records told us that blood tests are carried out for monitoring the diabetic needs of residents although gaps were noted in the blood monitoring chart of one resident. Following the inspection, the Manager carried out an investigation to find that the blood test had been taken but not documented on the blood glucose monitoring chart. The residents care plan relating to eating and drinking made no reference to diabetes. Residents weight is monitored generally on a monthly basis. One care plan that we looked at informed us that a resident weighed 69.4 kg in January 2010, 77.6kg in February 2010 and 72.8kg in March. This indicated that the resident had put on 8.2kg in one month, and then lost 4.8kg from February to March 2010. Records showed that another residents had lost 14 kg in a month. We were told that there had been problems with the weighing scales at that time. It is of concern that the significant differences in weight that were recorded were not commented on in the care plans. There was no record indicating that the nurse in charge had been informed of these weight records, and that action had been taken in response to this information. Where residents had benefited from the input of members of the multi-disciplinary team, their advice had not been translated into the care plan. A residents malnutrition assessment indicated the need for a residents weight to be monitored weekly, however when we checked the care plan there was no reference for the residents weight to be monitored. The care plan of another resident made reference to them receiving sub-cutaneous fluids. We checked with the Manager who told us that this was no longer the case. The care plan had not been updated to reflect this change. The homes management of medication was assessed on two units. The home has a medication policy and procedure. Medication is stored securely. Controlled drugs are stored separately in a lockable cabinet. Records are correct and signed by two people. Care Homes for Older People Page 15 of 38 Evidence: The registered nurses on duty administer the medication to people using the service. We were told that the medication administration records are checked daily. Medication audits are undertaken by the management team. The home has copies of up to date British National Formulary (BNF) reference books. This details medicines prescribed in the UK, with special reference to their uses, cautions, contra-indications, side effects, and dosage, which is useful for reference to staff working in the care home. Care Homes for Older People Page 16 of 38 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. There was some evidence that residents were supported to take part in activities. The food in the home is of satisfactory quality and meets the dietary and cultural needs of people who use the service. The lack of sufficient staffing levels does not ensure that residents have their meals at suitable intervals. Evidence: The home employs an activity coordinator. There was an activity programme in place. This was seen to be displayed in fairly small print. The home could look at developing the format of the information to ensure that it is as accessible as possible to people using the service, particularly with regard to those who have difficulty in reading. The activity programme told us that there were different activities taking place on each floor of the home each day. These activities include board games, ball games, art, films, crosswords, and music. A resident showed us some crochet that she was doing. There was one session of exercise per week recorded with regard to the second floor. In view of the mobility needs of the people living on the unit, the home could look at ways of developing and increasing the number of exercise sessions for people. It was also evident from the activity programme record that people using the service have the opportunity to have their religious needs met. Various church representatives visit the home on a regular basis. Staff were seen to interact with residents in a positive Care Homes for Older People Page 17 of 38 Evidence: manner during a ball catching session and during a dance activity. Residents seemed to enjoy the music and dancing. There were significant periods of time during the inspection where people using the service dozed in the lounge and had minimal interaction with other residents. The activity Co-ordinator told us that residents had the opportunity to participate in occasional day trips, and shopping trips, and that others sometimes went out for walks with staff. The unit displays the day, date and details of the weather on a wall hanger in the passage way of the 2nd floor unit. This information could be in a larger format and displayed in the lounge to make the information as accessible as possible to people. The visitors record book indicated that people regularly visited the home. Residents spoke of visitors that they had had. We spoke to visitors during the inspection, some told us that they are happy with how their relative is looked after, and that the home communicates any changes in their care to them. Comments included staff are very good here and a visitor spoke of being happy with the home. Other visitors however commented that they felt that staff are very tired and that there is a bad atmosphere in the home, which is affecting the quality of care. A person using the service spoke of receiving regular telephone calls from family members, and of having a telephone in her/his bedroom. The home has a four week menu. We could not see menus on the first floor, but we saw in the dining room area of the second