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Inspection on 22/06/10 for Willow Tree Nursing Home

Also see our care home review for Willow Tree Nursing Home for more information

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

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

This was a random inspection and therefore not all the core standards were assessed. People observed and spoken with during our visit seemed content and happy with the care they are receiving. The home was clean, free from any offensive odour, appropriately decorated and well maintained with good quality furnishings and furniture. Twelve new nursing profile beds with specialist mattresses had recently been provided so that physically frail people could be nursed with more comfort. There was an appropriate skill mix of staff and an experienced registered manager. There was a strong commitment to staff training and development, which benefits people using the service.

What the care home could do better:

This was a random inspection and therefore not all the core standards were assessed. Some improvements are needed to medicine management which will assist in providing a safer system. Staff must support people as stated in their care plans to ensure their health and well being. People who need bed rails must be assessed for the risks associated with the use of bed rails.

Random inspection report Care homes for older people Name: Address: Willow Tree Nursing Home 12 School Street Hillmorton Rugby Warwickshire CV21 4BW one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Patricia Flanaghan Date: 2 2 0 6 2 0 1 0 Information about the care home Name of care home: Address: Willow Tree Nursing Home 12 School Street Hillmorton Rugby Warwickshire CV21 4BW 01788574689 01788551791 carol.mccullough@redwoodcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Isabelle Finister Type of registration: Number of places registered: Conditions of registration: Category(ies) : Culpepper Care Limited care home 47 Number of places (if applicable): Under 65 Over 65 0 47 dementia old age, not falling within any other category Conditions of registration: 47 0 The maximum number of service users to be accommodated is 47. 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 (OP) 47, Dementia (DE) 47 Date of last inspection Care Homes for Older People Page 2 of 12 Brief description of the care home Willow Tree Nursing Home is registered to provide personal and nursing care for up to 34 people over the age of 65. The home can offer care for a variety of medical conditions including side affects from a stroke, naso-gastric feeding, wounds, paralysis, incontinence, Parkinsons Disease, Diabetes, and other conditions. Following a recent extension to the home, the service also now accommodates people with dementia. The home is situated in a local suburb of Rugby approximately three miles from the town centre. It is close to local shops and a bus route. The home is set back from the road and there is ample parking available near to the entrance. The single rooms have increased from 26 to 41 and there are also three twin rooms. All rooms have either washbasins or full en suite facilities, which include a washbasin, toilet, bath or shower. There are also communal bathrooms with assisted facilities for those people who are less mobile. Each room has a call bell facility so that people can alert staff if they need assistance. There are two communal lounges and dining rooms and the communal areas are situated at each end of the home. Bedroom accommodation is now available on two floors. There are various outside areas for people to sit including courtyard type garden areas and a patio area which can be accessed from the large lounge. The home is staffed by a complement of qualified nursing staff and care assistants. The fees for this home are published in the Service User Guide. These are subject to change and persons may wish to obtain more up-to-date information from the service. Extra charges are made for hairdressing, newspapers, chiropody, dry cleaning, treatment by dentists or opticians or the purchase of clothing and personal effects. Care Homes for Older People Page 3 of 12 What we found: We, the Care Quality Commission (CQC) undertook this random inspection visit to monitor standards of care at the home, which was rated as adequate at the last key inspection on 11 August 2008. This random inspection was undertaken by two inspectors and was unannounced, which meant the home was not given notice of our visit. Before the visit we looked at information we received since our last inspection of the home. This includes how the service dealt with any complaints, the views of people who use the service, staff and the managers views of how well they care for people. The service sent us their annual quality assurance assessment (AQAA) within the required timescales. The information in the AQAA was clear and provided us with most of the information we asked for. During the visit we spoke with people who live at the home, three visitors and staff on duty. We looked at information about people who use the service and medication records. We checked that staff had the knowledge, skills and training to meet the needs of the people they care for and we looked around the building to make sure it was clean, safe and comfortable. The manager told us of improvements she has made to the service since her appointment. - A new head chef has recently been appointed and menus are currently being revised to ensure the best nutrition possible for our residents. - Picture menus are being developed so that all our residents are able to choose what they would like at mealtimes. - Disabled cutlery, non slip mats etc has all been purchased to ensure residents are able to feed themselves , of course with help as needed, independently for as long as possible. - The refurbishment of the dining room is now almost complete, just the curtains to be hung. The breakfast kitchen has been completely