Inspection on 19/06/08 for The Willows

This inspection was carried out on 19th June 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Willows 27/06/07

The Willows 22/06/06

The Willows 13/09/05

The Willows 25/04/05

The Willows 19/10/04

The Willows 04/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Willows (The) 72 Boreham Road Warminster Wiltshire BA12 9JN Lead Inspector Sally Walker Key Unannounced Inspection 19th June 2008 09:05 DS0000028543.V362082.R01.S.doc Version 5.2 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 DS0000028543.V362082.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 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. DS0000028543.V362082.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Willows (The) Address 72 Boreham Road Warminster Wiltshire BA12 9JN 01985 215757 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) karen@exalon.net www.exalon.net Exalon Care Homes Ltd Vacant Care Home 10 Category(ies) of Learning disability (10) registration, with number of places DS0000028543.V362082.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who may be accommodated is 10. 27th June 2007 Date of last inspection Brief Description of the Service: The Willows is registered to provide care to up to ten people with a learning disability. It is owned by Exalon Care Homes Limited. Mr Steve Tayler is the proposed manager. The Willows is a large detached Victorian property with a large enclosed garden to the rear. Two sitting rooms, a dining room, kitchen, utility are on the ground floor. The service users bedrooms are located on the first and second floors, together with shared bathrooms with toilets. The manager’s office is to the first floor. Some of the accommodation is in a recently completed and registered extension. The home is situated a walk away from the centre of Warminster, with shops and amenities close by. As well as the home having two cars for the use of people who use the service, there are very good public transport links to neighbouring towns and further a field. Weekly fees are in the range £1170.00 to £1390.00. DS0000028543.V362082.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 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced Key inspection took place on 19th June 2008 between 9.05am and 5.05pm. Mr Steve Tayler commenced working as the manager in May 2008. His application to register with us is awaited. When we visited Mr Tayler had only been in post for 5 weeks. We looked at care records, medication records, staff records and menus. We spoke with 4 people who use the service and 2 staff. We made a tour of the communal space. As part of the inspection process we sent survey forms to the home for people who use the service, relatives, staff and healthcare professionals to tell us about the service. Comments can be found in the relevant section of this report. We asked the home to complete an Annual Quality Assurance Assessment (AQAA). This was completed in full and received on time. Some of this information is included in this report. Since the last Key Inspection we made a Random inspection because we were concerned about the number of incidents resulting in referrals to the Safeguarding Adults procedure. We were also concerned that guidance and advice from the care managers and the Behavioural Specialist Nurse were not being put into practice. We also wanted to establish whether the activities programme had improved following suggestions at the Safeguarding Meetings. At the Random inspection we saw evidence of risk assessments, triggers to behaviours and strategies for managing and reducing behaviours in some people’s care plans. All of the new behaviour management strategies had been sent to the relevant care managers for their consideration. We saw that some care plans contained photographs of how staff should hold and move a person away from challenging situations. We were told that staff received internal training in these techniques. We were concerned that this training focussed on physical interventions rather than preventative measures. We were concerned that the training had little focus on how staff’s own attitude and behaviour can affect people and how they might work differently. The previous manager told us that staff were now aware of triggers and gave 2 examples of how incidents had reduced as a result of staff response. The previous manager had set up activity sheets for staff to record different things that people had been involved in. We found that these records did not evidence an activity for each person each day. There was little evidence of a structured plan for any purposeful activity and occupation for each person. We noted that the previous manager had researched some voluntary work through DS0000028543.V362082.R01.S.doc Version 5.2 Page 6 a specialist placing agency together with what was provided by a local private college. Since the Random inspection the home has sent us fewer notifications of incidents. We have not attended any Safeguarding meetings. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? Mr Tayler has been appointed as manager. He has a clear focus of how he plans to develop the service. He has already established good working relationships with the people who use the service and the staff. As a result of considering advice from external professionals and different ways of working, some behaviours that challenge have been reduced. Some people who use the service are beginning to have more opportunities for educational and leisure activities and work. People who may not have done so before are being encouraged and supported to access the locality more independently. DS0000028543.V362082.R01.S.doc Version 5.2 Page 7 The new staffing rota focuses on the needs of people who use the service with staff available at key times, day and night, to support people in what they want to do. Staff are beginning to be offered more relevant training. The home now tells us if the staffing levels fall below the minimum for any reason. People can administer their own medication. More opportunities for staff to train in subjects relevant to their work are being planned and implemented. Although it is not staff’s immediate responsibility to report directly to the Safeguarding Adults process, they must be familiar with the procedure. The grounds have been cleared so that they are more accessible to people who use the service. 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 DS0000028543.V362082.R01.S.doc Version 5.2 Page 8 be made available in other formats on request. DS0000028543.V362082.R01.S.doc Version 5.2 Page 9 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 DS0000028543.V362082.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home makes the statement of purpose available in different formats. Although no new people have been admitted to the service, we consider that the home will continue to make detailed assessment with potential people who wish to use the service. EVIDENCE: In the AQAA the home told us about the statement of purpose and service users guide being produced in symbols and large print for easy reading. Mr Tayler showed us the service users guide, as an example. There had been no new people coming to live at the home for some time. Mr Tayler told us some people had taken an interest in the vacancies. They had visited with their families to see the accommodation and meet with the residents and staff. He said he was waiting for up to date assessments by their care managers. The home does not take emergency admissions. Comments from relatives in survey forms included “I ensured [the resident] was fully consulted before moving to The Willows. Not only written DS0000028543.V362082.R01.S.doc Version 5.2 Page 11 information, we also had a meeting with the manager to ask questions that were not covered in the literature.” DS0000028543.V362082.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans do not reflect the needs of people who use the service. Although people are encouraged to make decisions about their lives, this is not always recorded. Risk management encourages people in gaining independence. EVIDENCE: The home told us in the AQAA that the care plans had been recently reviewed to a standardised format. We looked at the care plans. The files contained large amounts of information. We found that not all current information, particularly about medical conditions and medicines was in the care plans. Mr Tayler told us that the current format was not working and needed rationalisation. He said that staff were duplicating information. He showed us his new care planning and reporting format that he planned to introduce. The daily record sheet had a section for evaluation of the daily events. We saw that staff were not completing these sheets. DS0000028543.V362082.R01.S.doc Version 5.2 Page 13 As Mr Tayler was new to post we agreed a new timescale to the requirement we made about care plans. We said in the requirement that the home must ensure care plans capture all current care needs of the people who use the service. Mr Tayler agreed to meet his requirement by the 1st September 2008. He planned to meet with staff to discuss rationalising the files with an index. Any duplicated or out of date information would be archived to another file. As the care plans were due to be reviewed and revised, we could not judge whether the good practice recommendation about signing and dating any amendments to care plans when needs changed had been undertaken. We also made a good practice recommendation that the recording formats should be rationalised to reduce duplication. This will be addressed as part of Mr Tayler’s review and revision of the formats. Action had been taken to meet the requirement we made that training in behaviour management must emphasise preventative measures. Action had also been taken to meet the requirement we made that external professional advice is put into practice and records made of progress. Mr Tayler told us he was considering strategies for reducing incidents. He had already achieved reductions in some areas with different ways of working. One person who uses the service had moved to a bedroom with ensuite facilities. With the introduction of waking night staff, behaviours had stopped because staff were now able to respond immediately to the person’s requests for a bath as soon as they awoke. Behaviour risk assessments had been reviewed in January 2008. We saw that staff were engaging more with people who use the service. We have received a reduced number of notifications under Regulation 37, about incidents between people in the last few months. It was clear from talking with some of the people who use the service and staff that people are encouraged to make decisions in their daily life. We found that this was not always recorded in their care plan or daily record. Risk assessments did not restrict people from experiencing new opportunities. In a survey form, one of the people who use the service told us “I do most of the connection to my family and friends. [They] only get notified when I ask.” DS0000028543.V362082.