floor that there were menus on the tables. These were in written format, but it was unclear as to what day these related to (it was not related to the meals on the day of the inspection) . It was noted that one of the plastic menu holders was sticky and not clean. These menus were removed by staff. People who we spoke to were unable to tell us what was for lunch. The menu information could be displayed in the home on a daily basis in a format that is more accessible to people using the service who have difficulty in reading and/or with remembering information. The use of photographs was discussed with the manager. This could help in informing and reminding people using the service of the choice of meals planned to be served to them that day. We saw people receiving their breakfast and lunch during the inspection. On the first floor, residents had their breakfast after 09:30. Visitors commented that breakfast is sometimes served very late between 10am and 10:30am, and then lunch comes too soon after breakfast at around 12:30 and their relative is not ready to eat it. Staff on the first floor were very busy attending to residents, which was contributing to the lateness of breakfast being served. Staff commented that the process of ensuring that all residents received their dinner can take up to three hours (usually start at 4pm and finish around 7pm) as they are short of staff in the afternoon and a number of Care Homes for Older People Page 18 of 38 Evidence: residents are requiring assistance to eat and drink. The home was asked to review staffing levels on the first floor unit. Meals could be presented in a more attractive manner. On the second floor, tables were seen to have a table cloth, and there were plastic flowers in vases on the tables, but there were no condiments on the tables, napkins were paper, there were plastic drinking beakers, and most of the residents were seen to be wearing large bibs. The care plans that we looked at did not indicate that these were needed, and most people using them did not appear to spill any food down themselves. This was discussed with the manager. The use of large cloth napkins instead of bibs could be considered as being more dignified for people, and it should be assessed as whether the resident needs them or chooses to have one. I did not hear staff asking residents if they wanted to wear one. Five residents ate their meals in a small room off the main lounge on the second floor. They sat in arm chairs and had a portable table from which to eat their meal. It was noted that one gentleman was sitting on a portable chair which we were told was a shower chair. When this was pointed out, the resident was assisted to a chair in the lounge. It wasnt clear whether this was used due to their being a lack of suitable chairs in that room. There was no evidence that residents are assessed and supported to be as independent as possible during their meals, i.e. being able have pot of tea on their table and pouring it themselves, and possibly buttering their own toast etc. This was discussed with the manager. Residents had various cooked breakfasts. One resident had a waffle left on his plate. We asked him if he liked it, and was told that he didnt. A resident was asked whether she wanted cereal or porridge. It was not evident from talking to residents that they were aware that they could choose what to eat. Some people were offered squash to drink, but most only drank tea for breakfast. It was discussed with the cook as to the possibility of residents being offered fruit juice for breakfast rather than squash as a more healthy option and possibly more preferable to some. Lunch included food that met the particular cultural needs of residents. The nurse in charge told us that the home ensures that people have the opportunity and choice to eat meals that meet their ethnic/cultural needs. Residents told us that they enjoyed the meals that were provided. Comments included I like the food, the food is marvellous. Food likes and dislikes were recorded in care plans inspected. Hot and cold drinks were regularly provided to residents during their meals and throughout the inspection. The meals were unhurried, and assistance with meals was provided by staff as and when needed by them. A staff member helped a resident with his meal in a generally sensitive manner. The cook told us that she had been employed in the home for several years, and ensures that meals are made using fresh ingredients, and she told us that residents Care Homes for Older People Page 19 of 38 Evidence: can choose what to eat, and informed us how she gets to know the preferences and dietary (including specialist and cultural dietary needs) needs of residents. She informed us that the menu is flexible, and fresh fruit is regularly provided to people using the service. She also told us that she regularly asks residents for their feedback with regard to the meals that they receive in the home. Care Homes for Older People Page 20 of 38 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure in place. Some feel that their concerns are not taken seriously and some staff feel unable to voice any concerns. Residents are not safeguarded by robust procedures for responding to significant issues including allegations of abuse. Evidence: The Manager confirmed within the AQAA that Willesden Court has a robust complaints procedure in place. All complaints are taken seriously. Responses to complaints are resolved within 28 days. We send out a holding letter on receipt of a complaint and then proceed to investigate the issues highlighted in the complaint. We spoke to some visitors