Inspection on 12/02/08 for The Willows

This inspection was carried out on 12th February 2008.

CSCI found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Willows 25/02/09

The Willows 14/03/07

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Willows 38 Westminster Road Earlsdon Coventry West Midlands CV1 3GB Lead Inspector Sandra Wade Unannounced Inspection 12th February 2008 08:25 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Willows Address 38 Westminster Road Earlsdon Coventry West Midlands CV1 3GB 02476 220161 02476 550126 willowsmanager@adeptgroup.org 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) Willows Care Home Ltd vacant post Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th March 2007 Brief Description of the Service: The Willows is a residential home for thirty-two older people. The home is located in the Earlsdon area of Coventry, close to the city centre, and is readily accessible to amenities such as shops, places of worship and public transport. The home is located on three floors, with the upper floors easily accessed by a passenger lift. The accommodation consists of thirty-two single bedrooms, six of which have en-suite facilities. There are also two lounges on the ground floor, eight toilets, three bathrooms, one shower facility, kitchen, conservatory/ dining area and administration office. There is also a basement, which is used as a staff room and for storage. The home has gardens to the rear of the establishment and also has around six car parking spaces for visitors. Fees are detailed in the Service User Guide for the home and at the time of the inspection ranged from £386.00 to £411.00 a week. There is a detailed list also of additional charges that apply over and above these fees. This includes charges for staff escorts on trips, meals for guests, hairdressing, clothes labelling, chiropody, lost room keys, electrical portable appliance testing, electricity for any oxygen equipment, charges for larger personal jobs over half an hour by maintenance engineer, newspapers, toiletries, TV licenses for rooms, items you damage other than normal wear and tear, insurance cover for valuables, private telephone installation, private nursing care, external entertainment and outings and alcoholic drinks. The Willows DS0000069660.V351630.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 the people who use this service experience good quality outcomes. The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This unannounced inspection took place from 8.25am to 5.05pm. Before the inspection the manager of the home was asked to complete an Annual Quality Assurance Assessment (AQAA) detailing information about the services, care and management of the home. Information contained within this document was considered as part of this inspection and is included within this report where appropriate. Three people who were staying at the home were ‘case tracked’. The case tracking process involves establishing an individual’s experience of staying at the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. Records examined during this inspection, in addition to care records, included staff training records, the Service User Guide/Statement of Purpose, staff duty rotas, kitchen records, accident records, complaint records, health and safety records and medication records. Service users were observed during lunchtime to ascertain choices and meals made available. A tour of the home was undertaken to view specific areas and establish the layout and décor of the home. What the service does well: Prospective residents have access to good information about the home to enable them to make an informed decision on whether to stay. Pre admission assessment records contained all information required to ensure staff could develop suitable care plans to meet the needs of the residents. The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 6 Care records provide clear information to staff on the needs of the residents and these are regularly reviewed to enable staff to identify any changes in care needs and staff support. Residents spoken to were happy in the home and felt they were being well cared for. There is a programme of social activities in place which includes sing a longs, physical fun, carpet bowls, skittles, church service, bingo, dogs, art and craft mornings or evenings. Care plans give clear information on specific choices that residents have made about how their care and services are provided. This includes details of residents preferences in relation to social activities, cultural interests, meals and mealtimes, daily living routines, relationships and religious needs Menus contain a good choice of meals and meals observed looked appetising. Residents spoken to were happy with the food being provided. The home had an easy to understand complaints procedure which is displayed on the notice board in the home for residents, staff and visitors. The home environment is clean and well maintained, with pleasant furnishings to make this homely for the residents. Staff were observed to be friendly and approachable towards residents and residents spoken to were complimentary of the staff in the home. One said “staff are great, supportive and very helpful”. Another said “smashing girls on nights”. What has improved since the last inspection? Hot water temperatures are now being recorded appropriately including the temperature following any adjustments to the control valve to ensure the hot water is at a safe level to prevent scalds to residents. The temperature of the area where medication is stored is now being recorded so staff can identify if the temperatures are running too high. Hand washing facilities are now available in the shower room identified at the previous inspection so that residents and staff can wash their hands. Medication Administration Records (MARs) are now being completed over a 28 day cycle so that medications can be easily checked to make sure what has been given and what is remaining is correct. The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 7 There have been improvements made to the garden area to make this a more pleasant area for residents, this includes a patio sitting area. New furniture has been provided for the bedrooms in the home to improve the bedroom environment for residents. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 8 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 The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3 were assessed. Quality in this outcome area is good. Residents have sufficient information to make an informed choice about living at the home and are assessed prior to their admission to ensure their needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an Information Guide that includes all the information required for the Statement of Purpose and Service User Guide. The information given to residents ensures that they have sufficient information to be able to make a choice about living at the home. A copy is given to all prospective residents and the acting manager advised copies of the inspection report are provided to prospective residents with this booklet. Copies of the inspection report are kept on display in the entrance hall to the home which the provider said visitors can take away. The guide is detailed and attractively presented. It also includes the Terms and Conditions statement for the home and a ‘Life Profile’ section that residents are asked to complete and bring with them on The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 10 admission to assist the staff in devising a care plan. These sections are photocopied an included in their file. The Information Guide includes reference to there being copies available in large print and an audio version available if two months notice is given. Three care files were examined. An assessment information sheet was available in each file giving information about each persons needs. This had been compiled using the information collected when the resident was assessed prior to their admission. Original assessment records are kept in separate files in the home and were viewed to confirm these had been completed. It was evident that assessment details had been integrated into the care plans to ensure staff were clear on each residents care needs and how these were to be met. The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9, and 10 were assessed. Quality in this outcome area is good. Service users health care needs are set out in an individual plan of care and systems are in place to ensure their health and medical needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans were closely viewed and further care plans were viewed to identify if specific areas of care had been met. Care plans were detailed and well written with information about the needs of the residents easy to identify and follow. Care plans were up-to-date and are being reviewed on a monthly basis to identify any changing needs. Staff are reviewing each care need individually so that it is clear if any changes in staff support is required. Risk assessments relating to tissue viability, nutrition, and moving and handling are included in each care file and from observations made of service users, information contained within these documents was relevant. The weight The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 12 of residents is being regularly checked and recorded and it was evident that a service user who was of a low weight had been closely monitored. This had resulted in the resident putting on weight demonstrating this was being managed well. A risk assessment was in place for one service user who suffered from dizziness presenting a risk of falls. The risk assessment did not show if there is any pattern to the dizzy spells such as at a particular time of day or if the resident had suffered any falls as a result. It was also not clear if the dizzy spells have increased/decreased or continue to be the same. It was noted that this particular aspect of their care was not mentioned in the monthly reviews so that staff knew to monitor this. The provider agreed to address this. One resident was identified to have a colostomy bag. There was no information in the file about how this should be managed other than the resident needed the assistance of a member of staff to change it. This care plan should include details of what equipment is needed and instructions to staff on how this should be changed as well as problems to look out for and report if necessary. One resident with pressure sores was receiving regular treatment from the district nurses. The tissue viability care plan in place within the home detailed that the district nurses were visiting twice a week to apply dressings. There were no instructions in the care plan in regard to how the pressure areas should be managed in between district nurse visits. This includes instructions to staff such as monitoring dressings remain in tact, how personal care should be addressed and the application of any necessary creams to protect the skin as required. It was however evident from the monthly review documentation that one of the sores had healed and the other was healing well. The provider agreed to review the care plan records as necessary. Equipment for pressure relief such as cushions and mattresses were seen in use at the home to reduce the risk of pressure sores. The care files included clear evidence that the residents had visits from a dentist, optician, and chiropodist and visits from or to a GP. A care plan relating to the management of a catheter indicated how often