Inspection on 22/06/06 for The Willows

This inspection was carried out on 22nd June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

The Willows 19/06/08

The Willows 27/06/07

The Willows 13/09/05

The Willows 25/04/05

The Willows 19/10/04

The Willows 04/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Willows (The) 72 Boreham Road Warminster Wiltshire BA12 9JN Lead Inspector Roy Gregory Unannounced Inspection 22nd June 2006 10:00 Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Willows (The) Address 72 Boreham Road Warminster Wiltshire BA12 9JN 01985 215757 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) karen@exalon.net www.exalon.net Exalon Care Homes Ltd Karen Jane Wilkinson Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (1) of places Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users who may be accommodated at any one time is 8 Only the male service user referred to in the variation application dated 10 November 2004 may be aged 65 years and over. 13th September 2005 Date of last inspection Brief Description of the Service: The Willows is registered to provide care to up to ten people with a learning disability. It is owned by Exalon Care Homes Limited. The Willows is a sizeable detached Victorian property with a large enclosed garden to the rear. Two sitting rooms, a dining room, kitchen, utility and office accommodation are on the ground floor, whilst the service users bedrooms are located on the first and second floors, together with shared bathrooms with toilets. Some of the accommodation is in a recently completed and registered extension. The home is situated a walk away from the centre of Warminster, with shops and amenities close by. As well as the home having its own car for the use of residents, there are very good public transport links to neighbouring towns and further afield. Weekly fees are in the range £1125 to £1336. Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced visit for this inspection took place between 3:45 p.m. and 8:45 p.m. on Thursday 22nd June 2006, and from 8:50 a.m. to 4:40 p.m. the following day. The inspector, Roy Gregory, spoke at length with three residents, and talked with each of the other five people resident at the time. The inspector joined residents and staff at the evening meal and joined social interactions in the sitting rooms and garden. There was a discussion with a visiting relative and social worker, and the inspector sat in with them on part of a service user’s first review. The registered manager, Karen Wilkinson, was available during most of the visit and made documentation available. Additionally there were conversations with both team leaders and several care staff. The inspector selected a number of care plans and daily records to compare observations of care and residents’ perceptions with written records. Other records consulted included those relevant to recruitment and staffing, and health and safety. All communal areas of the building were visited and one bedroom was seen. Other bedrooms had been seen on a previous visit in connection with the recent registration by the Commission of two additional rooms in an extension to the home. This inspection took account of a random unannounced inspection carried out on 18th April 2006. The latter had been arranged to follow up on concerns arising from a vulnerable adults matter investigated earlier in the year. That inspection was positive: improvements in the production, keeping and monitoring of incident reports were noted. There was evidence of team leaders having received renewed guidance about incident reporting, including Regulation 37 notifications. A requirement was set in respect of disciplinary arrangements for a member of staff, which had already been commenced by the company. This was confirmed as having been met in full. Questionnaires sent by the inspector were received from five service users, two indicating they had completed these without additional support. Comment cards were sent to, and received back from, the close relatives of two service users who do not have verbal or literacy skills. Responses were also received from the GP surgery used by all the service users, and from two care managers. The judgements contained in this report have been made from evidence gathered during the inspection, which included the visit to the service and taking into account the views and experiences of people using the service. What the service does well: With the exception of some views on the cleanliness of the home, service user responses via questionnaires and in person were very positive about The Willows. Comments included “I like it here” and “this is my home now”. A relative wrote, “X is very happy at The Willows and all the staff are absolutely Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 6 superb. No complaints at all.” Some excellent care interactions were observed, and an observed transgression of good carer/service user relationships was dealt with effectively by other staff and was to lead to disciplinary attention. All service users had had, or were planned to have, holidays of their choice if they wished, including with one-to-one support in some instances. Community access and individual activities were very much part of every day life. The home has good provision for encouraging service users to have their say on how the service should be delivered, and acting on these. A person had been recently admitted to the home. They and their family were able to describe an effective assessment process and support to make the transition from a former care environment. Provisions for people’s health and welfare were very good. A GP who works closely with the home reported good communication and advocacy on the part of home staff, and confirmed his satisfaction with the overall care provided by the home. Care managers have also reported co-operation with care planning aims. The inspector was able to identify clear signs of progress in key areas for some residents. What has improved since the last inspection? What they could do better: Despite the efforts towards better internal reporting and notifying significant events to others, there was still evidence of delay and over-reliance on the Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 7 manager, hence a requirement made to ensure notifications are made quickly, in line with regulation. The inspector has identified scope for further improvements to recording and passing on of information within the home. Daily records maintained for all service users do not truly reflect their daily experiences, because they are mostly compiled by a single member of staff at the end of a long day’s shift, rather than by staff actually present as things have