refurbished. - Reception has also been refurbished and we now display all forthcoming events so that relatives can join us if they should choose. - The refurbishment of the nursing unit continues, one bedroom has been completed and two more have been redecorated. As rooms become empty they too will be refurbished to a high standard. - New equipment continues to be purchased, including more profiling beds, hoist slings, air mattresses, pressure relieving cushions, slide sheets, transfer belts, specialised seating system, shower chairs, commodes, dressing trolleys, changing trolleys. - We have just purchased a roller press for the laundry. Care Homes for Older People Page 4 of 12 - The newly appointed training manager has now developed a training plan for the home which ensures all staff have all the relevant training. Our matrix shows we are on target with this. New staff are completing the Skills for Care induction and i currently have 3 carers doing their NVQ 2. That will leave only 2 carers, both newly appointed, not qualified to NVQ. - We also now have a more structured activities programme, visiting entertainers and organise outside activities. To address residents spiritual needs we have organised a monthly church service. Part of our current training plan includes training on meaningful occupation and activity which we will incorporate into the residents day. - We will be introducing a monthly Newsletter for residents and relatives in the very near future. - We have introduced the named nurse system into the Home and are currently reviewing our care plans and trialling a new system. All trained staff have undergone/undergoing training on care planning skills. - We have been successful in the recent recruitment of new staff, which will furthermore enable us to give an excellent standard of care to our residents. We saw that The Willow Tree is a very pleasant place in which to live. The home was clean and tidy throughout. The decor in communal areas is good and lighting is domestic in style. The manager has ensured that seating in the lounge areas are arranged in a way that encourages people to interact with each other. People are encouraged to personalise their own bedroom with items of furniture and other belongings. We looked at the care records for two people. The manager explained that the home had introduced a different care planning format to make care plans more person centred and easier to read essential information. Care plans were based on information secured during an initial assessment of need when the person was admitted to the home and supplemented by continual assessment following their admission. We saw that care plans were available for the identified needs of each person and supplied staff with most of the information needed to make sure the persons needs were met safely and appropriately. We found an example of action that had been taken that was not updated on the persons care plan. It was recorded on the daily records that the persons sacrem and heels red, apply cream. A review of the persons pressure area care plan does not demonstrate a short term care plan had been put in place to meet this concern. There were no wound charts and it is unclear when or if the red areas had healed. There was also mention of bruising in the daily records, but again there was no evidence to suggest how this might have occurred and if it had healed. The manager undertook to investigate and update the care plans for this person. We saw from the records that a person had bed rails in situ on their bed. There was no bed rails risk assessment to determine whether this was the best course of action or whether they were properly fitted. The pharmacist inspector checked the management and control of medicines within the Care Homes for Older People Page 5 of 12 service. We looked at medication storage, some care records and medication administration records. Medicines were kept in two medicine trolleys, which were kept locked when not in use. Medicines were not always stored correctly. For example, we saw a drawer in a medicine trolley containing eye drops, ointments, creams and insulin. This means that there was an increased risk of contamination between peoples different medicines. A small room was used to store extra medicines, external preparations and dressings. The manager informed us that they had noticed that the temperature of the room was too high for medicine storage and an air conditioning unit was on order to ensure medicines were stored below 25 degrees C. We found the room small and cramped and was not of a sufficient size to ensure medicines and other healthcare appliances were stored tidily for the amount of people in the home. Medicines prescribed to be given as a variable dose, such as one or two tablets, were not recorded accurately onto the Medication Administration Record (MAR) charts. We particularly saw this for people prescribed medicines for pain relief. For example, one person was prescribed a tablet as one or two tablets to be taken four times a day. We looked at the MAR chart and saw that nursing staff had not recorded whether one or two tablets had been given. This means that nursing staff would not be able to determine whether the maximum dose had been given and therefore be able to determine if another tablet could be given for extra pain relief. Some people did not have their prescribed medicines available to give. We particularly saw this for people prescribed medicines for pain relief. We looked at two peoples records. We saw one person was prescribed a tablet for pain relief when required. We looked at the MAR chart and saw there was no date of receipt and no balance carried forward from an old MAR chart. We looked in the medicine trolley and could not find the tablets. We looked in the store room and could not find any tablets for the person. We saw a care plan for pain relief for the person, which was not dated but stated Taken for headaches or pyrexia. Will ask. The records showed that