this should be changed and how often the bag should be changed but there was no indication as to how often the bag usually needed to be checked and emptied. Care plans identified that those residents with diabetes needed to have a low sugar diet and their nutritional intake monitored. Risk assessments in place stated actions to ensure staff managed this. Staff said they had not been requested to monitor the blood sugar levels as it was not felt necessary due to the diabetes being controlled by tablets. Staff advised blood sugar monitoring being managed by the doctor. Staff were aware of the symptoms associated The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 13 with high and low blood sugar levels but this information was not detailed in the care plan to ensure all staff were aware of this. Daily records are being completed each day although not each shift. Records gave a good account of what residents do each day from a social point of view. This included information about visitors, outings and what residents had been doing during the day which is good practice. Daily records were less specific in regards to staff actions undertaken to meet care needs and detailing how care needs are being met. Daily records should give a picture of how the resident is being cared for over a 24hour period and should detail information about any ongoing care need and how this is being met. It was evident that despite records not being completed the care needs of the residents were being followed up and met appropriately. Residents observed during the inspection looked well presented and content. A review of medication was undertaken. On the whole this is being managed well but there were some areas in need of attention. Boxes and bottles contain specific prescribing instructions that the GP has made. The Medication Administration Record (MAR) chart should reflect these instructions but it was found that this is not always the case. Eye drops stated on the box “one drop into the eye” but on the MAR it stated “one drop in each eye”. It was not clear if the eye drops had been prescribed for one eye or both, sometimes separate eye drops are prescribed for each eye depending on the condition. Instructions on the pot of Calichew stated “chew one twice a day” but this had not been copied onto the MAR running the risk that staff may not remind the residents of this when administering it. A box of eye drops had not been dated when opened to ensure staff knew when to discard them after 28 days. Paracetamol that had been prescribed for “1” or “2” to be given when required was being indicated on the MAR by squeezing a “1” or “2” on the MAR next to the signature. This can result in the record becoming illegible and it was advised a protocol is developed on how to manage this more effectively. One person’s medication record showed that 56 tablets were available at the beginning of the medication period and 37 tablets had been signed for and there were 18 left. This amounts to 55 tablets meaning there was one tablet missing and unaccounted for. One residents medication could not be effectively audited as it was not clear from the MAR how much medication they had started with at the beginning of the medication cycle. Staff explained that the resident had been in hospital and due to the hospital prescribing different medications to the GP, this had The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 14 impacted on the incomplete records of medications in the home. Staff advised that the resident was due to have a medication review of the day of inspection with the GP to confirm all medications prescribed were correct and appropriate. Staff had taken actions since the last inspection to keep a record of the temperatures within the medication room and medication fridge and this record was viewed. It was evident that the medications room is consistently of a higher temperature than is recommended. The fridge is also running at variable temperatures. The provider agreed to look into this matter and felt that the fridge thermometer was not operating correctly. Controlled drugs available were accurate in regards to what medication was available and the records in place. The home does not have a specific cabinet specifically for the storage of these medications and this is recommended. It was evident however, these were being stored safely. Staff are not using a controlled drugs register but loose leaf sheets which could get lost. The provider advised that a register had been ordered specially for the effective recording of controlled drugs and this was expected to be delivered soon. The privacy and dignity of the residents was maintained throughout the inspection and no concerns were raised in this regard by residents. The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15 were assessed. Quality in this outcome area is good. A variety of stimulating social activities take place to occupy the residents and visitors are made welcome. Residents are able to exercise their choice in regards to care and services provided and enjoy the choices of meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An activity schedule has been devised which is regularly updated detailing activities available to residents each week. A copy of this was on the notice board in the entrance hall of the home. The home also produces a leaflet detailing planned entertainment and activities. This was viewed for February and listed: fashion with fun, arts and crafts, fizzical fun, nail and beauty sessions, pancake tossing, valentines day film show and a keyboard player. A member of staff spoken to said that they aim to provide social activities each day and a member of staff is allocated to do this. The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 16 On the day of inspection bingo was