happened. A general overview of each day is useful in enabling accurate reviews and evaluations of care plans by key workers, and should relate to care plan aims. Some service users would undoubtedly like to be included in this process, to reflect on their experience of a day as positive or not, and to be reassured as to the nature of records being made. There would also be benefit in ensuring a “debrief time” towards the end of each shift, to enable staff to identify what they have achieved, and whether there is any outstanding report to be made. It is also recommended that incident sheets show clearly who has been notified of their contents. The one area of the service criticised by a number of service users in questionnaires was cleanliness. The inspector found many high risk areas to be insufficiently clean, including a shower, toilets (one with a broken seat), kitchen hand wash area, and parts of the laundry. This was disappointing given the environmental improvements of recent months. The manager had identified that standards were slipping, and considered it related to the much greater amount of cleaning necessary now the home has been extended. There is therefore a requirement that action must be taken to ensure all parts of the home are kept clean, with high risk areas cleaned to recognised infection control standards. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 4 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents are only admitted to the home on the basis of a professional assessment that demonstrates their needs can be met. Good information is provided to prospective residents and their supporters, as well as the opportunity to visit the home. EVIDENCE: There had been one new admission since the previous inspection. Whilst this had taken place on almost an emergency basis, Ms Wilkinson had undertaken a full assessment by visiting the person concerned at their previous placement, and considering assessment information from there and from the care manager. The reasons for not being able to arrange a pre-admission visit to the home were set out in writing by the care manager. The company’s assessment tool was comprehensive and showed the sources of information. This led into formulating the initial care plan. The inspector was able to sit in on part of the resident’s first review meeting. The care manager was complimentary of the thoroughness of the home’s assessments, prior to and since placement. The resident’s parent also thought the whole process had been well handled, and confirmed receipt of information about the home at an early stage. The resident himself thought he had been helped to make the transition to a new placement. He confirmed his Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 10 involvement in commencement of his care and support plan soon after arrival. Ms Wilkinson has rejected other referrals during the same period on the grounds the home would not fully meet identified needs. Another prospective resident had visited the home together with family members, as well as being seen in their present care setting. The service users’ guide had been updated and made more accessible to service users by use of pictures. All residents had been issued with one of these. Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6-9 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents are aware of the care planning process and its links with the inputs of other professionals. There are good systems in place for consultation with residents about every-day and special events in the home. On an individual level there is appropriate support to risk-taking in order to promote independence. EVIDENCE: There was a care and support plan in place for each resident. In those selected for detailed reading, there was evidence of regular care manager reviews and of ongoing internal reviewing by key workers. This included attention to objective setting and monitoring with residents. For the recently admitted service user, the care plan noted their wish to have time to think about objectives and to return to this at a later stage. For that person, the support plan reflected many issues he had shared with the inspector, and he clearly recalled his direct involvement in preparation of the support plan. Aspects of the plan in operation were evident during the inspection visit. Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 12 For a service user with communication difficulties, the plan contained evidence of much work undertaken by the key worker on preparing word and picture cards to progress interaction and making choices. All sections of this person’s support plan were in symbol form. The active work on communication was mirrored in interactions observed between staff and this service user, and was commented on by their care manager. Risk assessments were written in a way to enable participation, independence and community access. Another person’s support plan linked strongly to their care manager’s care plan, and to ongoing work with particular behaviour management needs. Plans showed an emphasis on support to service users’ preferences and choices. A resident spoke of freedom of choice of rising and retiring times, and this was reflected in their plan. For another, their “eating and drinking” section referred to full access to the kitchen, and facility to make drinks or snacks at any time. An advantage of the home’s recent extension has been to create a user-friendly kitchen and laundry, both of which were seen to be readily used by service users, with (or without) support in line with individual care plans and risk assessments. The quality of the latter had improved. Importantly, staff had a good awareness of contents of care plans and risk assessments. It is a feature of the company’s monthly monitoring visits that staff are randomly asked to demonstrate such knowledge. A care leader spoke of ensuring care staff have time to read plans, whilst all risk assessments seen had been signed by staff. Support plans included details of agreed support to individuals for managing their finances. For the recently admitted person, this had entailed a high degree of liaison with the previous placement and others, as well as the service user himself. For others there was evidence of assistance to dealing with benefits providers. At the time of inspection, enquiries were being made about possible advocacy support for a service user. Residents’ meetings were now being held monthly, with minutes taken forward to staff meetings. These represented another means by which service user choices were canvassed, for example about provision and organisation of activities and meals. As has been pointed out before, the minutes did not show that the resident group had clear feedback at each meeting of progress on matters raised at the previous meeting. Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 - 17 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The nature of working relationships between service users and staff, mean that residents have access to planned and spontaneous activities that fit their individual wishes and needs. These provide for access to the wider community, and maintenance of significant relationships. Good quality meals are served, taking account of individual needs. EVIDENCE: There was a weekly activities programme that service users confirmed was based on wishes expressed by them. This provided for an organised in-house activity and community access of some form each day and service users opted in and out as they chose. Additionally, individuals had activity plans as part of their support plans, for example one person was currently attending swimming one day a week and horse riding on another day. One member of staff had particular responsibility for progressing activities and had shown imagination, whilst key workers tapped into this and also developed ideas with their key users, especially with regard to holidays. One service user had just returned Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 14 from a holiday in Ireland with one-to-one staff support. The newer resident already had holiday plans made, which he discussed animatedly with a member of staff who will accompany him, whilst there were pictorial plans prepared by others in respect of a holiday they were to be taking together. The manager described having changed the staffing arrangements for one service user’s holiday at short notice, to be the more sure it was the service user’s choices that were being met. Daily activity records, kept for each resident, provided evidence of what they had done or offers of engagement they had turned down. These seemed to give a reasonable picture of how service users were spending their time and being stimulated, although there was considerable spontaneous activity also. For example, the sitting room where smoking is possible had been provided with a snooker table. One resident was engaged in a game with a member of staff, with another enjoying watching, and it was apparent from talking to others that a number of service users enjoyed this activity. In the same room service users made full use of hi-fi equipment. The garden showed evidence of regular use for games and relaxation. Some residents were risk-assessed for unsupported community access, for example one had been a member of a theatre club in the town. Use of the immediate environment was encouraged. Two service users were seen supported at different times to make telephone contact with family members when they wanted to, in line with written support plans. A parent of one of them spoke of the value not only of the contact, but also of the agreement between all as to how it was best managed. Support plans included consideration of employment and training opportunities and a variety of individual arrangements were current. Someone who had tried part-time employment was being supported in their decision to have terminated it, and how to progress their goals from there. In the home was current guidance on such issues, which were also shared with care managers. Incident records showed there were sometimes disagreements between service users. The potential for these was recognised in risk assessments and there were management strategies in place, with encouragement given to service users to work out how to co-exist. Equally, strong bonds between service users were recognised and given space. One service user said they appreciated the support and discretion shown by staff in this regard. Service users had unrestricted access to communal areas of the home and garden, and all made use of keys to their own rooms. Staff showed respect for privacy, whilst also interacting for the most part appropriately with service users. Indeed, some excellent examples of patience, understanding and support were observed during the inspection visit, but their professionalism was let down by one member of staff airing personal issues to the discomfort of service users. Other staff members took appropriate actions to try to Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 15 minimise the impact of this on the service users present. The manager was to address this as a disciplinary matter, after the team leader had sent the person home from the shift. Meals were prepared in line with a four-week menu that had been arrived at with service user consultation. Support staff were free to diverge from this, for example on the day of inspection there was a change at the request of a service user, and the weather might lead to other changes being canvassed. The inspector joined an evening meal that was well presented and substantial. Staff ate with residents and there was a sociable atmosphere. The dining room had been tastefully redecorated. Residents joined and left tables as they were ready, and helped themselves to sweets from the fridge. They were involved in preparation and clearing of meals. Prior to the inspection the manager had provided the inspector with a summary of a meals survey undertaken in the home. Individual responses were filed in support plans. A service user confirmed his comments on breakfast preferences had been acted on in full. The most recently admitted person told the inspector he was very satisfied with the food provided, which he later demonstrated. Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 - 20 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Staff offer personal support that matches service users’ needs and recorded preferences. Healthcare needs are recorded and their management includes use of external consultation and guidance in order to identify and meet needs. There are good systems for management of medications, subject to careplanning for use of “as needed” medicines. EVIDENCE: Personal support was offered discretely and in line with support plan guidance. There was good recording of observations of possible ill health indicators, especially for those unable to express symptoms verbally. The manager also described a pro-active approach to seeking medication reviews in order to minimise use of medication in the home. Individual records bore out that the GP and consultant psychiatrist regularly reviewed medications, with advice given of anticipated effects. One service user who had been observed by staff as repressed and sleepy had been referred for medication review, resulting in a lesser regime. The inspector noted this person as much more sociable and confident than at previous visits. A care manager spoke