Inspection on 20/01/09 for The Willows

This inspection was carried out on 20th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Willows 23/03/07

The Willows 10/03/06

The Willows 05/09/05

The Willows 16/11/04

The Willows 10/06/04

The Willows 11/02/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Willows Summer Lane West Wick Worle North Somerset BS24 7TF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Paula Cordell     Date: 2 0 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: The Willows Summer Lane West Wick Worle North Somerset BS24 7TF 01934510404 01179699000 jill.marshall@brandontrust.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Brandon Trust care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is 7 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability (Code LD) Physical disability (Code PD) Date of last inspection Brief description of the care home The Willows is a small, homely provider offering care for up to 7 service users with severe learning, physical and sensory disabilities. The Willows is a pleasant bungalow situated in a quiet cul-de-sac on the outskirts of Worle. The home has single rooms and has been extensively adapted to meet the needs of service users. The team strive to provide a broad range of life experiences both inside and outside of the home environment. 7 7 Over 65 0 0 Care Homes for Adults (18-65 years) Page 4 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit as part of the key inspection process. The purpose of the visit was to monitor the quality of the care to the individuals living at The Willows. There were no requirements or recommendations from the visit in March 2007. The visit was conducted over five hours and included a tour of the home and reading records relating to the running of the home, in addition to speaking with staff and observations of the people who live in The Willows. The individuals accommodated at the Willows communicate using non verbal communication. There have been no complaints made directly to the home or the Commission for Social Care Inspection, although Brandon have received a complaint about the Care Homes for Adults (18-65 years) Page 5 of 31 contribution towards transport from a relative. This is still being resolved. Information received prior to the visit including regulation 37 notifications, monthly provider visits and the completed annual quality assurance assessment these were used to plan the visit. No surveys were received. What the care home does well: What has improved since the last inspection? What they could do better: 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals have sufficient information about the service provided at the Willows. Individuals can be confident that their assessed care needs are being kept under review. Evidence: The home has a statement of purpose and a service user guide. This has been kept under review and clearly describes the service that is provided to the individuals living at The Willows. The Willows has been home to the individuals for many years. There have been no new admissions for approximately ten years. The home is fully occupied. The statement of purpose included information about the assessment process describing how they would involve the individual in visits prior to making a decision to move to the home and liaising with relatives and professionals. This was clear and offered guidance to both the individual and the staff working in the home. Care Homes for Adults (18-65 years) Page 9 of 31 Evidence: It was evident from reading care files that assessments are kept under review including the placing authorities assessment and care plan. The local placing authority was reviewing the care provided on an annual basis involving relatives, the individual and other professionals where relevant in conjunction with the home. The Willows provides personal and nursing care to seven individuals with physical and profound learning disabilities. It was difficult to seek the views of the individuals living in the home due to the level of learning disabilities and that the individuals did not communicate verbally. However, it was evident that the staff had worked with the individuals for some considerable time and had developed some understanding of the non verbal communication that is expressed. In addtion care documentation included information on how the person communicates. Individuals have a contract of care that states the services that are available. A letter is written yearly to individuals to update them on their fees. Letters were seen in care files written to relatives about changes to the transport contribution. There was a lack of responses seen. The person in charge said that these may have been sent direct to Brandon Trust. Good practice would be for a copy of the response to held in the home. The member of staff in charge stated that one relative is not happy with the contribution towards transport and this is being discussed with the placing authority and Brandon Trust. Individuals are expected to contribute 65 of their Disability Living Allowance towards the transport in addition to the petrol based on usage. Care Homes for Adults (18-65 years) Page 10 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals care needs are being met in a person centred way. Individuals can be confident that the home is ensuring that their safety whilst encouraging them to lead full and active lifestyles. Good documentation is in place however the home could better evidence the decision process behind the use of some of the practices in the home that ensures individuals are safe in relation to restrictions. Evidence: Three persons care was reviewed as a means to determine the quality of the care provided to the individuals living at The Willows. An opportunity was taken to speak and meet with all the individuals