Inspection on 14/06/05 for The Willows

This inspection was carried out on 14th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 27/10/08

The Willows 16/10/06

The Willows 14/11/05

The Willows 08/10/04

The Willows 20/04/04

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Southfields

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

CARE HOME ADULTS 18-65 The Willows 33 Stade Street Hythe Kent CT21 6DA Lead Inspector Julian Graham Unannounced 14 June 2005 9:30 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 H56-H05 S23563 The Willows V221926 140605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Willows Address 33 Stade Street, Hythe, Kent, CT21 6DA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01303 266963 Lothlorien Community Ltd Care Home only 6 Category(ies) of Learning Disability x 6 registration, with number of places The Willows H56-H05 S23563 The Willows V221926 140605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 08/10/04 Brief Description of the Service: The Willows is registered to provide accommodation and personal care for up to 6 people with a learning disability. The registered providers are Craegmore Healthcare. The Manager, Mrs Donna Yarnley, left the home on 2nd June 2005, and there is no manager at present. The Willows is located in a residential area close to the centre of the town and the seafront. The house is a substantial detached property with a parking facility for 2/3 cars on a private road which runs along one side of the premises. The accommodation is arranged on two floors. All of the Residents have their own bedrooms and one with an ensuite facility. The garden area is small with seating areas and is a sun trap in the warmer months. Hythe is a small southern coastal town and has a selection of shops, cafes, entertainment, etc. There are public amenities, and public transport links nearby. The Willows H56-H05 S23563 The Willows V221926 140605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 09.30 a.m. and took place over seven hours. The inspector spoke to the five residents at the home during the visit, four of whom in private. One resident was very new to the home. The inspector also spoke to five care staff. A tour of the premises was undertaken, including viewing three of the bedrooms. Some records were also examined, including care plans, risk assessments, a staff file and medication records. The manager, Mrs Yarnley, left the home two weeks before this inspection, and Mrs Caroline Davies, a manager of another home owned by Creagmore Healthcare, is currently overseeing the management of the Willows, pending the recruitment of a new manager. Mrs Davies visits the home two or three days a week. She was not on duty at the commencement of the inspection, but kindly came in shortly afterwards and gave the inspector every assistance. Towards the end of the inspection, some concerns in respect of the attitude and approach of a staff member towards residents came to the inspector’s attention. These concerns had been reported to the then manager some time ago. This matter was discussed with Mrs Davies who reported the concerns to Social Services under Adult Protection procedures, and is currently being investigated. Residents spoken with by the inspector earlier on the day, had said that they like the staff. What the service does well: Residents were seen to be relaxed, cheerful and comfortable with staff on duty at the time of the inspection. A resident new to the home said staff “treat you nice”. Another said “ I like the staff and they like me”. The staff demonstrated good awareness of the core principles of care and involve the residents in the life of the home. Since the last inspection, one of the residents with the support of staff has been able to move on to semi independent living, which is an achievement for both the resident and staff. Staff have access to a range of training courses enabling them to know what to do to meet the needs of the residents. Staff turnover remains low resulting in a settled team in the main, with the residents able to receive continuity and consistency of care which is of benefit to them. The Willows H56-H05 S23563 The Willows V221926 140605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? 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 Willows H56-H05 S23563 The Willows V221926 140605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection The Willows H56-H05 S23563 The Willows V221926 140605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,4 Prospective residents’ needs and aspirations are not being properly assessed prior to admission. EVIDENCE: The inspector examined the file of a resident who moved to the Willows a short while ago from another home owned and managed by Craegmore Healthcare. There was no evidence of a new and up to date assessment being undertaken prior to admission to the Willows, with just the original assessment at the previous home and dated October 2003 coming with him. Whilst there was some evidence of review of needs since moving to the Willows, the person’s care plan, and individual personal goals, drawn up in March 2004, had not been updated. The person said he has had no involvement in his care plan. However, the person said he is settling into the home very well, and made a positive choice to move to the Willows. Introductory visits were made prior to the decision being made to move, with opportunities to meet the staff and residents. Requirements made at the last inspection regarding the residents’ contract were not inspected on this visit. The Willows H56-H05 S23563 The Willows V221926 140605 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9 Care plans are generally clear, informative and accessible. Residents are in the main enabled to participate in the life of the home. EVIDENCE: A sample of care plans and risk assessments were viewed and with the exception of the care plan for the resident new to the home, these are being regularly reviewed. There is little involvement of the residents in the drawing up of their care plans, however. They have had input in completing the “My Way Forward” document, which gives them an opportunity to say, and have recorded, what is important to them in their lives. It is again recommended that some of these wishes and aspirations are translated into personal goals and recorded in their care plans, to be followed up and monitored. Staff have a good understanding of residents’ needs and there