observed to take place in the dining room area and several of the residents took part. Some residents chose to sit quietly in dining area on the comfortable chairs provided and some were seen reading newspapers and watching television. Residents spoken to said they liked it in the home and felt they were being well looked after. One resident commented they would like to go out more. A member of staff said that they do try to take residents out and regularly and they regularly take service users for a walk to the local shop. This is done on a one to one basis. Daily records record the social activity that residents take part in each day whether this be watching television or enjoying a visit from relatives/visitors which is good practice. The care plan files seen contained a ‘life profile’ detailing significant dates for the resident, their preferences in how care and services are provided, their interests, hobbies and details of their life history. One file viewed showed the time the resident liked to get up and go to bed, their favourite foods and their preference to have a shower rather than a bath. This information helps staff to provide care according to the needs and choices of the resident. Care files also indicate whether residents are “politically aware” and whether they would like to vote so that staff can organise this as appropriate. The Annual Quality Assurance Assessment (AQAA) completed by the home shows that they have an all female staff with the exception of one male carer. This allows residents some choice in regards to having a male/female carer but is restrictive if a resident has a specific choice for a male carer at all times. This was not found to be the case during this inspection. During the morning a member of staff was observed to ask residents what they would like for their meals later that day. Residents were given two choices for their main meal as well as the tea time meal. On the day of inspection the meal served was ‘toad in the Hole’ or cheese and onion pastie with potatoes, mixed veg, cabbage, rice pudding for desert. This was observed at lunch time and looked appetising and portion sizes were generous. Menus viewed showed that there are always two choices offered at each meal. Breakfast usually consists of grapefruit, choice of cereal, porridge, toast and preservatives. Food stores were well stocked and the cook advised they tend to use frozen vegetables as these were just as nutritious as fresh vegetables and sometimes more so. It was evident that the cook prepares puddings which are fruit The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 17 based and those on the menus included baked pears, fruit jelly, plums and custard and fruit sponge with custard. Residents spoken to were satisfied with the food provided. One person indicated staff gave them lots of food as they smiled to a member of staff in the kitchen. Two residents said the food was “alright” and stated they were not a big eaters, one person said the food was “very good”. One resident who had left their food was complimentary of the meals but said they didn’t feel like it today because they were not feeling well. The dining area was observed to be clean and pleasantly presented with table decorations and condiments on each of the tables. Visitors to the home were complimentary of the dining room and said how nice it was for the residents. They were also complimentary of the home and staff. The cook advised that she did not need to do any separate meals for the diabetic residents and when she prepared sugary puddings she used a sugar alternative so all the residents could eat this. This matter was discussed as this is not always appropriate for other residents who may need a high calorie intake to maintain their health. It was advised this is considered when preparing puddings. It was also advised that records are kept of any alternative puddings prepared for diabetic residents so that it is clear their dietary needs are being met. At the time of inspection there were no residents who were in need of liquidised or soft food diets. The cook advised these could be prepared if needed. Adapted cutlery was not in use in the home as it was not felt any residents needed this but there was a plate guard available for one of the residents to assist them in eating their meal independently. The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. Quality in this outcome area is good. The home has an easy to understand complaints procedure and complaints are taken seriously and acted upon. Systems are in place to manage any allocations of abuse to ensure the protection of residents can be maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no complaints received by us since the last inspection. There has been one complaint received by the home in relation to catheter care. It was evident from records in place that staff within the home had been fully cooperative in allowing this matter to be investigated by an outside organisation to a satisfactory conclusion. An easy to understand complaints procedure is available and is displayed within the home so it is readily available to residents, staff and visitors. This contains all relevant contact names, addresses and telephone numbers as required. Staff spoken with were also familiar with the complaints procedure as well as the adult protection procedure and knew what to do if a complaint or allegation of abuse was brought to their notice. The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 19 Training records viewed showed that staff undertake training in the identification and prevention of abuse and that this is ongoing for those staff who have not yet completed this training. Residents spoken to said that they would find out who the person in charge was for that day if they needed to report a