Inspection on 02/07/09 for The Willows

This inspection was carried out on 2nd July 2009.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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 18/02/2010.

Key inspection report CARE HOME ADULTS 18-65 The Willows 30 Slinger Road Thorton-Cleveleys Lancashire FY5 1BN Lead Inspector Christopher Bond Unannounced Inspection 2nd July 2009 09:30 The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Willows Address 30 Slinger Road Thorton-Cleveleys Lancashire FY5 1BN 01253 858660 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) Mr Seemy Addingadoo Manager post vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Willows DS0000073085.V374915.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 people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability- Code LD The maximum number of people who can be accommodated is: 6 Date of last inspection This is a new service. Brief Description of the Service: This is a small, registered home for six adults who have a learning disability. The service is situated close to Cleveleys town centre. There are shops and other amenities close by, meaning that the people who use the service have the opportunity to experience an active life where resources are available without travelling long distances. The home is an ordinary semi-detached house. Parking in the immediate area is difficult because of restrictions; there is, however, a pay-and –display car park quite close by, and within walking distance. Cleveleys bus station is a short walk away and there is a tram service that runs from Cleveleys to Blackpool and Fleetwood. Transport links are good, meaning that the people who use the service are able to use a wide range of resources and facilities. There are six bedrooms at this property, one being used by care staff who provide night time cover. One of the larger rooms is being used as a shared bedroom. There are en-suite facilities in two of the rooms. One bedroom is on the ground floor because the person who uses this room has a physical disability. The owner of the service has provided information that informs prospective residents and their families/ representatives of the purpose, aims and objectives of the service. The current fees for the service are from £473.50 to £678.00 per week. There are extra charges for chiropody. The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 5 The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was a key, unannounced inspection that took place over a period of six hours on the 2nd July 2009. This was the first inspection of a new service. The current owner became registered for this service in February 2009. We looked at the care records that were available and checked the administration of medication within this service. We observed the care staff working and spoke to them about their work. We also sent out surveys to the care staff and five were returned to us. The results of these have been included in this report. We looked at the care staff files and checked how people were recruited and what checks were made prior to this. We also spoke to the people who use this service and asked them about the care they received. We also spoke to the owner of the home about the service. We looked around the home and examined what facilities were available for the people who used the service. We also asked the owner of the service to complete an Annual Quality Assurance Assessment about the service and the action that he had taken since taking over the service, and what changes he plans to make in the future. The results of this have been included in this report. What the service does well: This service generally provides a clean, welcoming and homely environment for the people who live there. The home is situated close to Cleveleys Town Centre, meaning that the residents only have a short distance to travel to get to local shops, transport connections, restaurants, and other important facilities. The sea front is only a short distance away, and can be used for walks along the new promenade. The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 7 Most of the people who use this service have day occupations, and good support is available during the day to ensure that the residents go out into the community to enjoy activities. The staff that we met were enthusiastic and competent in their role. The residents were well -cared for and were treated respectfully by the carers. One of the residents that we spoke to said that the care staff were ‘great’ and that it was enjoyable living at the home. The people who used the service that we spoke to said that they enjoyed the food that was prepared, and enjoyed helping with the tasks that were associated with mealtimes, such as shopping for food, preparing meals, and washing up. What has improved since the last inspection? What they could do better: We found that there is much work to do for this service to reach the required standards that are set down for registered homes for younger adults. The owner told us that he was going to manage the service himself and he felt as if he was ‘in at the deep end’ regarding the running of the home. He has no previous experience of providing a service for adults who have a learning disability. Information about the home wasn’t in a format that most people could understand. There were no photographs and illustrations, or other methods of communication that would help those with a learning disability to find out information about the service. This was evident when we looked at the service user guide, the Statement of Purpose, care planning and the complaints procedure. We found the care planning for the people who use the service to be disorganised and ‘ad-hoc’. There were two large folders that were full of both current and old information. It was unclear what information should be in each file and individual records were unclear and information was difficult to find. It would be better if the plans were individually bound and presented with the interests of the residents in mind. The owner told us in the information that he sent to us before we visited the home that the people who used the service were working towards goals to develop their skills and competencies. We found no evidence of these. Appropriate goals can be used to guide the care staff in their daily work and The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 8 provide opportunities for people who use the service to develop their skills and use a range of daily activities. There was no evidence of a review process within the care plans. We would expect that each resident has their care and support re-evaluated