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although some people who use the service have more opportunities for meaningful activities, some people are without purposeful activities. Some people regularly access facilities in the local community. People are encouraged to build appropriate personal, family and sexual relationships. People are encouraged to follow a healthy diet. EVIDENCE: The requirement we made about ensuring all people who use the service have opportunities for appropriate and purposeful activities and occupation was in good progress. Mr Tayler had asked people what they wanted to do. One person wanted to do a mechanics course and this was being sourced at a local college. One of the people who use the service told us that they were doing DS0000028543.V362082.R01.S.doc Version 5.2 Page 15 more than they used to. They showed us the word games that they liked to do. Various games had been bought for use in the garden. One of the staff is a qualified assessor for ASDAN (Award Scheme Development and Accreditation Network). One of the people who use the service showed us the education work they were doing with the assessor. Some of the people who use the service told us about their holiday in Cornwall. Other holidays were being planned for this year. They told us that they each had different holidays. One person showed us the jewellery they had made. They told us they were making jewellery for the fete later in the year. Two people have part time work on a local community farm. One person has a job in an office for one day a week. They have a job coach to support them. One person goes horse riding every week. One person had little purposeful activities save walking in the garden or going out for a walk. Some of the people who use the service told us that they regularly went to the Gateway Club. One person told us they had entered a talent competition. Another person told us they liked to go into Warminster or Devizes shopping or for a coffee. Another person told us about their interest in music and fishing. People regularly go to see live music events. Two people went shopping for new clothes with a member of staff. Another person went to see their family for the day. People go to the local pub to play skittles and regularly go to the cinema. One of the staff was working with one person to support them in going into town independently. One of the staff told us that they provided relaxation sessions. This included grooming, hand and foot massage and makeup sessions. They said that some of the people who use the service liked to do baking and preparation of the Sunday roast. Action had been taken to meet the good practice recommendation we made that any board games or educational equipment was age appropriate for the people who use the service. People who use the service and staff told us about the plans to turn the downstairs office into a relaxation and games room. The room will be redecorated and a new large screen television with electronic games installed. We noted that appropriate and proper provision is made if people using the service want to have a sexual relationship. We looked at the menus. There was a range of nutritious dishes. At lunch time most residents had a sandwich with a filling of their choice. One resident DS0000028543.V362082.R01.S.doc Version 5.2 Page 16 had a ‘pot noodle’. People either eat in the dining room or in the sitting rooms or their bedrooms. Later in the day one of the staff was cooking the evening meal from fresh ingredients. Vegetarian and other choices were available. One of the people who use the service told us that they regularly had an Indian takeaway. Although the stores were depleted as the weekly food shopping was due that day, there were sufficient ingredients available for people. There were also treats, fresh fruit and snacks. Comments from relatives in survey forms included “the home is kept at an acceptable standard whilst ensuring it feels like ‘home’.” DS0000028543.V362082.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Some improvements in staffing arrangements have meant that all people who use the service can now receive personal support in the way they prefer. People have good access to healthcare professionals. Healthcare needs are being met but there is little evidence in the records. People are not supported by proper plans for management of medical conditions and administration of medication taken only when needed. People can administer their own medication. Systems are in place for staff to administer medication. EVIDENCE: Each person had a health action plan, separate to their care plan. The plans identified that people were having regular access to dentists, GPs and consultants as needed. We noted that one person was taking medication to manage diabetes. Their care plan was very limited in showing how this condition and their diet was being managed or monitored and by whom. We asked staff about how this person’s condition was managed. The information they gave us was not in the person’s care plan. DS0000028543.V362082.R01.S.doc Version 5.2 Page 18 Food supplements were available if people needed to retain a good weight. One person’s care plan had a