during the inspection. Visitors told us that they knew how to communicate a concern/complaint and that appropriate response was taken by staff. A resident told us that she felt listened to. There was a thank you card displayed on the unit, which included some positive comments about the service provided by staff. Other visitors were not so positive and commented that they felt that the Manager is defensive and felt that nobody can say anything about the service as they would hold a grudge. They told us that they feel that comments are not welcomed and when they have commented in the past staff may have listened but it doesnt mean that anything is done. Staff told us that they felt that they were unable to raise any concerns in fear of loosing their job. Care Homes for Older People Page 21 of 38 Evidence: During the inspection, we checked complaints records. We saw that the home had investigated an allegation of physical and psychological abuse of a resident by a member of staff. It was not clear from the records held about this complaint, whether the Safeguarding team had been notified, although the Manager assured us that discussion had taken place. This allegation had not been reported to the Commission as per the requirements of the regulations. The Manager acknowledged this omission and formally notified the Commission of this allegation following the inspection. Also following the inspection, we were notified that the service had not reported an allegation of physical abuse on a resident to the Safeguarding team and to the Commission although the police had been notified. Urgent steps must be taken to ensure that all incidents which adversely affect the well being of residents are reported to the Commission without delay. The Manager must ensure that policies for safeguarding vulnerable adults from abuse are robustly followed. Accident records were viewed during the inspection. Records are completed following an accident. We noted that one resident had sustained a bruise to the left side of their head. The records did not outline if the GP or relative had been notified. We checked the residents care plan and found that the care plan made no reference to the bruising. We checked records including daily notes and relative contact sheets and did not see evidence that the relative had been contacted. Steps must be taken to ensure that care plans are updated following an accident or when bruising have been noticed. Care Homes for Older People Page 22 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is purpose built and provides a physical environment that meets the needs of the people who live there. The home would benefit from better decor to make the accommodation more homely. Evidence: The home is purpose built. It is located within a few minutes walk from Willesden Green and Harlesden, and close to a variety of amenities including shops, restaurant, bank, and cafes. Public train and bus transport facilities are accessible close to the home. The home employs a maintenance person. He spoke to us about his role in ensuring that maintenance issues are responded to promptly and that safety checks are carried out. We toured the building. Upon arrival onto the 2nd floor unit there was a slight unpleasant odour that was noticed by us. We spoke to the house keeper staff member. She told us that this was due to some bedroom carpets that though had been thoroughly cleaned they still emitted an unpleasant odour. She told us that she had informed the manager who was looking into replacing the flooring in these rooms. The home needs to ensure that there are systems in place to ensure that there is no unpleasant odour in the home at anytime. There were pictures on some doors on the unit that referred to the use of the room, i.e. bathroom and toilet. This is positive with regard to helping residents to be orientated in the unit. Care Homes for Older People Page 23 of 38 Evidence: There are areas that could be better decorated, for example there are areas were the paint on walls has been damaged by furniture, and could be repainted. The dining room and lounge could be made to look more attractive and homely. The lounge has bare walls, apart from a displayed clock, and the dining room has some prints of old country scenes which could have been on the wall for some years. There were 15 high backed arm chairs in the fairly small, lounge, which left little room for any other furniture. New furnishings (such as less institutionalised arm chairs) and fittings, pictures etc could make the environment much more pleasing for residents and their visitors. This was discussed with the manager. There were some small sensory boards located on several walls in the unit, which displayed various items such as types of materials and objects. It was not clear whether residents were made aware of these. We looked at the bathrooms on the second floor. One bathroom seemed to be used for storing hoists and other equipment. The bathrooms were plainly decorated i.e. white tiles and paint. There could be furnishings to make these rooms more pleasant for residents. In one bathroom the panelling covering some pipes was loose and should be repaired. The nurse in charge told us that she would ensure that the maintenance person is informed. We were also told that one resident on the unit uses a bath, whilst others prefer a shower, which meant that all the other residents on the unit tended to use one shower facility rather than the baths. This was discussed with the manager. The home should look into the bathroom facilities on the 2nd floor unit and their usage, and if necessary develop more