complaint. No concerns were raised by residents during the inspection. The complaints procedure is detailed in the Service User Guide booklet for the home. This guide states that it can be provided in large print or tape if the resident requires. The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 were assessed. Quality in this outcome area is good. The Willows offers comfortable, safe and well maintained indoor and outdoor accommodation for the residents. Apart from one area, the home is free from unpleasant odours and there are procedures in place ensure infection control can be managed effectively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the building was undertaken. The home is pleasantly decorated, homely and is accessible to wheelchairs. There is a lift which can access all floors and a ramp which leads from the dining room into the attractive gardens to the back of the home. It was noted that there is a slight lip for wheelchairs to negotiate from the doorway onto the ramp. Staff said that no residents go into the garden without staff supervision so this has not presented a problem. On the day of inspection the home was found to be clean and tidy and the majority of the home did not have any unpleasant odour. There was one The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 21 downstairs room which did contain and odour which also was apparent in the corridor. The two lounges in the home are pleasantly decorated and both were used by residents during the inspection. Staff explained that sometimes one lounge might be more lively than the other and social activities took place in both. There is also a seating section in the dining room with a television which residents can use as a ‘quiet’ area if they wish. The downstairs corridor and dining room areas have wooden floor panels and the lounges have carpets. Bedrooms viewed were carpeted and pleasantly decorated and had been personalised with photographs and various other personal items to make them homely. One resident who was in bed said they had been ill and didn’t feel like getting up. It was noted that their call bell was out of reach across the other side of the room. Action will need to be taken by the home to address this. The resident said if they needed anything they would just shout staff as they saw them and they didn’t appear worried about the inaccessible call bell. There are sufficient bathrooms and toilets in the home to support the needs of residents and the baths have chairs to assist the less able when getting into the bath. The laundry room although small contains two washing machines and two driers to support the laundry needs of the home. The provider stated that the washing machines had been changed since the last inspection to ensure sluice washes could be undertaken on a hot cycle. There were baskets available to sort dirty and clean washing and there were individual named baskets for staff to place residents clothes. Gloves and aprons were available as well as a handwash basin to allow staff to practice good infection control procedures and maintain hygiene. The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30 were assessed. Quality in this outcome area is good. The home provides sufficient numbers of trained staff to support the needs of the residents. Suitable recruitment systems are in place to ensure staff are checked and deemed safe to work with the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the manager of the home has departed and the home are in the process of arranging to recruit to this post. There is an Acting Manager in place and the Homes Services Director is also on the premises most days and was present on the day of inspection. There are sufficient staff on duty at the home to meet the needs of the residents. The Acting Manager said that they aim to have five staff on duty during the morning, four of these work from 8am to 1.30pm and one of these works from 7.30am to 1pm. Three staff on duty for the afternoon and evening shift and two waking night staff who work from 9pm to 8am. Duty rotas viewed confirmed these numbers. It was noted that duty rotas do not detail full the names of staff to provide an effective audit trail and it was advised this is reviewed. The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 23 A member of care staff spoken to said that there was a task sheet which detailed each day specific jobs each carer is to undertake. For example some staff are required to assist residents with showers and make beds, others are required to take the tea trolley around and others are responsible for undertaking social activities with the residents. The member of staff said that this works well because all carers have the opportunity to do something different each day and workloads are evenly divided. Residents spoken to were positive in their comments of the staff. One stated “staff are very nice, very sociable and friendly”, another stated “smashing girls on nights” and a further two residents said they were happy with the way staff looked after them. Residents explained how staff came in during the morning to help them get up washed and dressed. All spoken to said staff would bring them a cup of tea. One resident who had been in the home for a long time said the home was “really good”. In addition to care staff the home also has specific staff to undertaken cooking, cleaning, laundry, maintenance and administration work. There is a cook in the home for seven days each week. The cook is supported by a kitchen assistant from Monday to Friday. The kitchen assistant also works in the laundry during the weekdays and at the weekends the carers do this. A discussion took place with the manager around the management of infection control as the kitchen assistant is working in two different environments. The laundry is