record of meals monitoring. Staff training in diet, nutrition and epilepsy was planned for the next month. Action had been taken to ensure that any requests from GPs regarding specific information on people’s medication is followed up if the GP does not reply. Mr Tayler planned to meet with the GP surgery to introduce himself as the new manager and review people’s medication. Mr Tayler showed us an example of the checklist he had compiled so that all the person’s medication, including those which are taken ‘when required’, could be reviewed by the GP. There was a section for specific administration instructions. Mr Tayler told us he planned to review the procedures for administration of medication. The storage of medication would remain where it was for the present time as people who use the service were familiar with going to this area at different times during the day to receive their medication. One of the staff showed us the arrangements for administration and control of medication. People can self medicate following a risk assessment. We found that care plans did not always state why certain medications were being given. For example we could not establish the reasons for giving one person three different pain killers. The care plan did have a protocol for medication prescribed to be taken ‘when required’. However it recorded ‘for pain’. We could not establish from the records why one person’s medication had been changed from 2 to one on the medication administration record. The medication administration record for one person stated that they self medicated but their care plans stated that they did not take any medication. We noted a device for cutting tablets. We advised that as the medication was put up by the supplying pharmacist into a monitored dosage system, staff should not have to cut any tablets in half. We suggested discussing this with the pharmacist. We found a ‘prescription only’ topical cream in the medicine cabinet without a label. We advised that it must be discarded. We advised that the medication administration record must be kept securely. We also advised that where details of medication needed to be handwritten into the record, the entry must be witnessed, signed and dated. Since this inspection Mr Tayler has told us of his successful meeting with the GP practice, to introduce himself as the new manager and to review all the people’s medication as a matter of urgency. He has since told us that these meetings will continue to be held every three months. DS0000028543.V362082.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and investigations carried out. Although staff are not totally familiar with the reporting process for any allegations of abuse, we know that the organisation will follow up any issues of concern. EVIDENCE: The home follows the organisation’s complaints procedure. The complaints log showed records of outcomes of investigations and response to complainants. More confidential information about any investigations was kept at the organisation’s head office. Those people we spoke with about making complaints or talking to someone if they were not happy, said they would ‘go to Steve’. Staff told us that they had been training in the local Safeguarding Adults procedure. We talked with 2 staff about how they would report any allegations of abuse. We recognise that it is not staff’s immediate responsibility to report directly to the Safeguarding Adults procedure, however they must be aware of the process. The organisation is confident in using the Protection of Vulnerable Adults list referral process. DS0000028543.V362082.R01.S.doc Version 5.2 Page 20 People who use the service can keep small amounts of cash at the home for safekeeping. Only shift leaders and the manager have access to the accounts. Records and receipts are kept of all transactions. If people have a meal out as part of an activity it is paid for out of the home’s petty cash account. Comments from relatives in survey forms included “Until recently with the appointment of the new manager, [the resident] felt it was a waste of time making any comments – complaints, suggestions or praise as it fell on deaf ears. There have been major concerns…these have been appropriately addressed…the new manager has given me confidence that similar issues will not arise in the future. I have not had any cause for concern on my visits.” DS0000028543.V362082.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service live in a comfortable, clean, well-presented and homely environment. EVIDENCE: All of the accommodation for people who use the service is single bedrooms to the ground, first and second floors. Mr Tayler told us that he plans to have all the accommodation re-decorated room by room. The dining room was one of the first to be done. The manager’s office had been moved to what was a bedroom. The old sleeping in room was being advertised as an ensuite bedroom suitable for someone who may have reduced mobility. DS0000028543.V362082.R01.S.doc Version 5.2 Page 22 We saw that the bath panel in one of the bathrooms had come away from the side of the bath. Mr Tayler told us he would arrange for the handyman to fix it. We advised that a more substantial panel should be considered. The grounds and garden had been substantially cleared and are now more accessible to people who use the service. The gardener showed us the planting and talked about plans for further improvements. They also