and the staff that were on duty at the time of the visit. Information in care files was informative and person centred to guide staff in their day to day practice. Each person had two files one predominately about lifestyle and Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: personal care and the other relating to maintaining a healthy lifestyle. In addition to the care files it was evident that staff had a good knowledge of the people living at The Willows. As mentioned previously the individuals communicate using non verbal communication. Each person had a booklet that detailed how they liked to be supported, what equipment was required to support them ensuring they stay safe and how they communicate. It was positively written detailing the likes and dislikes of the individual and clearly describing the diverse and individual needs of the person. This is good practice and could help new staff or professionals in getting to know the individual better. From reading care files it was evident that the information was being reviewed ensuring it was current. Care staff complete monthly key worker reviews covering all aspects of daily living, relationships, work and leisure, health and community participation. This is evidently used to formally review the care on a six monthly and annual basis. Risk assessments were viewed. These covered a range of activities including accessing the mini bus, wound management, personal care, manual handling and activities in the home and the community. It was evident that these did not curtail individuals from living life to the full. This was evidenced in the range of activities that the individuals participate in, which includes horse riding, swimming, activity holidays, canoeing and accessing the community. It was evident that individuals were supported and their safety was maintained. It was noted that some of the individuals have bedsides and wheelchair straps and the use of monitors at night to ensure staff can hear if individuals have an epileptic seizure. This could be better recorded as these are viewed as restraint and an invasion of someones privacy. This must be clearly recorded in the plan of care, including why the restrictions are in place and consent sought where possible from the individual, their representative and an appropriate professional. Staff could clearly describe the rationale for the use of these measures and one social worker had included the use of bedsides in the plan of care but this had not been included in the plan of care drawn up by the home. A member of staff on duty stated that they were planning to attend training on the Mental Capacity Act and that this could have implications on how the home is supporting individuals due to the level of understanding of the individuals living at the Willows. From talking with staff it was evident that the home has built good relationships with the local Community Learning Disability Team. Relatives are Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: involved in the care of the individuals along with the professionials and the staff it is evident that best interests of the individuals are taken into account. Staff were aware that clear records must be maintained of the decisions that are being made. Care Homes for Adults (18-65 years) Page 13 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are offered a wide range of activities and they are not discriminated against due to their disability. Individuals are supported to have a healthy and varied diet. Good levels of support is in place in relation to the individuals dietary intake including consultation with other professionals. Evidence: Individuals at the Willows have meaningful occupation as evidenced in conversations with the staff, a day care worker and care records. It was evident that the individuals were not discriminated against due to their physical or learning disability. Activities were varied and included swimming, horse riding, attendance at a day centre, outings to places of interest, meals out, going to the theatre and music concerts. Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: It was difficult to determine from the individuals whether they were happy with the activities that are on offer. Staff stated that individuals are observed throughout activities to ensure that they are not distressed and dislike the activity. One individual goes to church on a Sunday supported by staff. Other individuals go to a club on a weekly basis for an evening meal and to meet up with friends. It is evident that the individuals needs would be met in an person centred way tailored to the individual. The statement of purpose details how individuals are supported with meaningful activities ensuring that the diversity of the individuals is met. It is evident that the service has to take into account the needs of the individual and as a group. Staff described how their plan activities to ensure that it was equitable. There are usually four staff on duty at all times during the day and evening supporting the seven individuals. However, each person needs at least one carer when out in the community assisting with their mobility. Most of the individuals use a wheelchair when out in the community especially for long distances. Staff said that the manager will plan the rota to enable additional staff to be working so that everyone can occasionally go out for example the Christmas meal and the pantomime. Individuals have an annual holiday and this was evidently tailored to the individuals interests. Some of the individuals have been on a cruise, others have been to Disney Land Paris, Butlins, Cornwall and some have been on activity holidays. Photographs were displayed throughout the home and in peoples bedrooms. Individuals are well supported by staff with a two staff to one ratio when on holiday. This