Inspection on 20/10/08 for The Willows

This inspection was carried out on 20th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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Extracts from inspection reports are licensed from CQC, this page was updated on 20/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Willows 170 Newton Road Great Barr Birmingham B43 6BU     The quality rating for this care home is:   three star excellent 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: Jean Edwards     Date: 2 4 1 0 2 0 0 8 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 35 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 35 Information about the care home Name of care home: Address: The Willows 170 Newton Road Great Barr Birmingham B43 6BU 01213570124 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Karen Sandra Maureen Godwin Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service user to be registered is 5 The registered person may provide the following category of service only: care Home Only - Code PC To service users of the following gender: Either Whose Primary care needs on admission to the home are within the following categories: Learning Disabilities (LD) 5 Date of last inspection Brief description of the care home The Willows is a family run Care Home, providing accommodation and personal care for up to five people with a learning disability some of whom may be over the age of 65. The large, attractive, detached house has easy access to shops, public transport routes and is about a mile and a half from the M5 Motorway. The Home is bright, homely and tastefully decorated. There is a well maintained garden at the rear of the premises, with good access for the people living there. Each person has their own bedroom. There are toilets and bathing facilities on each floors. The Proprietor is also the registered manager and is assisted by a small staff team to provide the care for Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 5 Brief description of the care home the people living at the home. The registered manager lives at the home with the people accommodated. Care Homes for Adults (18-65 years) Page 5 of 35 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: three star excellent 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: The last key inspection took place on 11 April 2007. We, the Commission for Social Care Inspection (CSCI), undertook an unannounced key inspection visit. This meant that the home had not been given prior notice of the inspection visit. We visited the home for two separate half days. The range of inspection methods to obtain evidence and make judgements included, discussions with the registered manager and staff on duty during the visit. We also had discussions with people living at the home and made observations of people without verbal communications. Other information was gathered before this inspection visit including notification of incidents, accidents and events submitted to the CSCI. A number of records and documents were examined. The registered persons submitted the homes Care Homes for Adults (18-65 years) Page 6 of 35 Annual Quality Assurance Assessment (AQAA) as requested at the time of the inspection visit. We toured the premises, looking at communal areas of the home, the bathrooms, toilets, laundry, kitchen areas, and peoples bedrooms, with their permission, where possible. The home had not published the range of fees for the service and people are advised to contact the home for up to date information about the fees charged. What the care home does well: What has improved since the last inspection? What they could do better: This was another very positive inspection and as a result only a small number of requirements for improvements have been made. The required improvements relate to peoples records, staff recruitment and notifications to the CSCI. Care Homes for Adults (18-65 years) Page 8 of 35 As identified at the previous inspection visit, the registered manager must continue with the ongoing development of a quality assurance system with a cycle of planning, action and review and monitoring, which includes the views of people living at the home, relatives and other visitors to the home. 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 9 of 35 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 10 of 35 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has good, clear information about the service, which means that residents and their advocates have good information to base their decisions about their choice of home. All residents have their needs assessed and reviewed with multidisciplinary health care professionals. The home actively encourages introductory visits and people are given ample opportunity and time to make decisions, which are right for them. Everyone has a contract with terms and conditions of residency giving information about their rights, entitlements and any agreed restrictions. Evidence: The information contained in the homes AQAA about what it did well stated, Promote and encourage independent and skills in an attractive, homely and welcoming environment. This was supported with a comment in the homes comments book from a community nurse based in Sandwell, have visited the home on two occasions and have found it very welcoming and enjoyable. Had time to chat to Karen and her clients that live here and have been made to feel relaxed and at home. Very pleasant visit. Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: The AQAA stated that the evidence to show what it did well included, Positive feedback from all clients, clients families and friends and all those who visit The Willows. Quality assurance feedback forms and passed CSCI inspections. We received excellent feedback from professionals who visit The Willows especially from social services. The AQAA also cited the following improvements over the last 12 months, we have planned and developed a ground floor bedroom for a client with changing needs, we have registered a fifth bedroom with en suite facilities. Started person centered planning programme with all clients. Employed to new members of staff. We have introduced a green energy reduction program to counter rising fuel costs, all major appliances have been replaced with energy-efficient ones, most lighting has now been replaced with energy efficient units. We looked at copy of the homes statement of purpose and service user guide, which had been reviewed and updated in 2008, following the homes new registration after the sad demise of the late registered proprietor. The proprietors daughter, who had worked at the home with her mother since it was opened, had purchased the home and successfully completed CSCI registration process to become the new registered proprietor and registered manager. The documents contained comprehensive information and the service user guide contained some pictorial formats. The information about the range of fees had not been included in the service user guide. We discussed this omission with the registered person who told us that the fees charged were based on the fees paid by the Local Authorities. We recommended that information about the range of fees should be included in the service user guide to give people comprehensive information about the service to help them make decisions about the choice of home. From the information provided at the home we noted that all of the residents were funded through the Local Authorities. There had been no new admissions since the last key inspection. We looked at the care records for two people whose needs had changed since the last key inspection. We saw evidence that they had contracts and terms and conditions, which had been updated and included information about individual fees. We were told that everyone living at the home had been given contracts with up-to-date terms and conditions and information about their individual fees. The registered person told us that any new people would be offered the opportunity for trial visits to the home. Also each person living at the home would be consulted before decisions reached for new people to come and live there. The registered person told us that there was no hurry to admit anyone into the newly registered fifth bedroom and that it was more important for everyone to feel settled with the new arrangements which had to be put in place this year. Care Homes for Adults (18-65 years) Page 12 of 35 Care Homes for Adults (18-65 years) Page 13 of 35 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a clear and consistent care planning system in place to provide the information to satisfactorily meet residents needs. The evidence of good multi disciplinary working taking place on a regular basis continues to be good and the health needs of residents are well met. Evidence: We looked at a sample of residents case files containing care plans, risk assessments and held discussions with people and staff about how each person was supported and given assistance to meet their daily needs. We noted that the residents or their relatives and representatives, had signed the plans to indicate their agreement. The care plans we looked at showed that they were being developed following person centred planning principles. Plans recorded each persons life experiences and showed how all their current needs and aspirations were to be met through the very positive individualised support this home could offer. Examples were one person was supported Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: to socialise successfully, another person had become more physically active and as a result of exercise and a healthy diet, had reduced weight and another had recently had surgical procedures to remove cataracts from both eyes, which had enabled her to see more clearly and enjoy her hobby of tapestry. The care plans included comprehensive risk assessments, which were regularly reviewed. The manager and staff continued to demonstrate a positive attitude and risks were managed positively to help people living at the home to live as they wish. For example one person with deteriorating mobility and no longer able to use the stairs to the first floor, had been provided with a ground floor bedroom to encourage normality and independence. There was evidence that limitations on freedom or choices were introduced in the persons best interests, such as close supervision for one person to minimise the risk of choking when eating. We could see that efforts were made to make sure the people living at the home understood any limitations, such as not going out unaccompanied, which was documented and reviewed on a regular basis. There were regular documented monthly reviews of the support and care provided for each person and good daily records kept. The registered manager had taken action to make sure that each person had at least an annual formal documented review meeting, inviting the person, social worker, family or advocate to attend. From observations and discussions it is evident that the manager and staff are aware of the need to treat people with respect and make great efforts to consider dignity when delivering personal care. Though two people were unable or unwilling to communicate verbally, appropriate signs and gestures were used and well understood between the person and staff. The residents were well groomed and one person decides on a daily basis, or sometimes more often, about how she will have her hair styled. Similarly another person took great pride in her personal appearance, especially her clothing. Care Homes for Adults (18-65 years) Page 15 of 35 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. There are planned and spontaneous activities available on a regular basis and people are able to take advantage of and develop socially stimulating opportunities. Good contact is maintained with family and friends for the majority of people living at the home and there is evidence that they are supported to exercise control and make decisions about their lives. People have a well-balanced and varied diet, which meets their tastes and preferences. Evidence: The homes AQAA stated what they do well, 3 of our clients access local day centres. The remaining