was evidence that residents are encouraged to make decisions that affect their lives. One resident , for example, told the inspector that he can choose the day time activities he wants to participate in at the Company’s Further Development Programme facility. Another resident said “I can choose the time I go to bed and get up”. Two residents told the inspector that they take responsibility for cleaning their room with staff assistance when required. Whilst there is some resident participation in the preparation of meals, there remains little involvement with cooking or The Willows H56-H05 S23563 The Willows V221926 140605 Stage 4.doc Version 1.30 Page 10 doing the big weekly shop. To participate more fully in these areas within a risk management framework is a recommendation of this report. The Willows H56-H05 S23563 The Willows V221926 140605 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15,16,17 Residents are being supported in being more independent, and are being enabled to take part in leisure, work and social activities in the home and in the wider community. There was a relaxed “feel” to the home on the day of inspection. EVIDENCE: A number of examples were given to the inspector of ways residents’ personal development is being promoted in the home. One resident who has communication difficulties is now able to use symbols and pictures to make his needs and wishes better known. A staff member said that this person is now better able to let staff know which clothes he wants to put on. Another resident is now helping do his own laundry and is making tea and toast for himself. Residents are accessing community facilities, such as the swimming pool, gym and library. One resident watches local cricket and football matches from time to time. A resident told the inspector that arrangements are being made for him to attend some of the Further Development Programme activities run by the company. Links with residents’ families are being maintained, and one of the residents was staying with his family at the time of inspection. The Willows H56-H05 S23563 The Willows V221926 140605 Stage 4.doc Version 1.30 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 Residents are receiving good personal support in accordance with individual need and their healthcare is generally being promoted. The systems for administering medication are improving but still require attention in some areas to minimise risks of harm to residents. EVIDENCE: The inspector spoke in some detail with a resident who needs some assistance from staff with regards his personal care needs. He said that staff “do it nicely” and that his privacy and dignity is being respected. There was reference to health care needs in care plans, and these are discussed in staff handovers where necessary. Staff have received training in medication administration, but some errors reported to the Commission before this inspection, indicate a further assessment of staff competence is needed. One staff member said that the former manager had regularly assessed his competence and understanding, using a form for the purpose, whilst another member of staff was not so sure. There was no supporting documentary evidence available at the time of inspection. Medication records were in order and the medication cupboard was clean and orderly. Separate MDS racks for each resident is recommended to ensure medication is taken to a resident in his room in its original container. The medication policy needs to include a procedure for ensuring staff are made aware of any changes to residents’ medication, including changes to the times of administration. Staff advised of an apparent deterioration in behaviour in respect of one resident. This person has been The Willows H56-H05 S23563 The Willows V221926 140605 Stage 4.doc Version 1.30 Page 13 receiving periodic input from the psychologist of the CTLD, and it is recommended that this person is accessed again for additional support at this time. The Willows H56-H05 S23563 The Willows V221926 140605 Stage 4.doc Version 1.30 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 The vulnerable adults procedure, whistle blowing policies and the Complaints Procedure are not working effectively to ensure that the people living in the home are protected from abuse. EVIDENCE: Concerns were expressed to the inspector regarding the attitude and approach of one of the staff members towards residents. These concerns had over recent months been reported to the manager and been documented in various records. There was no evidence that these concerns had been properly acted upon or reported under adult protection procedures by the manager. The inspector was told that all staff received training on adult protection a short time ago. Nonetheless, the home must ensure that all staff, including the manager and senior staff to whom concerns may be reported, know what action to take to protect the residents. The whistle blowing procedure must be strengthened to ensure staff feel able to report any concerns they may have and with the confidence that appropriate action will be taken. It was noted, however, that the residents spoken with at the time of inspection, said they like the staff and enjoy living at the Willows. Systems for effectively seeking the views of the residents, including residents being able to complain without fear, need review and improvement. A resident new to the home said he had not been given a copy of the Complaints Procedure, but may have seen it on a notice board. The Willows H56-H05 S23563 The Willows V221926 140605 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,27,28,29,30 The standard of the environment is generally acceptable, although some improvements will enhance the residents’ quality of life. EVIDENCE: Little change in the environment was noted since the last inspection. Residents have chosen new lounge furniture, the inspector was told, and delivery is awaited. Three bedrooms were visited but not examined in detail on this occasion. The carpet in the bedroom of resident SC was grubby and worn in places and would benefit from replacing. Another resident said that he would like a change of carpet, as it was in place when he moved in to the home some time ago, and is one that he does not particularly like. Pictures are waiting to be put up on walls throughout the home. This would greatly enhance the homeliness of the premises. A resident said that a lot of the walls are very bare. The acting