on a regular basis. Changes can then be made where necessary and information updated. Goals can also be assessed, and progress noted. Changes and adjustments can be made to people’s care to address current need. The plans must be regularly reviewed. The people who used the service enjoyed various activities both individually and in a group. Activities involve a certain level of risk, and controlled risk is necessary for people to develop their skills in a positive way. This means that elements of risk have to be assessed to address possible hazards and to negate these where possible. Unfortunately we found no risk assessments within the information that we looked at. Some people had been prescribed medication by their doctor and needed the care staff to help administer this. Storage of this was poor, with little reference to security. Records of administration were incomplete; there were gaps where the staff should have signed to show that the medication had been given. No training had been given to the care staff regarding the safe administration of medication for some considerable time. We were also told by the owner of the home within the information that he sent to us prior to our visit that the service did not hold any ‘controlled’ medication or medication that is closely monitored due to its strength or content. He also repeated this whilst we were at the home. We found, however, that controlled medication was being administered, and the correct procedures regarding storage and recording were not being followed. The owner of the home did not know what his responsibilities were regarding ensuring that people were safeguarded from harm. Policies and procedures kept by the service were old and outdated and care staff had not been adequately trained. No training had been planned regarding safeguarding vulnerable adults. The décor and furnishings of the home looked quite ‘tired’ in places and a plan should be made to ensure that the décor, fabric and furnishings of the service are renewed and replaced at reasonable intervals. It is important for people to live in a well maintained and pleasant environment with nice things around them. One of the bedrooms that we looked at did not smell very nice and measures should be taken to ensure that continence management is addressed properly and cleaning regimes are improved. Investment in the environment will also help to improve the status of the individuals who live there: this would help to ensure that people live in a nice home with quality fitments and furnishings. This is particularly relevant to the bathroom areas, which haven’t seen investment for some considerable time. The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 9 It is important that the care staff are appropriately trained in key areas of safety and care; this improves their skills and ability regarding providing a good service to the residents. Training had been very infrequent and there were no records to show what training had been planned. Only two of the care staff had a nationally recognised qualification in care (National Vocational Qualification level 2 or 3 in care). The owner of the home must also undertake a recognised qualification in management should he continue to manage the service. No information could be found to confirm that the care staff were being adequately supervised by the owner of the service. There were no supervision records on file. Good supervision is important because it enables training issues to be discussed and performance to be assessed. It is particularly important when people sometimes work in small teams or in isolation without direct managerial support. Supervision should take place on a regular basis, at least six times a year. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 10 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 DS0000073085.V374915.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2. 3, 4 and 5. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about this home was not available in a format that was accessible to all. Needs assessments had been completed for most people, but not all, meaning that this service could not be entirely aware of individual health and social care requirements. EVIDENCE: Most of the people who used this service had information gathered about their needs and abilities before they moved in. This meant that the care staff are aware of their needs and a decision can be made as to whether the service could meet their social and health care needs. One person who recently came to live at the service had not had their needs assessed by the service. Information was provided by the local authority, which placed the person within the home. This meant that only limited information was available about the needs of this person before they moved in. All of the other residents had needs assessments on their files. The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 12 The person who was recently admitted to this home had the opportunity to visit the service and see what facilities were available before they made a decision as to whether the home was right for them. Information was available about the service to help people make an informed choice. This was in the form of a service user guide. It would be better if this information was available in a form that most people were able to understand, such as an illustrated guide, or DVD. The current guide could only be accessed by those who had literacy skills. The guide described the service, its purpose and its aims. The guide told people what to expect and how to voice their concerns should they have a problem. Everyone who used the service had a contract on their personal file that described the agreement regarding what service they would receive. This is important because the people who used the service and their representatives would know what to expect when they moved in and would be aware of their rights as residents of the service. Again, this would be better if this information was in a form that most people could understand. The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7, 8, 9 and 10. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning within this service was poor, meaning that a lot of information was either not recorded, or recorded inadequately or inappropriately. Care plans were not reviewed and peoples’ health and social needs were not updated on a regular basis. The management of risk was inadequate, meaning that areas of hazard had not been sufficiently identified and addressed. EVIDENCE: We looked at all of the information that was recorded about how the people who used the service had their needs met. Everyone had a care plan where the owner and care staff could record important information about social needs, individual goals, and how the residents’ health issues were addressed. We found this information to be poorly presented and confusing. Some of the The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 14 information was not dated, so it was unclear as to when this was written, who wrote it and whether the information was current. For example, one of the residents had information written down about what services they attended during the day. The owner of the home told us that this information was old and the person no longer used these services. The owner told us in the information that he sent to us before we visited the home that the people who used the service were working towards goals to develop their skills and competencies. We found no evidence of these. Appropriate goals can be used to guide the care staff in their daily work and provide opportunities for people who use the service to develop their skills and use a range of daily activities. There was no evidence of a review process within the care plans. We would expect that each resident has their care and support re-evaluated on a regular basis. Changes can then be made where necessary and information updated. Goals can also be assessed, and progress noted. Changes and adjustments can be made to people’s care to address current need. Because there were no reviews carried out the people who used this service did not have their care plans updated regularly and important information was not recorded. A lot of information that we found that was inappropriately filed. The care plans were not individually bound and information was difficult to find. Information that should have been evident within car plans was stored elsewhere and there was too much important and confidential information that was inappropriately filed. For example, we found that information that had been recorded about the frequency of seizures was not entered on the care plan meaning that this could be missed, or not linked to other issues. We found some evidence to suggest that people were being involved in making decisions about what type of care they received. The carers told us that house meetings were held, but information discussed at these meetings had not been recorded. We spoke to four people who used the service. One person told us that they didn’t like living at the home and had made a decision to leave. Another resident said, “I like living here, it’s nice. The staff are great.” The owner of home and two of the care staff told us that the people who used the service were involved in preparing meals and contributing to life within the house. We found that some of the residents were involved in activities in the community. One person worked as a volunteer in a local shop. People also used the leisure facilities and resources that we all take for granted. All these activities involve a certain level of risk, and controlled risk is necessary for people to develop their skills in a positive way. This means that elements of risk have to be assessed to address possible hazards and to negate these where possible. Unfortunately we found no risk assessments within the The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 15 information that we looked at. Even though the owner of the home had told us, in the information that he supplied to us prior to this visit that risk assessments were available and that people were developing in a risk controlled environment. The owner and two of the care staff that we spoke to were aware of the importance of confidentiality, and ensuring that personal information was handled correctly. It was noted, however, that a lot of personal information was held in an unlocked cupboard in the kitchen area. There was adequate space in the office area on the top floor of the home to store this information more confidentially. This would also help to provide more space in the residential part of the home, ensuring that the environment was more homely. The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 16 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): This is what people staying in this care home experience: Standards 11, 12, 13 14, 15, 16 and 17. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who used the service were able to enjoy appropriate leisure activities within the local community. Friendships and family contacts were encouraged. EVIDENCE: It was good to see that people were using community facilities and had opportunities for development. One person who used this service worked in a local shop as a volunteer. Other residents used more traditional day services such as a local rehabilitation workshop and a purpose built day service for adults with learning disabilities in Fleetwood. The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 17 All of the residents used a local Mencap facility every Thursday evening as part of their leisure activities. Some people enjoyed more individual activities such as shopping, going to the cinema, visiting restaurants and pubs, and going swimming. The owner of the service told us that the residents were well known in the local community. There was a social club close to the home and some of the residents attended social functions there. The staff rota was looked at and staffing throughout the day was good. In the evening one of the care staff usually finished at 7:00pm, meaning that only one carer was around after that. This meant that some individual activities had to finish by this time because of a lack of staff cover. It would be good to see more staff working in the evening so that individual activities could be planned and the residents would have more support to do things that they enjoyed without having to go out in a group, or share support with others. The people who use the service would be enabled to enjoy more individual lifestyles. There were no visitors to the service whilst we were there. The care staff told us that some families visited frequently and people were able to invite friends and family round to the home whenever they wished. Maintaining family support and encouraging friendships is essential. Two of the residents told us that they enjoyed mealtimes and that the food was usually very good. One person told us that the food was ‘smashing’. It was good to hear that the people who used the service helped to prepare meals and were involved in the tasks around mealtimes. Although there were menu’s available, the care staff told us that people were able to choose what they wanted to eat and became involved in shopping for the things that they enjoyed eating. It would be pleasing to see that such activities were planned and part of a goals led service with records kept of progress and development. This type of information was lacking. Good care planning would mean that the care staff were working far more individually with people and concentrating on developing peoples lives through planned activity. This would mean that their work was more focussed. There was also a lot of concentration on group activity rather than developing a more individual service with one to one support. The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19, 20 and 21. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The administration of medication within this home was poor, meaning that people could be put at risk by bad practice. Information about the residents’ individual health and care needs was insufficient and unclear, which could cause uncertainty amongst the care staff. EVIDENCE: Some of the people who used this service were taking medication that was prescribed by their doctor. We found that this medication was stored poorly, in a filing cabinet close to the back door. Apart from this being an obvious risk, this storage facility was not secure and a more appropriate cabinet must be purchased. The owner told us that everyone’s medication was checked regularly and that regular audits were carried out. We found that there were several instances of medication not being signed for on the medication record The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 19 sheets. This had either not been administered or the person who gave this out had forgotten to sign the record. We could not see whether the medication had been given, or had been missed. One of the instances that we found involved medication that was prescribed for epilepsy, and missing this could have increased the person’s chances of having a seizure. We cross referenced this with the daily records and no instances of seizures were recorded at that time. We were also told by the owner of the home within the information that he sent to us prior to our visit that the service did not hold any ‘controlled’ medication or medication that is closely monitored due to its strength or content. He also repeated this whilst we were at the home. We found, however, that controlled medication was being administered and the correct procedures regarding storage and recording were not being followed. The controlled drug cupboard should meet the requirements of the amended Misuse of Drugs (Safe Custody) Regulations 1973. No training had been provided for the care staff in medication awareness for some time, and none had been planned. This would help the care staff to improve their knowledge and practice. This would also help to ensure that the people who use the service are not put at risk by poor practice. All of the people who lived within this service required some degree of personal care. This ranged from prompting and advice to complete personal assistance. We observed the carers providing support. They were respectful and caring in their role and spoke to the residents politely. It was clear that a good standard of support was being offered. The people who used this service looked well cared for and well- dressed. All had an individual and personal style of dressing. We spoke to two carers at length and they were positive and knowledgeable about their role. When we spoke to the residents in the morning before they went out, and some nice thing were said about the staff. One person commented that staff were ‘great’ and everyone looked happy and cheerful. The care plan described each persons daily routine, and what happens each day from when they rise in the morning to when they go to bed. There was some good information written down about each person. It was clear, however, that this information was not current and had not been dated. There was no evidence of a review process to update this information. The information had not been signed by whoever recorded it. New staff would find it difficult to follow routines if this information was followed. Clear, precise and current records of care routines are essential so that all the carers are able to work in the same way. This is also important because those who used this service who have an autistic spectrum disorder place importance on routine and feel safer and more comfortable when routine is built in to the fabric of the service. There had been no training in care related matters for the staff for some considerable time and none had been planned. Only two of the care team had The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 20 a nationally recognised qualification in care (National Vocational Qualification in care level 2 or 3). The minimum standard for this is 50 . No training had been given to the care staff regarding epilepsy. This training is important because some of the people who used the service had seizures. The care staff were unclear about what understood autism to be, and there was little information for them to read about this within the home. No specific information on epilepsy or autism was found within the care pans. Good, clear and current information regarding each persons individual health and care needs is essential and helps the care staff to provide a good standard of individual care, promoting good practice. There were records of visits by health and social care professionals to the home. These records, however, need to be precise and some outcome of the visit should be recorded. We found information about these visits to be brief. The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Training and information about safeguarding vulnerable people from harm was insufficient, which could put the people who use this service at risk. The process of enabling people to voice their concerns about the service was flawed, meaning that those who lived within this home were not adequately supported to do so. EVIDENCE: Advice was available about voicing concerns and making complaints about the service in the information that people were given about the home. This information, however, was not in a format that enabled most people to understand its content. It is poor practice to provide information to someone who is unable to understand, or read its content. Every effort should be made to help ensure that the people who use this service can voice their opinions or concerns about their care and support, should they wish to do so. This would involve presenting information in alternative format, and the owner of the service must explore ways of doing this. The owner of the home should also look at ways to ensure that all people who use this