Inspection on 19/01/06 for The Willows

This inspection was carried out on 19th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Willows 27/02/07

The Willows 21/06/05

The Willows 21/10/04

The Willows 24/05/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 The Willows 31-33 Sutton Drive Upton Chester Cheshire CH2 2HN Lead Inspector Mr Val Flannery Unannounced Inspection 19th January 2006 03:15 The Willows DS0000006666.V270912.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 DS0000006666.V270912.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 DS0000006666.V270912.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Willows Address 31-33 Sutton Drive Upton Chester Cheshire CH2 2HN 01244 382701 01244 382701 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) www.macintyre-care.org MacIntyre Care Ms Carol Jinks Care Home 5 Category(ies) of Learning disability (5) registration, with number of places The Willows DS0000006666.V270912.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 5 Service Users may be Learning Disability (LD) Date of last inspection 21st June 2005 Brief Description of the Service: The Willows cares for five adults with a learning disability. Located on a residential estate in Chester the home is close to local shops and is on the bus route to Chester city centre. The two-storey building was originally two separate semi-detached houses. Access between the ground floor and first floor is by the stairs. All the bedrooms are single, four of which are on the first floor. The fifth room is on the ground floor and contains an en-suite shower and toilet facilities. Sufficient communal toilet, bathing and shared space, including dining area, are provided for the service users. The garden to the rear of the home provides a secure area for use by service users. Staff are on duty twenty-four hours a day to deliver care to service users. The Willows DS0000006666.V270912.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over three hours as part of the yearly inspection process. One hour was spent reading the previous inspection report and reviewing the service history for the home. Three residents, the registered manager, a community nurse and two support staff were spoken with. Five service users, one relative and two health professionals comment cards were returned following the inspection. Two service users records were seen as well as a sample of the homes records. A partial tour of the home was carried out. Feedback following the inspection was given to the manager. Service users have restricted communication capabilities. What the service does well: What has improved since the last inspection? The Willows DS0000006666.V270912.R01.S.doc Version 5.0 Page 6 The home has been part of a nationwide project on communication between service users and staff. They were one of the eight homes chosen to be part of the project. During the inspection evidence was seen that the skills developed during the project were being put into practice, particularly in relation to a female service user. The development of the care plans and how best to improve the quality of life for service users is on-going. 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 DS0000006666.V270912.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 DS0000006666.V270912.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): 1/2/3/4/5 Information is available which will ensure prospective service users are aware of the services offered by the home. Assessments on the care needs of service users are carried out before they come to live in the home. EVIDENCE: A copy of the service user guide was seen in service users’ essential lifestyle plans. Service users spoken with said ‘it is home and that they like living here’. Records on the service user who has recently come to live in the home were seen. These showed that assessment of need, including personal histories and background information, were carried out by the placing authority and by staff from the home. It is the policy of the organisation that prospective service users are enabled to visit the home before making a decision about moving in. The records seen showed that visits to meet other service users and staff and an overnight stay were included in the pre-admission process. A copy of the statement of the terms and conditions of residency was seen on the service users’ files inspected. The Willows DS0000006666.V270912.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 Service users are encouraged and supported to make choices on how they wish to live their daily lives. EVIDENCE: The person centred plans and essential lifestyle showed that the assessed needs of service users have been identified and included in the plans. Service users’ care needs are monitored and action taken to address any changes. Risk assessments are also in place. Service users said staff talk to them and ask them if they like living in the home and how things could be improved. Staff in the home have recently been involved in a nationwide project to improve communication between service users and staff. They were one of eight homes in the organisation chosen to take part. The manager and support staff on duty said the project was ‘very worthwhile’. The communication between a service user currently living in the home, with specific communication problems, and staff has greatly improved using the techniques from the project. For example, the use of pictures has improved the quality of life for the service user particularly in relation to her daily routine. The Willows DS0000006666.V270912.R01.S.doc Version 5.0 Page 10 One service user said he is able to go to the shops and use other community facilities without staff supervision. MacIntyre have provided policies for staff on confidentiality of information, a copy of which is kept in the home. The Willows DS0000006666.V270912.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): 11/12/13/14/15/16/17 Service users are supported and encouraged to live fulfilling lifestyles- both inside and outside the home. EVIDENCE: During the inspection service users were seen returning from communitybased activities. One service user travels to and from his activity by himself. Other service users are supported by staff to take part in community based activities, for example, attendance at day centres and social events including discos. Service users’ plans of care showed that relatives are able to visit the home and be involved in the care and support of the service users. Records seen of the service user who has recently come to live in the home showed that her family visit on a regular basis. Staff spoken with were aware of their responsibilities with regard to ensuring service users’ assessed care needs are met. This includes helping them to make decisions about their daily lives. The Willows DS0000006666.V270912.R01.S.doc Version 5.0 Page 12 Service users were seen helping staff prepare the evening meal. Two service users said they could have what they like to eat and that they ‘like the food’. Four of the five returned service user comment cards showed that they ‘liked the food sometimes’. The Willows DS0000006666.V270912.