is good practice and demonstrates further that the home wants to make the holiday a success. Staff stated that all the individuals have contact with relatives. This was confirmed in care records. Some of the individuals go home to stay for holidays whilst others are supported by staff to go and visit. One person is supported on a monthly basis to visit an older relative who is unable to visit the home. From talking with staff it was evident that the home viewed this as an important aspect of support in maintaining contact with friends and relatives. It was evident from talking with staff they encourage individuals to participate in every day activities from food preparation to shopping. An individual was observed watching staff prepare the lunch. Positive interactions were observed between staff and the individuals. Staff were seen explaining what was going on for example during the meal time or when personal care was being offered or what was happening in the home. An opportunity was taken to review the menu. This provided evidence that individuals Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: are offered a healthy and varied diet. The home maintains a record for each individual due to the complex diets that are in place including PEG Feeds. Good records were maintained of the dietary needs of the individuals including likes and dislikes. Some of the individuals have their food pureed as agreed with the dietician. All foods are pureed together. Good practice would be that this would be pureed separately to enable the individual to differentiate between the different flavours. Staff have received training on eating and drinking and the PEG feed as confirmed in conversations with staff. The lunch time meal was observed and it was noted that individuals were supported in a relaxed and unhurried manner. All of the individuals require support for eating and drinking. Individuals were encouraged to help where they could. Staff were observed explaining to the individuals the process. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals can be assured that their personal and health care needs are being met. Good systems of administration of medication is in place. Storage of medication in the homes main fridge could be putting people at risk especially where they are not within the expiry date. Evidence: Care documentation included information relating to personal care and health care. Individuals are supported on a daily basis to bathe. Clear instructions were in place relating to the equipment that was to be used and the staff support. Less apparent was the personal side of the bathing like how hot their like the water, what type of toiletries were to be used. However from talking with staff it was evident that they were aware how each person liked to be treated and this is passed on during staff hand overs, inductions and staff meetings where changes or preferences are noted. The home has compiled an assessment in the event of someone being admitted into hospital which details important information about the person. This includes personal Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: care, health care and medication. This is good practice. It clearly details what is important to the individual. This could ensure a smooth admission to hospital especially as the individuals are unable to articulate their needs. Individuals require the support of staff in relation to all their personal care and when to get up and go to bed. Staff stated that this is done by observation and knowing the individuals. From discussions with staff it was evident that one person enjoys time in their room relaxing watching television or listening to music whilst others are happy to stay in the lounge. Care records provided evidence that that the home seeks advice from other professionals including the Community Learning Disability Team, the dietician, physiotherapists and psychology. Each person is registered with the local GP surgery. Individuals either visit the surgery or the GP will visit the home depending on the health concern. Individuals are supported to see an optician and dentist on a regular basis. Some of the individuals have aromatherapy which assists with relaxation. It was noted that some of the individuals have an exercise regime completed at their day centre it was not clear how the home staff were involved in this. The home has a robust medication procedure which clearly guides staff on the principles of safe administration of medication and what to do in the event of error. Good systems were in place to audit the stock within the home. Registered Nurses are responsible for administering the medication to the individuals. Information in care files detailed how each person liked to take their medication. Where medication is crushed or administered through the PEG feed guidance and confirmation has been received from the GP and other appropriate professionals. The only area of concern that was raised in relation to medication was that medication stored in the fridge was not held securely and that three out of the five tubes of cream were out of date in accordance with the manufacturers guidance. In addition there was no indication of when it was opened and first used by staff. Care Homes for Adults (18-65 years) Page 18 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff are innovative in ensuring that the views of the individuals are heard and understood. Individuals can be confident that appropriate safeguards are in place. Evidence: The home has a clear and robust complaints procedure. Complaints will be investigated within 28 days. A copy of the complaints procedure is included in the statement of purpose. The home has not received any complaints directly however the staff were aware that a relative has raised concerns about the contribution towards transport