manager has identified a need for a grab rail on the staircase for extra safety, and arrangements have been made to install one. The premises was generally very clean, although staff have noted within the past two days that a small area of carpet on the first floor is being soiled with urine. They are trying to investigate the cause and address it. The Willows H56-H05 S23563 The Willows V221926 140605 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 34,35,36 Positive relationships have generally been formed between the staff and the residents. Recruitment practices are sound. Staffing levels during the day are sufficient to meet the needs of residents, although night time staffing arrangements need reviewing. EVIDENCE: Staffing rotas show that three staff are normally on duty during the day. These numbers allow residents to go out and undertake interesting activities. There is one sleeping in staff at night, which might not be sufficient. It is a requirement of this report that night time staffing arrangements are reviewed, given the apparent deterioration in behaviour of one resident, and the possibility of nocturnal seizures of another resident. Some staff expressed concern to the inspector at being on their own at night given these circumstances. Other than the manager, there has been no changes in staff for several months now, and the residents are benefiting from this continuity and consistency of care. Staff presented well on the day of inspection, and were clear as to their role and responsibility. Two staff files were examined, demonstrating good recruitment practice, although these would benefit from being better organised. A range of training has been undertaken in recent months, including moving and handling, autism and Prada Willi syndrome. The staff training records need updating to reflect this. The Willows H56-H05 S23563 The Willows V221926 140605 Stage 4.doc Version 1.30 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 40,42 The home is currently without a manager, and the “acting manager” currently overseeing the home has a good understanding of what needs to be done to maintain and improve standards in the interim period. EVIDENCE: Whilst it is inevitable that some of the residents and staff are feeling a little unsettled at present owing to the recent departure of the manager, the home is benefiting from the support and input of the “acting manager” overseeing the home. Within the constraints of this interim position, Mrs Davies has been able to effect some positive changes, for example, amending the handover arrangements to ensure all medication is given at the correct time. Requirements in relation to safe working practices regarding the fire risk assessment, servicing of the gas boiler and moving and handling training have been met. The emergency lighting needs to be tested more regularly, however, and the temperature of the water remains too low, and may not be sufficient to control the risk of Legionella. The oven door handle is damaged and needs attention. The Willows H56-H05 S23563 The Willows V221926 140605 Stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 1 x 3 x Standard No 22 23 ENVIRONMENT Score 1 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x 3 3 Standard No 31 32 33 34 35 36 Score 3 x 2 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Willows Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score x x x x 3 2 x H56-H05 S23563 The Willows V221926 140605 Stage 4.doc Version 1.30 Page 19 yes Are there any outstanding requirements from the last inspection? 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 2 Regulation 14 Requirement Timescale for action 14/06/05 2. 6 15 3. 20 13 Accommodation must not be provided to residents unless their needs have been assessed. That assessment must be in sufficient detail to enable care staff to meet residents needs. The assessment must be kept under review and having regard to any change of circumstances be revised as necessary. With regards to care plans: a) 14/07/05 Residents goals and aspirations and how these are to be achieved and evaluated to be featured. (timescale of 12/11/04 not met). b) Residents to be involved in the drawing up of their care plans wherever possible. (timescale of 12/11/04 not met.) With regards to medication: a) 14/07/05 staff administering medication must be assessed as competent to do so, with supporting documentation. (timescale of 26/10/04 not met). b) Medication policy to include procedure to ensure staff are made aware of any changes to medication and the times of administration; and what action H56-H05 S23563 The Willows V221926 140605 Stage 4.doc Version 1.30 The Willows Page 20 to take in the event of an error. 4. 5. 6. 22 23 30 16 13 23 The complaints procedure must be given and fully explained to residents. The complaints, adult protection and whistle blowing policies must be effectively implemented. The strong smell of urine outside a residents bedroom must be investigated and appropriately addressed. Night staff arrangements must be reviewed to ensure a suitable number of waking/sleeping staff to meet the needs of residents. Training needs assessment for all staff to be undertaken and the staff training matrix maintained and kept up to date.(timescale of 11/12/05 not met). With regards to health and safety: a) the oven door must be repaired/replaced. b) emergency lighting to be tested at least on a three month basis (timescale of 12/11/04 not met). c) the hot water temperature to be regulated to ensure control of the risk of Legionella. (timescale of 12/11/04 not met). 14/07/05 14/06/05 28/06/05 7. 33 18 14/07/05 8. 35 19 28/06/05 9. 42 13 14/07/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 11 19 Good Practice Recommendations Strategies to enable residents to participate in the running of the home to include further opportunities to cook meals and do the main shopping. Referral to specialist services, including the Community Learning Disability Team in respect of residents to made as appropriate. H56-H05 S23563 The Willows V221926 140605 Stage 4.doc Version 1.30 Page 21 The Willows 3. 4. 5. 24 26 35 Dishwasher to be repaired. Carpets in bedrooms of resident SC and RP to be reviewed. Staff recruitment files to be better organised. The Willows H56-H05 S23563 The Willows V221926 140605 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 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. 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