service have a voice regarding how the service is being run. The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 22 Independent advocate services are available for those who cannot express their individual feelings and preferences. Such support would help enable people to be more active in expressing their views. Similarly, advice about voicing concerns was not displayed in the home, as it should be. This information must be available for visiting families and professionals to view, should they wish to complain about the service. Five of the care staff told us via our survey that they knew what to do should someone wished to voice their concerns about the service. Two of the care staff that we spoke to during our visit also confirmed that they knew what action to take. One of the residents told us that she did not like living at this service, and hoped to move on to alternative support elsewhere. She was being supported to do this by outside agencies. We spoke to the owner of the service regarding his knowledge of safeguarding issues and how he ensured that the people who used this service were protected from poor practice. No instruction had been provided for the care staff about safeguarding issues, and none had been planned. One of the carers who had achieved a nationally recognised qualification in care said that she was absent when safeguarding issues were covered. The home had a policy regarding ensuring people were safeguarded, but this was old and incorrect procedures were written down. A number of policies were available in the home’s records from the local authority. These were old policies and gave out incorrect information. The owner of the service is responsible for ensuring that people are properly safeguarded from unsafe or abusive practices and steps need to be taken to help ensure this is adequately done. He could not tell us what proper safeguarding procedures were in place should an incident occur, or what his role in this should be. The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 25, 26, 27, 28, 29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lived in a clean and ‘homely’ environment. The décor, furnishings and fitments were old in some places, and were in need of renewal or maintenance to ensure that people lived in a pleasant and safe home. EVIDENCE: The owner of the service showed us round the home. The environment was quite homely and generally clean. The communal areas were well furnished and people’s bedrooms were individual and personalised with ornaments and individual possessions. There was one bedroom on the ground floor because this person had a physical disability and used a wheelchair. There was special equipment available, such as a hoist, to enable the person to be transferred The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 24 comfortably and safely. There was also a special bed that could be raised for the comfort of the person and the care staff. Two people who used this service shared a bedroom. The owner of the home must assess whether or not the occupants are in total agreement with this, and whether they would prefer a single room when one became available. In the mean time appropriate measures need to be taken to ensure that both people have sufficient privacy and dignity. We did not see any screens in place to help ensure this. One end of this room was very dark and it was debatable as to whether enough natural light was available for the person who slept in this area of the bedroom. The décor and furnishings of the home looked quite ‘tired’ in places and a plan should be made to ensure that the décor, fabric and furnishings of the service are renewed and replaced at reasonable intervals. For example, the communal areas had wallpaper that was peeling off in places and the border had become unstuck in the hallways. Woodwork in some areas had been scratched and was in need of repainting. It is important for people to live in a well maintained and pleasant environment with nice things around them. As already stated, the medication for this service is kept in a filing cabined in ‘conservatory’ area at the back of the home. It is important that alternative storage is provided and the filing cabinet removed from this area to more appropriate surroundings. Files and information should not be kept in the communal living areas. This was ‘home’ for the people who used the service and should be treated as a domestic environment, not an office. Although these were photographs of people who used the service in the dining area the rest of the house did not have any pictures on the wall and looked very bare. It would be nice for people to have pictures in their room relating to their interests; this would make the house look more homely. There were enough bathrooms and toilets available within the home for the amount of people who lived there. It was clear that the bathroom suites had not been replaced for some considerable time; the owner should consider upgrading the bathroom facilities to provide a nicer environment. The floor boards on the landing on the first floor were very uneven and were causing the carpet to become raised. This was concerning and should be dealt with as soon as possible to ensure that the people who use the service live in a safe home. Accident forms and daily records showed that one of the residents had fallen on the stairs quite recently. The reasons for this were unclear and had not been investigated; it could not be determined that the uneven surface had caused this but this risk should be removed as soon as possible, and risk assessments completed. The central heating cover in the first floor bathroom had become unfixed from the wall and was causing an unnecessary hazard, exposing a hot surface. This The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 25 could also fall on someone and cause injury and must be repaired. One of the bedrooms that we looked at did not smell very nice and measures should be taken to ensure that continence management is addressed properly and cleaning regimes are improved. There were facilities for people to sit out in the back garden when the weather was good. The owner should ensure that these facilities are safe, and properly risk assessed, as some of decking area looked insecure and in need of maintenance. The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 34, 35 and 36. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training for this service was poor meaning that skills and competencies were not updated and refreshed. Staff were recruited properly and the residents were safer because of this. EVIDENCE: There were three care staff on duty when we arrived at the home. This was sufficient to help ensure that those who used then service had their assessed needs addressed properly. We spoke to two of the carers who were on duty and it was clear that they were caring and considerate in their roles. The rota’s showed that sufficient car staff were employed during the day, although evening cover was concerning, as mentioned previously in this report. We looked at the information that had been gathered within each staff members file. Some information was difficult to find, information was not The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 27 divided properly and sorted into sections. There was enough information to show that proper checks had been completed prior to people being employed at the home. This helped to ensure that the people who used the service were protected from unsuitable staff. Sufficient information was also available to verify identity, and each file had a photograph attached. The recruitment procedures for this service were good. It was concerning to find that the care staff had not had training to improve their competencies, skills and abilities for some considerable time. It was also concerning that none had been planned. Both of the care staff that we spoke to said that they had not attended a planned training event for some time. There were some certificates on file to show that training had taken place, but these were old and long-standing. A training matrix had been prepared by the previous owner of the home; this demonstrated how poor the training provision had been for this service. No information could be found to confirm that the care staff were being adequately supervised by the owner of the service. There were no supervision records on file. Good supervision is important because it enables training issues to be discussed and performance to be assessed. It is particularly important when people work in small teams or in isolation without direct managerial support. Supervision should take place on a regular basis, at least six times a year. The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 28 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 38, 39, 40, 41, 42, and 43. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management processes of this service were poor meaning that the outcomes for the people who lived there were in need of improvement. EVIDENCE: The current owner has been involved with the service for nearly five months. The previous owner had managed the service and had remained in place until March 2009. The current owner had told us that he was looking for a suitable manager to replace her, but had recently decided to manage the service The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 29 himself. He told us that he had been “thrown in at the deep end”, and acknowledged that there was a lot of work to do to ensure that the service met national minimum standards. The owner of this service is a registered nurse in mental health. There is a need for the owner to complete a nationally recognised qualification in management. This will help him to develop management skills. There was evidence to show that the home was not being run properly and successfully, which ultimately affected outcomes for the people who used the service. People were not receiving care that was planned and delivered in an affective way, and people’s safety was being compromised by poor medication administration and insufficient safeguarding knowledge. The care staff had not received sufficient training to complement their skills in these areas. The owner had recently completed an Annual Quality Assurance Assessment for the Commission but this had not been completed in sufficient detail and certain information was clearly incorrect. This was specifically evident when details were omitted of controlled medication kept by the service. The assessment had also stated that a training and development programme was in place, when clearly this was not the case. There were no systems in place to help ensure that the people who used the service had a say about what type of service was offered, and information available for the residents was in a format that most of them could not understand. Information about the people who use the service was poorly presented and important information had not been reviewed or updated. There must also be an improvement regarding the environment of the service, there are clear areas where the home does not provide quality outcomes for the residents. Investment is needed to bring the environment up to a reasonable standard and to ensure that the status of the individuals who live within this service is improved by good quality surroundings. Investment of this nature has not been forthcoming for some considerable time. There is a need to ensure that care records are kept confidentially and appropriately, away from the living area of the home. We could not find any form of risk assessment for the people who used this service. This affects their safety and welfare and these should be completed in a competent and appropriate manner for each person who receives a service. Training in mandatory safety areas had not been completed and no plans had been made to deliver this to the care staff. These areas include infection control, food hygiene, first aid, moving and handling, and health and safety. Checks had been carried out by registered tradespeople to ensure that the major appliances within the home were safe. It is the owner’s responsibility to The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 30 ensure that correct procedures are followed by the care staff in the event of a fire, and that equipment is properly serviced and functioning. The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 31 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 2 2 2 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 2 25 2 26 2 27 2 28 3 29 3 30 3 STAFFING Standard No Score 31 2 32 2 33 2 34 3 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 2 1 2 LIFESTYLES Standard No Score 11 3 12 2 13 3 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 1 2 1 2 1 2 2 1 2 Version 5.2 Page 32 The Willows DS0000073085.V374915.R01.S.doc Are there any outstanding requirements from the last inspection? No 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 YA2 Standard Regulation 14 Requirement A pre-admission assessment must be completed by a competent person from the service before someone comes to live at the home. This is to ensure that the service can meet their full, assessed needs. An individual care plan must be available that holds all current information regarding health and social care needs, in