with Brandon Trust and that social services are involved. This is still being discussed and the outcome is not known. Good practice would be that the home makes a record in the complaint record held in the home of the complaint and the outcome. All the individuals have some contact with family who actively advocate for the individuals. Care records included information on how the individual communicates including when they are happy or not. Staff had a good understanding of how the individuals communicate and their likes and dislikes. The home has policies relating to safeguarding including copies of No Secrets and the local placing authorities guidance. Staff were knowledgeable about what constitutes Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: abuse and the need to report this using the guidance that they have in place. Staff confirmed that they had completed training and that this forms part of the homes and the organisations induction. An opportunity was taken to review how the home ensures that the finances of the individuals are protected. Good records and safeguards are in place in respect of money held in the home and within their banks. Daily audits are completed on the finances held in the home, with the service development manager completing random monthly checks. In addition the finance department of Brandon Trust completes an independent financial audit at periodic intervals. An area the home could improve is ensuring that two staff sign financial records as the individuals in the home are unable to sign due to their physical disability. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Willows provides a safe, clean and comfortable place for the individuals living in the home which is meeting their individual needs. Evidence: The Willows is a pleasant modern bungalow with large gardens and parking for a number of cars. The bungalow is in keeping with the local neighbourhood. Access to the home is via a narrow lane. The local area is being currently developed for new housing and this has meant that more facilities are now within easy reach of the home including a large supermarket and a pub. The Willows has been developed to provide suitable accommodation for people who have mobility issues. Five of the seven people living in the home use wheelchairs in the home to enable them to move from one area to another with support from staff. Corridors and doorways are suitable for this to be done safely. The garden has level access to the rear and to the garden at the rear. A specialist swing was seen in the garden for people who use a wheelchair. The home was decorated and furnished to a high standard. All bedrooms were personalised to reflect the taste of the occupant. Specialist equipment was seen Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: throughout the home including profile beds, manual handling and sensory equipment. Individual rooms were comfortably furnished and contained music centres, televisions and sensory equipment. Photographs and pictures have been hung around the rooms to make them more homely. Light switches and mirrors are at low level to assist individuals who use a wheelchair. The premises were safe, bright, clean and free from odour. The home had sufficient bathrooms and toilet facilities to meet the needs of the people living in the home. Areas were large enough to move individuals using the specialist equipment in situ. The home has good infection control procedures as seen in documentation, talking with staff and observation. Sufficient handwashing facilities were situated throughout the home. There was a stock of aprons and gloves and these were being used throughout the visit. Maintenance records were kept. Whilst it was evident there was a rolling programme of maintenance it was evident that there has been some delays. The person in charge stated this is being addressed and this service is now being contracted out. The home has a refurbishment plan and the home is in the process of replacing the hallway carpet. Staff were aware that in addition the manager has requested the hallway to be redecorated. This would be good practice as it was evident that this area takes a bit of knocking from equipment and slightly distracts from the other areas in the home. Care Homes for Adults (18-65 years) Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are supported by a dedicated and competent workforce. The team is cohesive, with clear guidance available to support them. It is evident that the staff feel valued and are supported to be fully involved in the running of the home. Evidence: The statement of purpose clearly described the staffing levels of the home. The home is a care home that provides 24 hour nursing care. A registered nurse works in the home at all times. The staffing levels for the home are four staff during the day and evening with one waking and one sleeping in member of staff supporting the individuals at night. Additional staff are employed to support individuals with going out. Staff spoken with during the visit stated that they felt there were sufficient staff working in the home and that the workload was manageable. Staff are involved in both the care and the household chores. Staff described a good team spirit that is supportive with good lines of communication. Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: The home has a core group of relief staff that support the individuals but in the main staff working in the home cover the shortfalls in staffing due to absences or vacancies. Many of the staff have worked in the home for many years offering the individuals a consistent approach. It is evident that the staff spoken with enjoyed working in the home and supporting the individuals. Staff recruitment information is held at The Brandon Trusts main office and could be inspected at any time by the Commission for Social Care Inspection. The home presently has two staff vacant posts which equates to 75 hours. This is being covered by staff working in the home or occasional relief staff that already work for Brandon Trust. Staff said that agency is never used. Staff files were held securely and staff working on the day of the visit did not have access to this information. So therefore supervision and training records were not viewed. However, staff stated that they felt supported in their role and received supervision on a regular basis. An overview record was maintained and it was evident that staff were receiving regular supervision from either the manager or a registered nurse (assistant manager). Two registered nurses confirmed that staff that are in a supervisory role have attended training in this area. Five members of staff were spoken with during the visit. All confirmed that they regular attend training on fire, first aid, manual handling and health and safety training. All five staff confirmed that they had completed training in abuse. Other training included epilepsy, atuism, eating and drinking, mental capacity, mental health to name a few. Staff stated that there is a commitment for staff to regularly attend training. One of the staff has the responsibility to co-ordinate the training including making applications to the training department. A member of staff who was in the process of completing their induction commended the home on the level of support and information that is in place to guide them on their role. Staff complete the Learning Disability Qualification as part of the induction in addition to attending training with other newly appointed staff across Brandon Trust. Staff stated that the training includes equalities and diversity, values on supporting individuals with a learning disability as well as health and safety and statutory training. The training coordinator stated that the home has exceed the standard relating to ensuring that at least 50 of the workforce have an National Vocational Award in Care. Five staff have already achieved an NVQ, a further two staff are in the process of completing an NVQ out of ten care staff. Two of the staff have completed an NVQ 2 in care and are now doing an NVQ at level 3. This is good practice. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: The home has policies and procedures to guide them on recruitment, employment and equalities and diversity. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals benefit from a well managed service where they are the focus of the service being provided. Individuals safety is paramount and their benefit from the quality assurance initiatives that are in place. Evidence: Mrs Marshall is the registered manager for The Willows. She is a registered nurse with at least 20 years of experience in management and supporting people. Mrs Marshall was on training on the day of the visit. It was evident that her staff team have confidence in her management ability in supporting the individuals and the staff. Staff described an open and fair management approach. From evidence seen at this visit it was evident that there were a number of quality assurance initiatives taking place to ensure that the home runs smoothly including provider monthly visits, audits on the premises, monthly care reviews, staff meetings Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: and supervisions and audits on finances and medication. Other areas of quality assurance the member of staff stated that the manager would normally respond to. Policies and procedures were kept in the office and accessible to staff. Staff stated that as new policies are developed the manager always explains and discusses with the staff in both supervisions and in staff meetings/handovers. Staff confirmed that they had recently been involved in developing the fire risk assessment for the home. Good systems were in place to ensure the safety of individuals including risk assessments, the management of chemicals hazardous to health and maintenance of the property and equipment. Records were maintained of these. The home has recently been inspected by the fire service. There were two areas of concern one relating to the seals on fire doors and the other relating to a suitable person to check the fire equipment. Reassurances from staff were received in that both have been responded to. An external company has checked the fire equipment as part of an ongoing service arrangement. The fire log provided evidence that the staff are checking the emergency lighting, doors and the sounding the alarm at regular intervals. In addition staff are receiving fire instruction at regular intervals. It was noted that out of the sixteen staff not all have attended a fire drill once in a six month period. This must be addressed with the few remaining staff. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 For the home to document 26/02/2009 the use of bedsides, night monitors and any other restrictions that are in place. This should include consultation with professionals and relatives. Ensuring an open and transparent service is provided that takes into account the best interests of the individuals. 2 19 13 Ensure that topical creams are within their expiry date. Ensuring individuals are protected. 26/01/2009 3 20 13 Ensure that medication is stored in accordance with the Royal Pharmaceutical Guidelines. For medication that should be stored in a fridge this must be held secure offering the individuals more protection. 11/02/2009 Care Homes for Adults (18-65 years) Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 20 When topical creams are opened the date should be clearly recorded and discarded after one month. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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