shower facilities for people. Two residents kindly showed us their bedrooms. These included some personal items such as photographs and ornaments. They spoke of being happy with their rooms. The nurse in charge told us that there were enough wheelchairs for people using the service, and people are assessed re their mobility needs. Laundry facilities are located away from food storage, and food preparation areas. The housekeeper told us that clothes are named, but that sometimes due to name labels coming off, clothes get mislaid causing complaints but are generally tracked down, and the issue resolved. The recording of these complaints/concerns was discussed with the housekeeper, who told us that she would ensure that these with the action taken to resolve them are recorded in future. We were told that any clothes that are damaged are replaced. The home was observed to be clean. Visitors told us that it was always clean. Hand washing facilities are located throughout the home. Alcohol gel dispensers for hand cleaning are accessible in some areas of the home. There are accessible paper hand towels and soap in bathrooms inspected. Staff were observed to wear protective clothing including disposable gloves, as and when needed. Records told us that the Environmental Health food safety inspection had awarded the home a 4* (very good) Care Homes for Older People Page 24 of 38 Evidence: rating. Care Homes for Older People Page 25 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not always provide adequate numbers of staff to meet the needs of residents. The recruitment procedures of recruiting new staff are robust, ensuring the safety of residents. Staff receive training to make sure that they are competent and skilled to meet the needs of residents. Evidence: The staff rota re the 2nd floor unit was available for inspection. It told us that there were generally three to four care staff and one registered nurse on duty during the day and a registered nurse and care worker on duty at night on that unit. The nurse in charge told us that the number of staff on duty can vary according to the dependency levels of the people using the service, and that these were kept under review. It was not clear why on some days during the week there are four care staff on duty and on other days in the same week there are three care staff. On the day of the inspection there were three care staff on duty and it was noted that the staff were very busy and though they participated in the activity sessions, they seemed rarely to have time to spend much one to one time with people using the service. On the first floor, there were four care staff and one registered nurse on duty in the morning, and three care staff and one registered nurse on duty in the afternoons. Staff and relatives told us that there is insufficient staff on duty to meet the needs of the residents. They commented staff are very willing but there is not enough staff Care Homes for Older People Page 26 of 38 Evidence: and staff have not got the time and staff have a very heavy workload, staff are very tired - we feel there is an atmosphere here which is affecting the quality of care. Staff were seen to be very busy during the shift and some staff were unable to take a break in a twelve hour shift. The breakfast was served late as staff were busy assisting residents to get up and relatives told us that things are either done too fast or not done. We were told that one day there was only two members of staff on duty on the first floor whilst staff were being trained in the home. The Manager told us that in response to our feedback about staffing, an additional staff member has been authorised to be in place for the twilight shift 4pm to 10pm. The shifts worked by staff are generally 8am to 8pm and 8pm to 8am. This indicates that there is no set time for a handover period were staff can communicate about residents and any change in their needs. We were told that staff often come on duty early and/or leave a few minutes late to ensure that all staff have knowledge and understanding of the residents needs. The home should look at reviewing the staff shifts to ensure that it is evident that there is time to carry out a comprehensive handover about peoples needs. The rota also indicated that there was only one care staff worker on duty after 8pm. We were told by staff that most people are supported in getting ready for bed or go to bed prior to 8pm. The daily progress notes that we looked at, did not generally record what time residents went to bed. The home should show that it is evident that people have choice about the times that they go to bed, and that there are enough staff on duty to meet their choice. The home also employs domestic staff, a maintenance person, cooks, activity worker, and administration staff. At the start of the inspection, a number of staff did not have a name badge, others had later made a handwritten name badge. There could be information (such as names of staff and photographs of them) displayed to help inform residents who was on duty and who was expected on duty. During the inspection staff worked and communicated well together. They appeared to know the residents well and were observed to be very approachable and interacted with residents in a particularly positive manner during the inspection, promptly responding to requests (such as for drinks, access to the ground floor, and for assistance to the bathroom) from residents. The residents told us that they liked the staff. Visitors were also complimentary about the staff and mentioned some by name that they found to be particularly caring, and