client has 1 to 1 care and activities at The Willows to suit her age and interests, we access local amenities where her mobility permits. Contact has been made with one of our clients extended family whom she lost touch with after her Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: parents death, although this client does have other family members who visit her on a regular basis. We are in the process of introducing clients family and friends events which are held at the Willows, a barbecue was held in July with great success and other events are being planned. The homes AQAA cited the evidence to show what it does well, We have a great relationship with our clients and their families in our home from home environment. Diets and preferences are discussed with clients to enable us to plan a healthy enjoyable and varied menu, snack are always available. Mealtimes are sociable and an enjoyable part of the day, be used at the dining table, in front of the TV or eating out at a restaurant. The homes AQAA cited what had improved in the last 12 months, a more diverse menu and opening up of a second living room. Plans for further improvement included new kitchen area, spacious dining area and an area for client activities and to use the garden area to greater advantage, with growing your own food, croquet, bowls. Some people continued to attend community based day opportunities for younger people organised by the funding local authorities, whilst those who chose to remain at home were encouraged to participate in their chosen leisure time pursuits. We were told that where it was thought appropriate people were involved in the domestic routines of the home. We were given examples that some people could take responsibility for their own room or help with tasks in the dining room and kitchen. We noted that one of the residents particularly enjoyed helping around the home. We noted that regular activities took place with opportunities for people to participate in including arts and craft, exercise, singing, and one person was engaged in knitting an extremely long garment. People were complimentary about the food offered at the home and they especially liked going out for meals to the local pub. Fresh fruit, hot and cold drinks were readily available in the open kitchen area. The registered person and member of staff spoken to were aware of each persons needs and the importance of assisting at each persons pace. The registered person and the member of staff told us they organised and activities and outings so that people had access and opportunities to integrate into the local community. Examples of trips were visits to garden centres, shopping centres, local public houses, and cinema. Generally the homes vehicle was used as transport for the people living in the home. People also enjoyed musical activities and entertainments and the home had an impressive organ in the hallway. Everyone living at the home had enjoyed a holiday in Ireland at a property owned by the registered person. Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: We were told that the majority of people at the home had the opportunity to develop and maintain important personal and family relationships. Some people had family visitors at the home. Care Homes for Adults (18-65 years) Page 18 of 35 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health needs of people living at the home are well met with good evidence of multi disciplinary working taking place on a regular basis. The systems for the administration of medication are good with clear and comprehensive arrangements being in place to ensure each persons medication needs are met. Evidence: The homes AQAA cited the following evidence for what they say they do well, with regards to personal hygiene, we promote independence and uphold clients dignity at all times. With regards to bathing and washing, the clients are encouraged to wash to the best of their ability and help is on hand at all times if they require assistance with bathing or personal hygiene or care. All clients attend GP appointments for well man, well woman clinics annually. All clients attend their GP for their annual flu vaccine. All clients attend their GP for their medication review. All our clients are unable to administer and control their medication, therefore this is administered to them by trained staff. All clients attend to the dentist at regular intervals for treatment and healthy mouth screening. All attend regular eye checkups. All attend chiropodist on a regular basis. Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: The homes AQAA cited examples of how the home had improved in the last 12 months, we have trained more staff for administering drugs. To uphold dignity when bathing there are male staff for males, and female staff for female clients whenever possible. During the two half day visits we saw that the member of staff and registered manager, who also acts as part of the care team, demonstrated awareness and understanding of principles of support for personal care and were generally responsive to the varied and individual requirements of the people living at the home. They told us that they knew that personal care was highly individual and needed to be flexible and reliable. We were given examples of how each person was given privacy and dignity when providing personal care. With only as much support and attention as needed without intruding on their enjoyment of bathing. The level of sensitivity when supporting people was very positive. We were able to verify the statements made in the homes AQAA relating to people having a choice about which staff provided their personal care, which happened most times, though this was dependant on staff availability. We noted that people were supported and helped to be responsible for their own personal hygiene and personal care where it was possible. We saw very good evidence that people had good access to health care services that meet their assessed needs both within the home and in the local community. People had their own GP, and attended local dentists, opticians and other community