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): 18/19/20/21 Service users receive support from staff with their personal care needs. Their healthcare needs are monitored and any issues are addressed. EVIDENCE: Service users said staff help them and ‘look after them’. Their essential lifestyle plans showed that they have been asked how they wished to be cared for. This included the level of help required with bathing, meals and with their mobility. Staff were seen helping service users with personal care in a manner that respected their privacy. Plans of care showed that service users receive visits from healthcare professionals including doctors and specialist nurses. Letters seen on their personal files showed that they are supported to attend hospital appointments. The assessed needs of services users require that they need help from staff with their medication. Two service users medication records were seen during the inspection. These were satisfactory. Macintyre have provided policies and procedures on the administration, copies of which are kept in the home. A community nurse was spoken with during the inspection. She was very positive on the efforts made by staff to communicate with service users. The Willows DS0000006666.V270912.R01.S.doc Version 5.0 Page 14 The Willows DS0000006666.V270912.R01.S.doc Version 5.0 Page 15 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): 21/22 A complaints procedure is in place which residents and staff are aware of. The adult protection procedure ensures the safety and well-being of service users. EVIDENCE: Details on how to complain and raise issues of concern were on display in the home. Copies of the complaints procedure are included in the ‘Supporting service users’ policy file. Information on how to contact the Commission for Social Care Inspection was included in the procedure. The record of complaints showed that the home had received one complaint since the last inspection. This was investigated by the home. CSCI have not received any complaints since the last inspection. A copy of the organisation’s procedure on protecting vulnerable adults was available. Staff were aware of the procedure; they also said the manager takes complaints seriously and acts upon them. The Willows DS0000006666.V270912.R01.S.doc Version 5.0 Page 16 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): 24/25/26/27/28/30 The home provides a safe and comfortable environment for service users. Service users’ bedrooms are individually decorated and furnished and are suitable for their needs. EVIDENCE: Two of the bedrooms were seen during the inspection. These were individually furnished and decorated. One service user said he had chosen the décor and furniture for his bedroom. All the bedrooms are single. Four of the rooms are on the first-floor and contain hand-washing facilities, the remaining room is on the ground floor and contains an en-suite toilet and shower facilities. The home provides a dining room, large lounge with conservatory and one small lounge all of which are located on the ground floor. These areas are easily accessible to service users. A secure garden to the rear of the home is provided for service users. Two bathrooms and toilets are located on the first floor and one toilet on the ground floor. These areas have door locks that can be overridden by staff in the event of an emergency and ensures the privacy of service users is respected. The Willows DS0000006666.V270912.R01.S.doc Version 5.0 Page 17 On the day of the inspection the home was clean and free from unpleasant smells. A tour of the building showed that it is well-maintained and that a safe environment is provided for service users. Also that grab rails, bath hoists and a care call system are in place. Service users were seen moving freely about the home and were able to access their bedrooms as they wish The Willows DS0000006666.V270912.R01.S.doc Version 5.0 Page 18 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): 31/32/33/34/35/36 Service users are cared for by staff that have worked in the home for a number of years. Satisfactory arrangements are in place for the recruitment of staff. EVIDENCE: The manager confirmed that staffing rota is the same as the previous inspection which was as follows: • • • • • One One One One One support support support support support worker: 7am-2pm worker: 8am-12noon worker: 2pm-10pm worker: 3pm-10pm worker sleeps in to cover the night-time. The staffing rota for the weekend showed the following: • • • • One One One One support support support support worker: 7am-2pm worker: 10am-5pm worker: 2pm-10pm worker sleeps in to cover the nighttime. The registered manager is included as part of the rota. The Willows DS0000006666.V270912.R01.S.doc Version 5.0 Page 19 Staff said they are made aware of their roles and responsibilities - both to caring for service users and to the organisation. This is done through individual supervision with the manager and the policies and procedures provided by the organisation. During the inspection a staff member was seen receiving individual supervision from the manager. Staff said that they have access to NVQ training and other courses which will improve their skills in caring for service users. A list was seen during the inspection of the courses available to staff, this included manual handling, food hygiene, fire training and health and safety. The staff personnel files seen during then inspection showed that satisfactory recruitment procedures are in place. The Willows DS0000006666.V270912.R01.S.doc Version 5.0 Page 20 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): 37/38/39/40/41/42/43 The home is well run by an experienced and competent manager. MacIntyre have provided a range of policies and procedures, copies of which are kept in the home. EVIDENCE: The registered manager has worked for the organisation in a senior capacity for a number of years. She is in the process of completing NVQ Level 4 in care. Two of the service users spoken with said the manager talks to them and asks them questions. Staff said the manager would listen to concerns and complaints and act upon them. MacIntyre Care have provided policies and procedures to assist staff in the day to day running of the home, copies of which are kept in the home. These included administration of medication, risk assessments and the care planning process. Staff spoken with during the inspection were able to discuss how the policies and procedures are designed to ensure the safety and well-being of services users. During the inspection a tour of the building showed that potential hazards are addressed. Records seen showed the organisation has procedures in place to The Willows DS0000006666.V270912.R01.S.doc Version 5.0 Page 21 deal with health and safety issues. These include service records for electrical installation, portable appliance tests and fire fighting equipment. The records also showed that fire drills and evacuation and weekly tests of the fire alarms are carried out. The acting area manager for the organisation visits the home on a monthly basis. A copy of the report on her findings is sent to the Commission for Social Care Inspection. The Willows DS0000006666.V270912.R01.S.doc Version 5.0 Page 22 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 3 3 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 4 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 4 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Willows Score 3 4 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 3 3 DS0000006666.V270912.R01.S.doc Version 5.0 Page 23 No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Willows DS0000006666.V270912.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 DS0000006666.V270912.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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!