supportive. Call bells were answered promptly. Staff were generally positive about their jobs and told us that the home provides good induction training, and other training to ensure that they have the essential skills for Care Homes for Older People Page 27 of 38 Evidence: carrying out their roles and responsibilities. The home has worked to achieve minimum 50 care staff with NVQ level 2. Some staff commented about replacement staff not being provided when a staff member did not carry out the shift that they had originally been rostered to do, and that certain staff seemed to be favoured at times by management staff. The Manager told us that Staff employed in the home only when full recruitment checks including two satisfactory references are obtained and any gaps in employment are explored. ISA checks and NMC checks are also carried out. During the inspection we checked the files of three staff and found that all relevant recruitment checks had been completed. Care Homes for Older People Page 28 of 38 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a qualified manager in post but the management style could be more inclusive and approachable. Residents financial interests are protected by safe financial management systems. The homes quality assurance systems are inclusive of residents. The home appropriately addresses health and safety issues to make sure that all people who use the premises are safe. Evidence: The home has been without a Registered Manager for more than 18 months. The current manager was appointed in August 2008 and is currently waiting for a CRB check through the Commission prior to submitting an application form to register as the Registered Manager of the home. The Manager is a Registered Mental Health nurse and holds a Bsc (Hons) in Nursing Professional Practice. He has previous experience of working within the NHS at Ward Manager level. He has obtained the Registered Managers Award. Within our last inspection report we reported that staff made negative comments Care Homes for Older People Page 29 of 38 Evidence: about the management style of the manager. They stated that the manager does not listen to them and does not consider their views. They report that staff meetings tend to be one way when directives and orders are issued but their views not sought. Feedback about the management style of the Manager during this inspection were mixed. Visitors told us that they knew how to communicate a concern/complaint and that appropriate response was taken by staff. A resident told us that she felt listened to. We were told however that certain staff seemed to be favoured at times by management staff. We were told that the management style is not approachable and that staff feel unable to raise issues in fear of loosing their job. Certain staff felt that the management style was unreasonable. Relatives told us that staff are very tired we feel there is an atmosphere here which is affecting the quality of care and felt that the Manager is defensive and felt that nobody can say anything about the service as they would hold a grudge. In view of ongoing issues, it is a requirement that the management style be reviewed to ensure an open and inclusive atmosphere, where residents and staff are not afraid to raise concerns. We looked at the quality monitoring systems in use in the home. Monthly audits are carried out by the home manager, which include audits of the homes management of medication . Visits on behalf of the registered provider are undertaken on a monthly basis, although the reports were not available for inspection on the day. Copies were forwarded to us following the inspection. A full audit of the service was recently undertaken by Southern Cross Quality team. Results of the annual customer surveys was seen on display in the home. Where areas for improvement were identified, an action plan had been put together. We inspected the management of residents money by choosing the accounts of two residents and looking at the records.We were told by the administrator that most residents have the finances managed by relatives or significant others but the home (with monitoring from the organisation) does manage some residents allowances, and residents have access to money as and when they wish/need. We were informed that there are robust systems in place to ensure that each person using the service has an individual account and receives interest on their money. We looked at two records that confirmed that comprehensive recording of deposits and expenditure is carried out. We were told that weekly checks of these records and balances are carried out. Fire safety guidance is displayed in the home. Required fire checks and fire drills are carried out, and there is an up to date fire risk assessment. Fridge/freezer temperatures are monitored closely. As discussed previously within the report, accident records are completed following an accident. We noted that when a resident had sustained a bruise to the left side of their Care Homes for Older People Page 30 of 38 Evidence: head, the records did not outline if the GP or relative had been notified. The Management team must ensure that accident records are monitored and that steps are taken to ensure that care plans are updated following an accident or when bruising have been noticed. The Management team must also ensure that all incidents or accidents which adversely affect the well-being of residents are reported to the Commission without delay and that safeguarding procedures are followed. Care Homes for Older People Page 31 of 38 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 There must be up to date care plans in place that address all the needs of residents and that are followed by care staff to deliver care and support to residents. To make sure that the needs of residents would be met. 08/09/2009 2 27 18 The home must always 10/08/2009 provide adequate numbers of skilled and competent staff to care and support residents. To ensure that residents are cared for and supported appropriately Care Homes for Older People Page 32 of 38 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 Care plans must be updated following an accident and/or when bruising is noted. To ensure that the care plan reflects the current needs of the resident. 