services. There were positive comments from health care professionals about the management of the health care needs of people living at the home. The home had introduced appropriate ways to educate residents and help them to understand the need to regularly check themselves for any abnormal or unusual changes in their bodies. We noted that people were offered access to health care screening processes, with agreements, outcomes or refusals recorded in each persons case file. There was continuing work with community nursing colleagues to implement Priority Screening for Health, health passports, for each resident covering all aspects of well being. We looked at the weight records, and noted that generally peoples weight was being maintained at healthy levels. One persons care file contained comprehensive information relating to Down syndrome and dementia. This persons nutritional screening had been completed. In the early days at the home, this person had achieved some weight loss because she was overweight for her height. We were told that the GP was delighted with the current weight 7 stones 4ibs, which was stable. We noted that one person was at known risk of choking. There was the first and we were told the only episode recorded. We had not been notified of this event, which needed medical treatment, in compliance with Regulation 37. The recently registered Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: manager explained that any events requiring notification had been extremely rare over the past years and assured us the omission would not occur in future. The person concerned had a written risk assessment in place related to risks of choking, with detailed guidance for staff to sit opposite whilst person was eating and observe carefully to make sure all food was chewed and swallowed before the person puts more food is put into their mouth. This demonstrated good practice. The home had a comprehensive medication policy, which was accessible to staff. We were told that the home will be changing to a larger pharmacy provider, which will supply staff with accredited medication training and undertake regular medication audits. We looked at the MAR sheets, which were well maintained and up to date for each person. Medication received, administered and disposed of was appropriately recorded. The home had only small stocks of medication. However we recommended that records of medication balances on MAR sheets should be implemented for ease of auditing. The registered manager told us she was responsible for the administration of medication for the majority of times and she was knowledgeable and aware of each persons medication needs. Care Homes for Adults (18-65 years) Page 21 of 35 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints system with good evidence that peoples views are listened to and acted upon. There is evidence of safeguards in place and people are supported to exercise their rights as citizens. Evidence: The home had plans to provide alternative formats for the complaints procedure, such as pictorial and easy to read versions, which were more suitable for each persons capabilities. We were told that there had been no complaints made directly to the home or to other agencies. The people able to communicate with us at the home confirmed that they could tell the manager about any concerns and she would help them. The manager and her staff were aware of the multi-agency procedures and reporting processes safeguard vulnerable people at the home. The manager and staff had undertaken training relating to the protection of vulnerable adults provided by Sandwell MBC at Popes Lane training centre. There was information about the current training programme and there were plans to attend refresher training courses when available, which demonstrated very good practice. There were no concerns raised during discussions with people living at the home or with staff throughout the inspection visits. Care Homes for Adults (18-65 years) Page 22 of 35 Care Homes for Adults (18-65 years) Page 23 of 35 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the decor within this home is exceptionally high with evidence of improvement through continuous maintenance. People living at this home are provided with a very attractive and comfortable environment. Evidence: The homes AQAA cited the following evidence of what the home does well and what had improved over the past 12 months, we offer a home from home in a secure and safe environment with high standards of cleanliness. Soft comfortable furnishings and bright colourful surroundings to eliminate the clinical appearance that many homes, (we are told), have. Clients are encouraged to choose the room decor and personalise it with their own belongings. Clients have access to their rooms and communal areas including the garden at all times. The clients have a number of pets, dusty, the Lucky Black cat and Honey, the rabbit with attitude. These give the clients hours of pleasure. Our plans for improvement are, and the kitchen, dining area, activities area, carpets are replaced where necessary and cleaned bi-monthly. Increase Sky access in other rooms and create video and reading libraries. We took a brief tour of the premises there was evidence that the home continued to be maintained to exceptionally high standards with an ongoing maintenance programme. Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: The Willows was a large detached property, with very attractive landscaped gardens to the rear and ample car parking at the block paved frontage. The home was secure, with tasteful fencing, gates, railings and security lighting. The driveways and patios were block paved, a lockable gate had been provided to the rear garden and wrought iron railings and gates had been provided at the frontage for security. There have been many improvements since the last inspection. There had been additional internal redecoration and changes to the internal layout making the best of the accommodation to meet peoples changing needs. A quiet lounge had been created as part of the double bay window frontage, which was tastefully decorated and furnished and we were told was mainly used in the evenings. A new single, en-suite, ground floor bedroom had been created for one of the people who was growing older, with associated deterioration in mobility, due to Parkinsons disease. This room was decorated with very attractive floral print wallpaper, bedding and curtains and dark wood furniture to match the wooden beams. The room also had pictures painted by the person hung on the walls, and a vanity unit with a large mirror and decorative chandelier. These were important in helping the person maintain a good self image. We were shown the remaining bedrooms with each persons permission. One person wished to show us her bedroom, which was beautifully decorated and furnished containing prized personal possessions. Each person had a double bedroom, which they have personalised according to their individual taste. One of the person had chosen her favourite colour, lilac, for the colour scheme of the room. Another person had agreed a swap of the front bedroom for rear facing bedroom. This person had developed behaviour associated with autism, which meant that they would not access more than 8 feet of their bedroom. We were told that since changing bedrooms this behaviour had improved and the person was making use of the whole rear bedroom. The hallway, contained an electric organ, played by the registered managers spouse. We were told that one of the people living at the home also plays the demonstration melodies contained on the organ. We were told he comes from a musical family and a video had been made and sent to the family to show them his enjoyment of this musical instrument. The home had a new dinning room situated off the kitchen. This was almost completed, awaiting final decoration to paint the newly plastered walls. We were told that the people at the home were involved in choosing the colour schemes. At present one person wanted peach another wanted blue, so there was going to be some arbitration to reach an acceptable compromise. The kitchen was well organised, with well maintained equipment, and a wide range of Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: food stocks stored and prepared in good compliance with food safety. The laundry area was well equipped with a commercial washers and tumble dryer. The laundry service was generally well organised and the staff show good standards of infection control. There was a laundry procedure and measures in place for supplies of disposable gloves and aprons to be readily available. Throughout the home very high standards of cleanliness continued to be maintained and there were no discernable malodours during this visit. Care Homes for Adults (18-65 years) Page 26 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home continues to maintain stable substantive staffing levels and people living there receive very good and consistent care. Evidence: The homes AQAA cited the following as evidence of what they do well, service users were recently consulted and involved in the recruitment of new staff, the recruitment of new staff is carried out in accordance with the Willows recruitment procedure in a non- discriminatory manner, or prospective employees will undergo POVA and CRB checks and will have to provide at least two reliable referees and written references. The existing staff have worked at the Willows for an average of 15 years each, the stability of employment is established and supported the homely values we believe our clients and their families enjoy and give a familiar face to the Willows. With clients backgrounds, or home offers them the love and support they would normally receive from their family and see us as their extended family. All staff have either achieved or are working towards NVQ levels of training. Those staff with NVQ 2 qualifications will be enrolling for their NVQ 3 training in the autumn. All mandatory training is carried out and where necessary in house training is given by those with greater experience. All staff receive a structured induction training. The manager undertakes the role of training facilitator and arranges mandatory training, educational training and training Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: that relates to the changing needs of our clients. Each member of staff has a training matrix. We saw evidence that this service continued to be family run by the registered manager who succeeded her late mother as registered proprietor and registered manager. She was supported as before by her brother, one is a registered nurse, who had also achieved in NVQ qualifications in care. Additional members of staff had been recruited. One member of staff had left the homes employ and the registered manager told us she was searching to recruit another suitable person who would understand and be sensitive to the homes philosophy of empowering rather than just providing care for the people living at the home. The home provided a ratio of 1 to 2 staff to 4 people living at the home and this continued to appear be to adequate staffing levels to the needs of the people accommodated. The registered manager had moved into the home with the people living there, and provided sleep in cover. We were unable to verify all of the statements made in the homes AQAA. There had been two additional staff recruited in the past twelve months. The homes policy for recruitment and selection was satisfactory and was based around the required legislation and national minimum standards. However when we looked at staff personnel files, one person did not have full CRB clearance and needed an additional reference on file. We also pointed out that any person working on a POVA First basis must have a written risk assessment in place. Additionally as a matter of good practice the appointment of staff on a POVA first basis, which should only be in exceptional circumstances, should be discussed with the CSCI. We were given assurances that the member of staff without a full CRB disclosure was always on shift with registered manager and was never left alone with people living at the home. Although