there was no pain relief available to give if the person needed it. The second person needed to have their medicines given either as a liquid or as a soluble tablet. We saw that the person was prescribed a solid tablet for pain relief when required. Nursing staff had not ensured that the tablet was reviewed by a medical practitioner and changed to a soluble form or as a liquid. The MAR chart documented that there was none available to give. We looked in the medicine trolley and could not find any pain relief tablets for the person. We looked in the care plan which stated that the person was unable to to communicate all her needs and staff will need to assess the need for analgesia. There was none available to give if the person needed it. Nursing staff did not always document the medicine records correctly. We saw that the receipt of medicines, balances of medicines and the dates of opening of medicines were not correctly recorded. This made it difficult to check if medicines had been given to people as prescribed. For example, we looked at one person who was prescribed four different medicines. We checked the amount of tablets available in the home and checked the amount of medicines given according to the MAR chart. Three medicines could not be checked due to poor records. The first medicine record documented that two tablets had been given, however we saw that three tablets had been removed from the box. This means that there was no record documented for one tablet and the check was not correct. The second medicine record did not document the receipt of the medicine or if a Care Homes for Older People Page 6 of 12 balance had been carried forward. There was no record of the medicine being available to give. We found the medicine was available in the medicine trolley and the box had been dated when opened, however no tablets had been removed from the box. This check was not correct. The third medicine record documented the receipt of the tablet and recorded a balance carried forward from an old MAR chart. We counted the tablets remaining which did not match the MAR chart records. This check was not correct. This means that some of the medicine records were not accurate and therefore we were unable to check that medicines had been given to people as prescribed. We saw that people looked well presented and were dressed appropriately according to their preference. There was very good interaction between staff and the people living at the home, with conversation at a level and pace appropriate for each person. We spoke with a visitor who told us they felt their relative had improved since coming to live at the home. They said, the staff are marvellous. We gave full feedback to the manager. We explained the shortfalls identified in this random inspection and that we were concerned about the control and handling of medicines in the service and that people were at risk of harm. What the care home does well: 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 set out on page 2. Care Homes for Older People Page 7 of 12 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 12 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, 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 8 13 People who need bed rails 06/09/2010 must be assessed for the risks associated with the use of bed rails. This is to ensure bed rails are used appropriately, safely and in accordance with guidance provided by the HSE and MHRA. 2 9 12 To ensure that there is an effective system in place to request, obtain and retain adequate supplies of prescribed medicines for people living in the home so that they can be given to them as and when prescribed. This is in order to ensure that people have medication available to be given to them as prescribed by a medical practitioner. 06/09/2010 3 9 13 Medication administration records must be accurately maintained including recording the actual amount 06/09/2010 Care Homes for Older People Page 9 of 12 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 given for variable doses. The reasons for nonadministration of medication must be recorded by the timely entry of an appropriate code or entry on the medication administration record; that the meaning of any such codes are clearly explained on each record. This is to ensure that the care service maintains accurate records of medicines administered to people including reasons for non administration of prescribed medicines. 4 9 13 To make arrangements to 06/09/2010 ensure that records are kept of all medicines available in the home. This is to ensure that the audit trail for all medicines is seen and all medicines are administered as prescribed at all times. 5 9 13 The service must make 06/09/2010 arrangements to ensure that all medication is administered as directed by the prescriber to the person it was prescribed, labelled and supplied for. This is to ensure that people get their medicines correctly and that procedures for medicine administration are safe. Care Homes for Older People Page 10 of 12 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 6 9 13 Care plans must include 06/09/2010 detailed information and instructions for staff in respect of administration and management of medicines, including the reasons to give medicines when required and what constitutes needed for the named person. This is to ensure that there are clear directions for care staff to give medicines prescribed when required. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 You should ensure that all aspects of each persons care that need attention are detailed in the appropriate care plan. This will ensure all staff providing care have the information they need to meet the assessed needs of each individual. Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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 noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 12 of 12 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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