Inspection on 14/11/05 for The Willows

This inspection was carried out on 14th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Willows 27/10/08

The Willows 16/10/06

The Willows 14/06/05

The Willows 08/10/04

The Willows 20/04/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

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33 St John`s Church Road

Dovedale Court

Lyncol House

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 Announced Inspection 09:30 14 November 2005 th The Willows DS0000023563.V256806.R01.S.doc Version 5.0 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 DS0000023563.V256806.R01.S.doc Version 5.0 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 Adults 18-65. 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 DS0000023563.V256806.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Willows Address 33 Stade Street Hythe Kent CT21 6DA 01303 266963 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.hythe@craegmoor.co.uk Lothlorien Community Ltd Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Willows DS0000023563.V256806.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th June 2005 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 Craegmoor Healthcare. The commission is awaiting an application to register the manager, Mr Richard Mott. 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 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 DS0000023563.V256806.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced, and started at 09.30 and lasted approximately six and a half hours. A pre-inspection questionnaire completed by the manager was received prior to the inspection, along with two feedback questionnaires from residents, which their relatives completed on their behalf. Five of the residents were spoken with during the inspection, with one being away staying with relatives. Three staff were spoken with, one being interviewed in the office. The premises was toured, and time was spent with the manager including looking at aspects of the home’s administration and examining some records. What the service does well: What has improved since the last inspection? A new manager has been appointed and is settling well into his role and is beginning to effect positive changes. Both residents and staff referred to the “calmer” atmosphere in the home. Improvements made by the manager include monthly supervision sessions for staff, and more regular resident and staff meetings. The complaints procedure has been given and explained to residents. Three matters relating to health and safety, which were noted at the last inspection, have been attended to. Some new lounge furniture has been purchased, and a shower room and one of the resident’s bedrooms have been redecorated. The Willows DS0000023563.V256806.R01.S.doc Version 5.0 Page 6 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 DS0000023563.V256806.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection The Willows DS0000023563.V256806.R01.S.doc Version 5.0 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 the following standard(s): EVIDENCE: Not inspected at this time, as there have been no recent admissions to the home. The manager is aware of the need to admit new residents on the basis of a full assessment, and advised that the company is in the process of producing a new pre-admission needs assessment tool. The Willows DS0000023563.V256806.R01.S.doc Version 5.0 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 the following standard(s): 6,7,8,9,10 Care plans are not being consistently reviewed and updated to reflect personal goals or changing need. Residents would benefit from more opportunities to participate in the running of their home. EVIDENCE: A sample of care plans was examined, and whilst there was some evidence of updating, this was not consistent, with some aspects of personal care needs now being out of date. Some entries were not signed nor dated. Residents are being offered some opportunities to participate in the life of the home, with some household tasks, like hoovering and dusting being undertaken when they are all at home on one morning each week. Staff said that residents enjoy helping out with this activity and keeping their own home clean. It is recommended that residents are given similar opportunities at other times of the week as well. It was good to hear from residents that they are now more involved in doing the shopping for the home. There remains little involvement, however, in preparing and cooking meals. There was a note on the file of one resident in January expressing that person’s wish to do more cooking. The resident said this is not happening. Personal goals such as this need to be properly recorded and facilitated by the person’s key worker, with a means of The Willows DS0000023563.V256806.R01.S.doc Version 5.0 Page 10 monitoring and evaluation. It is a recommendation of this report that in-house training on the responsibilities of the key worker is provided to ensure all staff know what is expected from them. Owing to some residents having a medical condition which can make their presence in the kitchen problematic, a decision has been made for residents not to enter the kitchen, other than at breakfast time. There was no record of how this decision was reached, nor who was involved and so on. Any restrictions imposed on residents needs to be properly assessed and recorded and kept under regular review. It was encouraging to hear that the manager is looking to enable greater use of the kitchen following risk assessment, and with the appropriate amount of planning and individual support for residents. This has been a recommendation in successive inspection reports. Residents are however being enabled to make other decisions that affect their lives in the home with residents’ meetings now being held regularly. The Willows DS0000023563.V256806.R01.S.doc Version 5.0 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 