there was good evidence of a proactive approach to training and personal development, with the registered manager and staff keen to take advantage of training initiatives offered by the local authority, individual training plans and a training a development plan needs to be put in place. We were told that staff had an annual appraisal and there was supervision system, with the aim that all care staff received a minimum of 6 one-to-one supervision meetings. Care Homes for Adults (18-65 years) Page 28 of 35 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. The registered manager and staff are effective in providing leadership and good clear communication systems throughout the home. There is good progress to regularly review aspects of the homes performance through a programme of self review and consultations, which include seeking the views of people living at the home, relatives, and other professionals. Evidence: The homes AQAA cited what the home does well, the current registered manager has worked at the Willows for 20 years and is qualified to NVQ 4 in Care and Management. Karen Godwin took full control over the Willows after the death of Maureen Flanagan who was not only the proprietor but Karens mother. Karen Godwin is now the registered proprietor and registered manager of The Willows. The Willows has in place quality procedures to monitor and assess clients needs, issues a QA questionnaire bi-annually, the valuable feedback we gain from this questionnaire and our discussions with clients allow us to assess what we are doing Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: well and areas where we could implement improvements. The homes AQAA cited the following improvements over the past 12 months, dedicated financial person, all new staff received first aid and food hygiene training, and internal fire training from the fire marshall. The current manager was registered with the CSCI upon the successful completion of the Fit Person Process following the sad death of the previous registered proprietor /manager. She was in day to day control of the home, and she had considerable care and managerial experience. There was evidence of her commitment to training and personal development demonstrated by her completion of all required mandatory training along with the other members of staff, including accredited medication training, infection control training, first aid, fire safety, food hygiene, health and safety and safeguarding training for protection of vulnerable persons. We were shown progress for the further development of the quality assurance system to gain the views of people living at the home, families and visiting professionals. Pictorial questionnaires had been returned and the manager was planning to collate all views and develop an annual development plan. This would ensure that a systematic cycle of review based upon planning, action and review was in place and the home could be assured that it was meeting the aims and objectives of the people living at the home. We were told that none of the people currently living at the home was able to manage their own money. The registered manager told us that they were assisted to make purchases as they wish. One person was taken out by her family to purchase her own clothing and personal shopping. The manager had formalised and reviewed the management of each persons financial affaires at annual review meetings, making sure everyone had ready access to their allowance as they needed it. We examined a sample of fire safety and maintenance documentation and this was satisfactory. The manager had introduced improvements required at the last inspection, such as documented fridge, freezer and cooked food temperature checks. There was a food temperature probe and food safe wipes and probe calibration records, which ensured good standards of food safety for people at the home. There was only one recorded incident relating to chocking involving one of the people at the home, since the last inspection. This was highlighted at the Personal Care section of this report. The registered person was reminded that any event adversely affects people at the home must be notified to the CSCI without delay. It was positive that the risks had been assessed and actions were taken to minimise risks of harm. Care Homes for Adults (18-65 years) Page 30 of 35 Care Homes for Adults (18-65 years) Page 31 of 35 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 32 of 35 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 34 19 The registered person must 02/03/2009 ensure that any member of staff employed on a POVA First basis has two satisfactory written references and a written risk assessment in place, with named supervisors, until a satisfactory CRB disclosure is received. This is to safeguard people living at the home from risks of harm 2 37 37 The registered person must ensure that any event adversely affects people at the home is notified to the CSCI without delay. This is to safeguard the health and well being of people living at the home. 02/03/2009 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. Care Homes for Adults (18-65 years) Page 33 of 35 No. Refer to Standard Good Practice Recommendations 1 1 It is recommended that information about fees should be included in the service user guide to give people comprehensive information about the service to help them make decisions about the choice of home. It is strongly recommended that the appointment of staff on a POVA first basis, which should only be in exceptional circumstances, should be discussed with the CSCI. That individual training profiles are put in place for each member of staff and an annual training and development plan is implemented. It is strongly recommended that the quality assurance system be fully implemented to demonstrate that the home is providing good quality lifestyle outcomes for each person. 2 34 3 36 4 39 Care Homes for Adults (18-65 years) Page 34 of 35 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). 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. 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