spend part of their time completing domestic duties. No action had been taken to address the good practice recommendation we made about a smoke free environment. Although Mr Tayler showed us the information he had from the Department of Health website, it did not show the specific guidance to care homes. The room that people who use the service were using to smoke, also had music equipment that may be used by other people living at the home. We advised Mr Tayler to research the guidance document and make the necessary arrangements for a smoke-free environment for other people who use the service. Some of the people who use the service who smoke keep their cigarettes in the office. The cigarettes are rationed throughout the day. We asked one person about these arrangements. They talked about the price of cigarettes. They told us that if they had the packet themselves, they would smoke them all at once. They said they were happy with the arrangements and were never refused a cigarette by staff. The home was cleaned to a good standard with no unpleasant odours detected. Some people who use the service are involved in some light cleaning and domestic chores. Mr Tayler showed us the laundry. People who use the service launder their clothing according to a rota. Some people have staff support them with laundry. The home has a maintenance person for three days a week. DS0000028543.V362082.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Changes to the staffing rota mean that people who use the service have support when they need it. Staff now have more opportunity to undertake relevant training. A robust recruitment process is in place. 50 of staff have NVQ Level 2 or above. EVIDENCE: A new rota was being implemented so that the needs of people who use the service could be met at key times during the day and night. It also means that staff are not working exceptionally long hours. The new three week rota will provide for a handover period so that staff have time to share information and plan the shifts. There is a minimum of 4 staff during the day. Additional staffing hours are available to support people with their allocated individual day for activities. DS0000028543.V362082.R01.S.doc Version 5.2 Page 24 Action has been taken to address the requirement we made that we must be notified without delay if the minimum staffing levels are not achieved for any reason. Mr Tayler had interviewed potential staff for the waking night posts. Criminal Records Bureau certificates were awaited before they could commence duties. An additional shift leader post had been advertised. This appointment will mean that there are sufficient shift leaders at all times during the day. We looked at staff recruitment files. A robust recruitment process was in place with all information and documents in place before anyone commenced working with the people who use the service. No one starts work without checks on their suitability to work with vulnerable people. Five staff have left the service in the last year and most of these posts have new appointments. Each staff has an individual training record. The home had a training plan in place. One of the staff told us about the training they had undertaken. This included safeguarding adults, behaviour management, first aid, moving and handling, food hygiene and the Mental Capacity Act 2005. They said that future training included a course on Autism Spectrum Disorder. A new member of staff told us they had received a good induction into their role. Staff told us that Mr Tayler discussed future training needs at supervision. Five staff have NVQ level 2 or above. One of the agency staff told us that they had received an induction into the fire procedure before they had started their shifts. They said they had been given a short resume of people’s needs. They said they never worked alone and never gave medication. Comments in relatives survey forms included “I feel there is much training that could benefit both staff and residents. Although there have been difficulties within the home regarding staffing levels and some staff’s attitudes, I am satisfied that these have been addressed by the higher management. I hope to see the challenges of the new manager further influencing the agency staff issues and training levels.” Comments in staff survey forms when asked what the home does well included “handovers, communication, updates, supportive, very helpful”, “Good communication and handovers, a supportive and patient team of staff. Very helpful”, “The Willows seems to provide a good all round service” and “Makes the service users feel at ease and gives them a say in the day to day running of The Willows.” Other comments about their recruitment and training included “yes very thoroughly. [Induction] lasted for a whole week. I have been on quite a few training courses, all of which have been relevant to the needs of the service users and myself.” DS0000028543.V362082.R01.S.doc Version 5.2 Page 25 DS0000028543.V362082.