01/07/2010 2 7 12 The Manager must ensure that staff follow the care plans. To ensure that the healthcare needs of residents are met. 01/07/2010 3 7 12 Care plans must be kept up- 01/07/2010 to-date and reflect the current needs of residents. To ensure that residents needs are met. 4 8 12 The home needs to ensure 01/07/2010 that all staff know what to do when they record significant changes in residents weight, and that appropriate action (including Care Homes for Older People Page 33 of 38 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 recording in the care plan, reviewing the care plan, contacting other health care professionals and any other action such as servicing and or repairing weighing scales) is taken to respond to this. To ensure staff respond promptly to changes in residents weight. 5 15 16 The home must ensure that mealtimes are reviewed to ensure that meals are served at appropriate intervals. This is so residents can enjoy their meals at a time which is suitable to them. 6 18 13 The Manager must ensure that policies for safeguarding vulnerable adults from abuse are robustly followed. This is so the interests of residents are safeguarded. 7 18 37 The home must ensure that 01/07/2010 all incidents which adversely affect the well being of residents are reported to the Commission without delay. This is so the interests of residents are safeguarded. 01/07/2010 01/07/2010 Care Homes for Older People Page 34 of 38 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 8 26 16 The home needs to ensure that there are systems in place to ensure that there is no unpleasant odour anywhere in the home. This is to ensure that the environment is fresh and pleasant. 01/07/2010 9 27 18 Staffing levels must be reviewed and the home should look at reviewing the staff shifts to ensure that there are sufficient staff on duty for meeting the needs of residents and that there is time to carry out a comprehensive handover about peoples needs. 01/07/2010 10 32 12 The Management style 01/07/2010 should be reviewed to ensure that it maintains good professional and personal relationships with each other and with service users and staff and encourage and assist staff in maintaining good personal and professional relationships with residents. To ensure open and inclusive atmosphere, where staff are not afraid to raise concerns. Care Homes for Older People Page 35 of 38 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 11 37 17 The Manager must ensure that records including care plans are kept up-to-date. To ensure that information held about residents is current and correct. 01/07/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 Consideration should be given to developing the information relating to peoples cultural needs within the initial needs assessment. It could be more evident that care staff particularly those that have a key worker role have more access and input into residents care plans. It should be evident that the care plans are working documents, and be person centred (indicating that the person using the service is central to their plan of care, fully involved in its development and content, and have agreed how their needs are to be met by the home). The home should ensure that all health care checks are recorded, and look at supporting people using the service to have regular preventative health care checks ie a regular dental check which might minimise the risk of dental problems arising. Health care checks and appointments could be better recorded in peoples care plans. The home could look at developing the format of the information relating to activities on offer, to ensure that it is as accessible as possible to people using the service, particularly with regard to those who have difficulty in reading. The menu information could be displayed in the home on a daily basis in a format (i.e. photographs) that is more Page 36 of 38 2 7 3 7 4 8 5 6 8 12 7 15 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 accessible to people using the service. 8 9 16 20 Complaints about missing clothes should be recorded. The home should review the decor of the 2nd floor and put in place systems and furnishings to improve the attractiveness and homliness of the unit. The home should look into the bathroom facilities on the second floor unit and their usage, and if necessary develop more shower facilities for people. The home should repair the pipe panelling in one bathroom. There could be information (such as names of staff and photographs of them) displayed to help inform residents who was on duty and who was expected on duty. Staff should also wear formal name badges. The home should show that it is evident that people have choice about the times that they go to bed, and that there are enough staff on duty to meet their choice. 10 21 11 12 21 27 13 27 Care Homes for Older People Page 37 of 38 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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