the following standard(s): 12,13,14,16,17 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: Personal development is promoted in the home. Through support and encouragement from staff, for example, one resident is now able to use the shower independently, which is an achievement. A range of activities are open for residents to join in with if they wish, including bowling, going to the cinema from time to time, and trips to the local pub where, according to staff, residents are well known. Two relatives in feedback questionnaires, said there could be more in the way of activities being provided, although residents said they are satisfied with this part of the service. One resident said, “activities are getting better.” This resident, with help and encouragement from staff, now has a voluntary job in a neighbouring town, and undertakes the return trip home by train by himself. Routines remain flexible, with residents saying for example, that they are free to go to bed when they like. Comments about the The Willows DS0000023563.V256806.R01.S.doc Version 5.0 Page 12 food provided were good. Residents said they help to choose what goes on the menu and can have something different if they want. The Willows DS0000023563.V256806.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 20 The systems for medication administration are generally good ensuring residents’ medication needs are met, although improvement is needed in some areas. EVIDENCE: Records are available to show that the previous manager had assessed the four staff currently administering medication, and was satisfied with their competence and understanding to undertake this task. One of these staff still needs to have formal medication training and a date for this has been arranged. Medication records were generally in order, with comprehensive records being made of medicines ordered, received and disposed of. Care must be taken, however, to ensure that changes to the dose and times of administration are fully recorded and made known to staff. “As per GP’s instructions” is not satisfactory. The requirement in the last inspection report for there to be changes to the medication policies and procedures to ensure staff are made aware of changes and when there is an error, remains outstanding and must be addressed. The Willows DS0000023563.V256806.R01.S.doc Version 5.0 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 the following standard(s): 22,23 Residents know that their complaints will be listened to and acted upon. Staff feel more confident that the whistle blowing policy would be implemented properly thereby protecting residents from abuse. EVIDENCE: Since the last inspection, the complaints procedure has been given to all the residents, who have signed that they have received a copy. The minutes of a residents meeting showed that the procedure was explained to them. The procedure is also prominently displayed in the home. Residents spoken with said that they felt staff would take any complaint they might make seriously, and do what they could to put things right. Staff know what to do if any allegation of abuse is made, and all have had training on adult protection. Staff also said that they would feel comfortable raising concerns under the home’s whistle blowing policy. The Willows DS0000023563.V256806.R01.S.doc Version 5.0 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 the following standard(s): 24,27,28,30 There has been some improvement to the standard of the environment which is generally acceptable. Some parts of the premises are still requiring upgrading, however, and also could look more homely and welcoming. EVIDENCE: As required from previous inspections, some new lounge furniture has been provided. Staff, with some assistance from residents, have redecorated the downstairs shower room and a start has been made to redecorating the kitchen. Staff are undertaking this upgrading apparently because of the long delay in the maintenance team being allocated time to do the work. The manager said that the colour scheme for the kitchen was chosen by the residents. One of the residents was very clear that he did not like the colour at all. It is suggested that this is looked at again to ensure that whatever colour is chosen is acceptable to all the residents. Some parts of the premises, for example, the landing area, dining room and toilets and bathrooms, remain bare and uninviting. This has been referred to in successive inspection reports. The apparent delay in making these parts of the premises more homely and welcoming is very disappointing, and it is again strongly recommended that prompt action is taken to address this for the benefit and enjoyment of all the residents. The garden also needs attention to make this place somewhere The Willows DS0000023563.V256806.R01.S.doc Version 5.0 Page 16 pleasant for the residents to spend time in. New garden furniture is needed as it is now looking tatty. The home was clean and free from offensive odours at the time of the visit. One resident again mentioned that he would like a new carpet in his room. This request was also noted in the minutes of a recent residents’ meeting, and again is a recommendation of this report. The Willows DS0000023563.V256806.R01.S.doc Version 5.0 Page 17 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 Staff morale is good with staff generally having a good understanding of residents’ support needs. Positive relationships have been formed between staff and the residents. Staff could be more focussed on looking for opportunities to involve residents in the running of their home. EVIDENCE: Residents spoke very well of the staff who presented as kindly people who are motivated to promote the well being of the residents. They demonstrated good understanding and awareness generally of their role as enablers. It is nonetheless a recommendation of this report that staff are encouraged to be ever