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Although Mr Tayler had only been in post for 5 weeks he had developed good relationships with people who use the service and staff. He was clear about priorities in developing the service. The home is run in the best interests of the people who use it. Health and safety is well managed for people’s protection. EVIDENCE: Mr Tayler had been in post for 5 weeks when we carried out this inspection. He told us he was waiting for his Criminal Records Bureau certificate in order to complete his application to register as manager. He said he was registered to complete the Registered Managers Award and had NVQ Level 4. He is also DS0000028543.V362082.R01.S.doc Version 5.2 Page 27 an NVQ assessor. Mr Tayler was planning to do training in relation to the Mental Capacity Act 2005, deprivation of liberty and medication. Mr Tayler told us that he had received a thorough induction into his role as manager. The Head of Care Services had met with him each week at the home. He told us that the record for his induction was kept at the organisation’s head office. Mr Tayler was going to meet with the care managers and GPs to introduce himself as the new manager. Mr Tayler had been involved in developing the business action plan for the home. He met regularly with the Head of Care Services to discuss implementation and progress. Mr Tayler showed us the plan and checklist for implementing staff supervision. He intended that senior staff would attend training in staff supervision. Staff confirmed that they had supervision and could talk to Mr Tayler at other times about issues. The organisation contracts with two independent professionals to carry out the monthly unannounced visits required under regulation 26 and the quality audits. Reports on these assessments and audits are sent to the home. Mr Tayler told us that residents meetings would be held each month to gain their views on the plans for the home. The people who use the service also respond by using questionnaires about the service. The organisation produced generic risk assessments for the environment and tasks. Risk assessments specifically related to the home were regularly reviewed. Environmental risk assessments with each person who uses the service were reviewed at the end of January 2008. Mr Tayler told us that the member of staff with the delegated responsibility for health and safety was booked on a risk assessment course for the following month. We could not assess whether action had been taken to address the good practice recommendation we made about the quality of record keeping as staff were not completing the forms introduced by Mr Tayler. We said in the requirement that the daily records should provide a true reflection of the daily experience of people who use the service. Staff should avoid unclear statements such as ‘verbally aggressive’, ‘inappropriate behaviour’ and ‘came home with mixed emotions’. Mr Tayler showed us the recording sheet he had developed so that staff could focus on recording and evaluating the different aspects of people’s care plans. DS0000028543.V362082.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 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 Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 3 X 3 X X 3 X DS0000028543.V362082.R01.S.doc Version 5.2 Page 29 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(1) Requirement The person registered must ensure that care plans capture all the people who use the service’ current care needs and record guidance on how those care needs are to be met and monitored. (As Mr Tayler was new to his post as manager, a new timescale was agreed). Timescale for action 01/09/08 2. YA20 13(1)(b) & (2) The person registered must 31/07/08 ensure that any requests from GPs regarding specific information on people who use the service medication is followed up if the GP does not reply. (Mr Tayler has arranged to meet with GPs for a review of all medication). 16(2)(m) &(n) The person registered must ensure that all people who use the service have opportunities for appropriate and purposeful activities and occupation. (In progress). 01/09/08 3. YA12 DS0000028543.V362082.R01.S.doc Version 5.2 Page 30 4 YA20 13(2) & 17(1)(b) The person registered must ensure that confidential medication administration record are kept securely. 19/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA41 Good Practice Recommendations Explore ways to ensure daily records provide a accurate reflection of the daily experiences of people who use the service. (Staff should avoid unclear statements such as ‘verbally aggressive’, ‘inappropriate behaviour’ and ‘came home with mixed emotions’.) We could not assess this recommendation, as the new daily record sheet was not being filled out. 2. YA28 The person registered should consult the Department of Health website to gain advice on the smoke free advice for care homes. (Outstanding since 27/06/07). 3. YA41 The person registered should ensure that care plans and any amendments following change of need are signed and dated for monitoring purposes. (Outstanding since 27/06/07) The person registered should consider rationalising recording formats to reduce duplication. (Outstanding since 27/06/07). Consideration should be given to discussing the need to cut tablets with the supplying pharmacist. Prescribed topical creams should retain their dispensing label showing who owns the cream. If the label has come off the cream should be discarded. Handwritten entries in the medication administration record should be witnessed, signed and dated. DS0000028543.V362082.R01.S.doc Version 5.2 Page 31 4. YA41 5 6 7 YA20 YA20 YA20 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 DS0000028543.V362082.R01.S.doc Version 5.2 Page 32 - 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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