classed as a “dirty” area and the kitchen a “clean” area. The Acting Manager stated that the member of staff had a change of aprons between each of the jobs to help maintain hygiene. A review of training records was undertaken. There are thirteen staff employed by the home and of these ten have achieved a national vocational II or III qualification (NVQ) in care which well exceeds the 50 required by the care standards. A training schedule for the home confirms that staff have also undertaken training which includes moving and handling, food hygiene, infection control fire health and safety and dementia awareness. Not all staff on the schedule have completed fire training and the provider advised that this is usually done 6 monthly and another training session was due. She also stated that all staff had undertaken this training in July 2007. A review of staff files was undertaken to confirm that recruitment practices are being carried out as required to safeguard residents. The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 24 It was found that all of the necessary checks had been undertaken including Protection of Vulnerable Adult (POVA) First checks and Criminal Record Bureau (CRB) checks prior to their employment. In one file there were gaps in the persons employment that were not explained. Application forms should show a full employment history to enable appropriate employment checks to be made. Detailed induction records were available for new staff employed. It was evident that the induction training provided is in line with the Skills for Care Council common induction standards. This training enables staff to build up their competencies in a number of areas over a period of weeks so that they can provide safe and appropriate care to the residents. The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38 were assessed. Quality in this outcome area is good. Residents live in a well run home that aims to ensure the safety and welfare of the residents is promoted and protected although some actions are required to fully demonstrate this. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the manager for the home has left and this position was still vacant when this inspection was undertaken. The provider had however appointed an acting manager until such time this position can be filled. The acting manager advised that the provider was working in the home on most days. Although the home has developed systems for monitoring the quality of care and services, it was not evident some of these have been implemented for this The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 26 year. The provider advised that quality satisfaction surveys are in the process of being collated to obtain the views of residents and their families. Despite a quality system not being in place it was evident from the inspection process that residents in the home are happy with the care and services they are receiving. One resident said they were “happy with everything” another said the “staff are great, supportive and very helpful”. Residents stated that their call bell was answered within a satisfactory timescale when they used it. It was not evident there has been any recent resident/relative meetings whereby issues concerning the management of the home are discussed. Staff meeting notes were available but these were not dated to confirm these were from a recent meeting. Staff said that they were from a meeting in October 07. Various issues were discussed including resident care, management of food, cleanliness and tidiness in the home. Staff spoken to said they were happy with their roles in the home and felt well supported. There is a suggestion box available in the reception area of the home and there are forms available for those people who wish do make any suggestions. There is also a quarterly newsletter giving details of what is happening/what is planned in the home which also has a suggestion slip attached. The provider was preparing the newsletter on the day of inspection. As the provider is working in the home most days this does allow for some monitoring of the quality of care and services provided. There were no concerns raised by residents in regards to the home on the day of inspection. In regards to the management of residents money. The home operates a system, which is called a ‘Sundry Extras Charge’. This is a scheme, which is free of administration to residents but involves the resident calculating in advance how much money they are likely to need each month. The resident or their representative then pays this amount by standing order to an account managed by group accountant within the organisation. The home keep receipts for any transactions carried out for residents and these are forwarded to the Group Accountant who keeps detailed records of these transactions. Records of these transactions are not held in the home as required although copies of receipts are. The home keep an amount of petty cash to allow for any immediate payments needed for residents. Statements can be provided of each person’s expenditure by request but are not routinely provided. The monthly amounts can be increased or reduced by residents or their allocated representative to reflect any change. Details of the “Sundry Extras Charge” are explained in the Service User Guide booklet. Anyone not joining the scheme would be expected to handle his or her own finances. Appropriate security systems are in place for the storage of residents’ money. The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 27 As the accounts for each resident are held at the head office it was not possible during this visit to audit the accounts. At the time of the visit no one was able to confirm that residents’ monies are paid into a non-interest account. It has subsequently been