a format that the person is able to understand. This is to ensure that health and social care needs are recorded properly and delivered in a planned way. All information about current health and social needs must be available in one place and the care staff must contribute to this on a regular basis. The care plan must be reviewed on a regular basis. This is to help ensure that only relevant and current information The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 33 Timescale for action 31/08/09 2 YA6 15 21/08/09 3 YA6 15 21/08/09 4 YA9 13 (4) (b) is held within the plan and that development and health issues are properly recorded and acted upon. The people who use the service are supported to take appropriate risks that enhance their skills and development. Risk assessments must be available to supplement this. 21/08/09 5 YA20 13 (2) This is to help ensure that people develop their competences in a planned and safe way. The administration of medication 21/08/09 must be recorded properly at all times. This is to help ensure that people have prescribed medication at the correct interval and at the correct time. This is to help ensure that medication is administered safely and people are not put at risk by poor practice. All care staff who are responsible 21/08/09 for the administration of medication must have the appropriate training to do so. This training must be accredited. This is to help ensure that people are not put at risk by poor practice. Medication must be appropriately 21/08/09 and safely stored, according to current safe guidelines and advice. This is to help ensure that all medication is secure and that misuse or errors are less likely. Controlled medication must be administered and stored in line with current guidelines. This is to help ensure that this 5 YA20 18 (1) © 6 YA20 13 (2) 8 YA20 13 21/08/09 The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 34 9 YA23 13 (6) type of medication is not misused and is held properly, securely and safely. The administration must be closely monitored. The owner must ensure that the people who use the service are adequately safeguarded from harm and bad practice. This is to ensure that people are adequately protected by a trained staff team and a knowledgeable owner who is aware of what action to take should an incident occur. The owner must ensure that there is a clear and effective complaints procedure, which includes the stages of, and timescales, for the process, and that service users know how and to whom to complain. This must be visible within the home and in a format that most people can understand. The owner must ensure that the home is adequately maintained and that there is a current programme of renewal and refurbishment. This includes the repair of the floorboards on the first floor landing and the fixing of the central heating cover in the first floor bathroom. This is to ensure that people live in a safe home with nice things around them. A training programme must be available to help ensure that the staff have the right skills to undertake tasks correctly and adequately. This is to make sure that the residents of the home receive 21/08/09 10 YA22 22 21/08/09 11 YA24 13 (4) (a) 31/08/09 12 YA35 18 (1) (c) 31/08/09 The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 35 13 YA37 9 appropriate care from trained and competent care staff. The owner of the home, should he decide to manage the home, must have a nationally recognised managerial qualification. This is to help give him the skills to manage the home adequately. The owner of the home must ensure that training is available regarding safe working practices in: Moving and handling, fire safety, first aid, food hygiene, and infection control. This is to help ensure that all those who live and work in the home are properly protected in a safe environment. 30/09/09 14 YA42 13 (4) (5) 30/09/09 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 YA1 Good Practice Recommendations Information provided about the service should be in a suitable format. People who are using the service or are interested in living at the home must have information that they can understand in order to make an informed choice. Information stored about people who use the service must be confidentially held in an appropriate place. This is to help ensure that personal information is safe and held in confidence to protect the residents. Activities should be available to suit all of the residents on an individual basis rather than part of a group activity. Staff support should be available to enhance this via a planned and ‘goals led’ service. DS0000073085.V374915.R01.S.doc Version 5.2 Page 36 2 YA10 3 YA12 The Willows 4 YA18 This is to ensure that an individual service is available for all, and that group activity is kept to a minimum to prevent the services needs taking precedent over individual requirements. Individual needs must be addressed and care staff should be available to facilitate this. Training should be available for all care staff with regard to the personal support of the residents. This is to ensure that the care staff have appropriate knowledge in areas such as epilepsy and autism, and that people are cared for appropriately with individual needs in mind. The owner of the service should investigate the smell in one of the bedrooms and look at continence management and cleaning regimes to help improve this environment. This would make the room a nicer place to spend time in, and help ensure that the environment clean and fresh smelling, for the benefit of the person who stays there. 50 of the care staff should hold a nationally recognised qualification in care (National Vocational Qualification level 2 or 3). This is to help ensure that the care staff have the correct skills and values to provide a good standard of care. The home must have an effective staff team, with sufficient numbers and complementary skills to support service users’ assessed needs at all times. This is to help ensure that people are supported in accordance with their individual needs at appropriate times. Individual activity should take precedence over group activity. Care staff must be individually supervised at least six times per year. This is to discuss individual training needs, performance issues and individual roles within the service. Supervision should be recorded and records held on staff files. 5 YA30 5 YA32 6 YA33 7 YA36 The Willows DS0000073085.V374915.R01.S.doc Version 5.2 Page 37 Care Quality Commission North West Region Citygate Gallowgate Newcastle upon Tyne NE1 4WH National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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