alert for opportunities to offer the residents in taking a greater role in the life of their home. Staff were seen during the visit doing routine household tasks which could perhaps have been offered to residents. There is an experienced staff team working in the home, and staff turnover is low. This consistency and continuity of care benefits the residents. No staff has been recruited since the last inspection. Staff have attended a range of training courses since the last inspection, and a training matrix is in place. Staff training records are being well maintained, as required from the last inspection. Training on challenging behaviour is needed. Staff said they enjoy working in the home and feel well supported by the manager. Regular one to one supervision with the manager is being provided, and this good level of support is contributing to high staff morale. Staffing levels remain satisfactory with rotas showing that three care staff are on duty during the day with the The Willows DS0000023563.V256806.R01.S.doc Version 5.0 Page 18 manager supernumerary. Night staff arrangements have been reviewed as required from the last inspection, and no change has been deemed necessary. There is one sleeping in staff on duty during the night. The Willows DS0000023563.V256806.R01.S.doc Version 5.0 Page 19 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,41,42 The manager is new to the role and to the home and is settling in well. He has a good understanding of what needs to improve, including the need at times to adopt a more directive approach. Some records need to be more safely held and filed away directly to maintain security and confidentiality. EVIDENCE: The manager has been in post since July, and is quickly gaining the confidence of residents and staff, who appear to be responding positively to his relaxed style of management. He is booked to commence the RMA training, and has attended a number of courses over the past few weeks to update his knowledge and learn new skills relating to management issues. Now that he has settled in, he is aware that some areas of management may need a more directive approach and intends to work on these. An example being the need to ensure staff file away confidential records relating to residents which were seen to be loose and unattended at the time of the visit, so as to ensure these documents are safe and accessible when needed and do not get lost, and also to preserve confidentiality. The Willows DS0000023563.V256806.R01.S.doc Version 5.0 Page 20 No obvious health and safety hazards were noted on this visit. The oven door has been repaired since the last inspection, the emergency lighting is now being tested at suitable intervals, and the hot water temperature in the kitchen has been tested to ensure there is no risk of legionella. The manager is shortly to attend training on environmental risk assessments preparatory to reviewing the risk assessments currently in place. The Willows DS0000023563.V256806.R01.S.doc Version 5.0 Page 21 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 x x x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 2 x x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x 2 2 x 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 x 16 3 17 Standard No 31 32 33 34 35 36 Score 3 x 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Willows Score x x 2 x Standard No 37 38 39 40 41 42 43 Score 2 3 x x 2 3 x DS0000023563.V256806.R01.S.doc Version 5.0 Page 22 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 YA6 Regulation 15 Requirement Timescale for action 14/01/06 2 YA20 13 3 YA24 23 Care plans must be reviewed and updated, and include residents’ goals and aspirations and how these are to be achieved and evaluated. 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: 14/11/05 a) medication policy to include procedure to ensure staff are made aware of any changes to medication and the times of administration; and what action to take in the event of an error. (timescale of 14/07/05 not met.) b) Dosage and times of administration must be clearly documented on MAR sheets. “as per GP’s instructions is not acceptable ; c) handwritten entries on MAR sheets to be checked and signed by two staff. The garden must be tidied 14/05/06 and brightened up and be appropriately maintained. DS0000023563.V256806.R01.S.doc Version 5.0 The Willows Page 23 4 5 6 YA24 YA35 YA41 23 18 17 7 YA43 12 The dining room and kitchen to be upgraded as planned. Staff to receive training on challenging behaviour. Confidential records must be promptly and appropriately filed when written to ensure their security. Environmental risk assessments must be reviewed, updated and properly maintained. 14/01/06 14/02/06 14/11/05 14/12/05 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 3 4 5 6 7 Refer to Standard YA7 YA8 YA14 YA19 YA24 YA26 YA33 Good Practice Recommendations Any restrictions imposed on residents (for example, entry into the kitchen), to be properly assessed and recorded, and kept under regular review. Residents to be offered further opportunities to participate in the day to day running of the home, including preparing and cooking food. Residents to be offered the opportunity of a proper holiday outside the home during 2006. Referral to specialist services, including the Community Learning Disability Team in respect of residents to be made as appropriate. Premises to be made more homely. Resident, RP, to be offered new carpet for his room. Training to be given to staff on key worker role and responsibilities. The Willows DS0000023563.V256806.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Kent and Medway Area Office 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. Extracts may not be used or reproduced without the express permission of CSCI The Willows DS0000023563.V256806.R01.S.doc Version 5.0 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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