confirmed that this is an interest free account. The provider is undertaking formal staff supervision until such time a manager is appointed to post. A supervision schedule is available listing dates of those already undertaken. The provider stated she was aware that all staff are to receive formal staff supervision sessions at least six times per year. Accidents and incidents are being recorded by the home and include actions taken but it was evident that we are not being told of all accidents that should be reported to us. The provider agreed to address this. A review of health and safety checks was undertaken. The home have a detailed fire risk assessment which is being updated according to fire safety checks carried out during the year. Certificates were in place to confirm the hoists had been recently serviced so they are safe to use with residents. Electrical portable appliance testing records were dated 12 April 2006. The provider said that the Environmental Health Department had advised that some things need doing 3 yearly and some 5 yearly. It was not evident from records in place how often each electrical appliance should be tested and this will need to be followed up accordingly. The Landlords Gas Safety Certificate for the home could not be located. The Annual Quality Assurance Assessment (AQAA) completed by the home in October 2007 showed that the Gas appliances had last been checked in February 2006. The provider advised that they had recently had two new boilers fitted to the home so these should be safe to use. The provider agreed to follow up this matter and forward a copy of the certificate. The AQAA showed that the lift and electrical circuits for the home had been checked within the appropriate timescales. During the last inspection it was noted that the fire door adjoining two bedrooms on the first floor was linked to the fire alarm system. It was not clear if this could be used as a fire exit if one or both residents in these rooms decided to keep their doors locked. The provider stated that this had been discussed with the fire office and had been resolved. The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 28 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X 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 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 3 X 2 The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes 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. 1. Standard OP7 Regulation 17 Sch 3 Requirement Care records need to be reviewed to ensure they clearly demonstrate the care needs of the resident are being met. Timescale for action 31/03/08 2. OP7 13(4) Risk assessments should be 31/03/08 reviewed to ensure they detail all risks associated with the problem identified. This is to ensure any risks associated with resident care can be managed effectively. A review of medication management is required to ensure this is safe and appropriate in maintaining the health of the residents. This includes: Prescribing instructions on bottles and boxes of medication must be accurately reflected on the Medication Administration Records (MARs) to ensure these are followed consistently. Eye drops need to be dated when opened to ensure staff know when to dispose of them 31/03/08 3. OP9 13(2) The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 30 after the 28 day deadline. MAR records must be legible. (A protocol agreed for any tablets that are prescribed for one or two to be given as required). Medication must be given to residents as prescribed and records must accurately show this. Action must be taken to ensure medications are not stored above their recommended guideline temperatures as this could impact on the effectiveness of the medication. (Timescale of 30/04/07 not met) 4. OP35 17 in relation to Sch 4 A record of all money deposited by a service user must be kept at the home; this must state the date on which the money was received, the amount. The record must also state what money was used for and where applicable receipts must be available. Call bell leads must be assessable to residents in their rooms at all times to ensure resident can alert staff if they need assistance. 30/04/08 5. OP38 13 19/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. The Willows Refer to Good Practice Recommendations DS0000069660.V351630.R01.S.doc Version 5.2 Page 31 1. Standard OP7 It is advised that the information held on care plans in regard to the management of catheters and colostomy bags is improved so that it is clear to staff how these are to be managed. It is recommended that the home obtain a controlled drugs cabinet to increase the security and management of controlled drugs within the home. Action should be taken to identify the cause of the unpleasant odour noted in one area of the home and to remove this. Action needs to be taken to implement a quality monitoring system which seeks the views of residents, relatives, staff, outside professionals and interested parties on management issues relating to the home. Any results of the surveys will need to be published in a report as well as detail any proposed actions to address any issues raised. Action needs to be taken to ensure the home has an upto-date Landlords Gas Safety Certificate to demonstrate gas appliances in the home are safe. If electrical portable appliance testing is not being done annually, action needs to be taken to show the timescales required for testing specific equipment in the home with recorded evidence these appliances have been tested within their required timescales. 2. OP9 3. OP26 4. OP33 5. OP38 The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Willows DS0000069660.V351630.R01.S.doc Version 5.2 Page 33 - 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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