of a service user who, in a previous placement, had been subject to routine use of “as needed” Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 17 medication and physical interventions, conspicuously absent at The Willows. approaches that had been All service users’ records tracked and planned their chiropodist, dentist and optician appointments. There were good records of outcomes of medical appointments. The communication book reminded staff to ensure application of sun protection to two service users in particular, which was seen in practice. A GP returned a comment card, indicating satisfaction with the overall care provided by the home. He indicated that staff advocated effectively for service users about their medical attention needs, and that they demonstrated a clear understanding of service users’ care needs. All staff seen involved in medication administration and related recording demonstrated good practice. Storage and booking in and out procedures for medicines were sound. The team leader with delegated responsibility for this area of practice was updating guidance for staff on the purpose and possible side effects of all medicines in use in the home. He had instituted a system to avoid over-stocking or out-of-date use of medicines not fitting in the monitored dosage system, and had also acted on advice obtained from the pharmacist inspector about an administration difficulty posed by one service user, for whom an agreed prescription protocol had been negotiated with the service user’s GP. The related guidance had been added to the person’s support plan. It might be useful also to place a copy with the person’s Medicines Administration Record. Another member of staff explained how use of “as needed” medicines was sanctioned by the senior staff member on duty, and recorded. Whilst this was good practice, safety would be enhanced by ensuring there is a specific care plan in place for each prescription of “as needed” medication, preferably signed by the doctor prescribing, to show the criteria and protocol for usage. The team leader and another member of staff had completed a distancelearning course on medications, and it was intended all staff would undertake a related day course. Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Residents understand and use the complaints procedure, and trust staff to act on their views and concerns. Provisions for referral to vulnerable adults procedures are in place and the service is co-operative with these, but there continue to be delays in reporting matters indicating potential risk. EVIDENCE: Three complaints had been logged in the home’s complaints procedures since September 2005, each concerning inter-resident issues. Investigations followed a consistent approach. Service user accounts of complaints they had made accorded with how they were recorded. The manager kept a log and quarterly review of all incidents recorded in the home. Reports were numbered and signed off by the manager. They could be improved by showing who has been notified of each report. There was provision in the reports for showing a referral to Vulnerable Adult procedures, which was done where appropriate. Monthly quality assurance reports by the company show that service users are invited to air concerns and complaints as a means of improving the service they receive. Resident meeting minutes showed they were used as a forum for airing and discussing conflicts if service users wished, and also to remind them of their rights to make formal complaints at any time. A complaint to the Commission by a whistle-blower in January 2006 arose from a situation where an individual and the resident group were put at potential risk, compounded by non-adherence to proper reporting procedures. This led to a referral to local Vulnerable Adult procedures, and suspension of a member Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 19 of staff. The reinstatement of the latter was conditional on their being subject to measures proposed by the company (in respect of which a requirement was made at the random inspection on 18th April 2006). At this inspection it was confirmed from records and talking to those involved that these measures had been completed. An associated random inspection in April 2006 had ascertained that all staff had received renewed guidance on reporting procedures, including making “Regulation 37” notifications to the Commission. The Vulnerable Adults investigation process had also led to greater communication between the home and local Community Team for People with a Learning Disability about sharing of concerns and working together. A further matter was referred to Vulnerable Adults procedures in June 2006, which again highlighted the need to report matters both internally and to outside agencies at the first opportunity. There would seem to be scope for improving debriefs at the end of shifts to ensure responsibility for making an internal or external report is recognised and acted upon forthwith. (See also page 26 below). All staff had recently received physical intervention training for use as a last resort. There was an agreed intervention protocol for one service user, for use if their de-escalation care plan should fail. The person’s care manager and behaviour nurse had been party to the protocol and have expressed satisfaction with the home’s ability to work with it. Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. A good quality of environment is provided in line with service users’ needs, but there are deficiencies in maintaining hygiene. EVIDENCE: The two newly added en-suite rooms were not yet in use as the company was awaiting a certificate to confirm the Commission’s recent registration of the additional places. The rest of the extension to the original building was in full use. Other parts of the home had benefited from upgrades of décor and flooring, with completion of these tasks programmed. However, there were already signs that routine cleaning was inadequate to maintain the improved environment, consequently some high risks to hygiene were brought to the manager’s attention. Examples were a rubber shower mat left in situ, under which was an accumulation of dirt and debris; dust accumulation in the utility room, which also had a very dirty door; and an unclean hand-wash area in the kitchen. A service user commented on unclean toilets in a questionnaire, and another indicated the home was “sometimes” fresh and clean, rather than “always” or “usually”. The manager said she was to suggest to the company Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 21 that some staffing provision be dedicated to domestic tasks, as the extension to the building meant staff had a significantly greater area to cover. Communal rooms other than bathrooms and toilets presented well, whilst staff and residents confirmed there was regular support and assistance to keeping individual rooms clean. The dining room floor was cleaned after a mealtime was finished. Residents appreciated improved facilities in the bathrooms, but would benefit from provision of additional hooks or shelves. The recently admitted service user was content with his room and could identify ways of developing it as he wished. Although he had audio-visual equipment of his own, he preferred to use the communal facilities. To meet national minimum standards, his room needed the addition of a second chair and a table. The newly built bedrooms were well provided with furniture. All bedrooms had wash hand basins. Those affected by the building works had been made good. Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 - 36 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Staffing is sufficient in numbers and quality to ensure service users are safely and consistently supported. Recruitment practice is safe. Staff are supported in their roles by regular supervision and by planned training, including to NVQ, that is relevant to the needs of service users. EVIDENCE: Rotas worked and planned showed maintenance of four staff on duty through the day, whilst night cover consists of a waking staff member and a sleep-in person, backed up by a rota of on-call senior staff. There was evidence that the latter provision was used as appropriate. Staff were allocated to one of two teams, each of which was headed by a team leader, who had decision-making responsibilities up to a certain level in the manager’s absence, as well as providing supervision to members of their respective teams. There was some “mixing” of team membership when support staff offered to cover gaps in the rota. The staff team was mixed in terms of age and gender. Additionally the home has recruited a number of “bank” staff, which permanent staff said had made a positive difference. Two such staff had been recruited since the previous inspection. Records of the recruitment practice were comprehensive and included all statutory checks. Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 23 Staff were positive about the frequency and content of supervision received, which was confirmed by records seen. There was evidence of active use of an induction programme compliant with current expectations, which led into NVQ and LDAF training. Six support staff out of twelve currently had achieved NVQ to level 2 or 3, with two staff working towards level 2 and a number engaged in LDAF training. There was a training and development plan in place for the current year, showing completion of, or planned provision for, training in manual handling, protection of vulnerable adults, first aid and use of physical intervention. The latter had been given greater priority in response to the assessed needs of a newly admitted service user in particular. The plan showed an intention to procure staff training in food hygiene, infection control and Makaton. There were records of regular staff meetings, which were held alternately on different shifts to maximise attendance by staff from both teams. A team leader said there was an expectation on staff to attend meetings if possible. Minutes showed meetings covered a mix of operational and service user issues. Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The registered manager provides a lead to the home, by monitoring the delivery of care and encouraging participation by both residents and staff. Quality assurance systems are centred around service users, producing information that is used to improve the service. There are systems in place to identify and promote the health and safety needs of residents and staff. Records of individual service users’ daily lives are inadequate. EVIDENCE: The senior staff team had just introduced a system of delegation of a range of tasks to individual members of staff, for example monitoring of and reporting on cleaning, health and safety and maintenance checks, with provision for overall monitoring of outcomes by the team leaders. This had potential for a good quality of response to shortfalls identified, provided it is backed by support in the form of training and supervision. It is also important that issues can be prioritised as necessary, for example, a broken linen cupboard door had Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 25 been reported, but not the fact it was a fire door (signed “keep locked”) and therefore in need of urgent repair. There was good provision for dissemination of information among staff. Apart from monthly staff meetings, a communication book was much used, and individuals were required to sign that they had read messages there. A team leader agreed the inspector’s observation there was in fact some degree of “information overload”, in that staff were required to sign for all manner of written information regardless of its applicability to individual roles. It may be that the new system of delegation will allow for a more targeted approach. Complaints and vulnerable adult matters that have arisen have highlighted that at times there has been uncertainty on the part of team leaders and others about responsibility for internal incident reports and notifications to others. There were records showing how the company and manager have tried to address this area of practice with the staff. A further integration of team leaders’ and manager’s roles could be encouraged by including team leaders in events such as care manager reviews or vulnerable adult meetings. The company has demonstrated a commitment to quality assurance, by way of satisfaction surveys with service users and their families, and meticulous monthly monitoring visits, which result in delegated action plans. Provision for health and safety matters was well organised, probably helped by the need to have complied with a variety of regulations in extending the home. Fire precautions monitoring was sound, as was provision for upkeep of the house vehicle. The office was well organised and written records generally were of a good standard. A daily record was maintained for each service user, but these were not very informative. Staff said the expectation was on the sleeping-in member of staff each evening to compile these records, but this person was not necessarily in the best position to do so. For example, there were instances where the writer of the records had spent shift time primarily with one or two service users, and thus did not know enough about significant events for others to be able to write a meaningful record. During the week of the inspection visit, a service user had broken a window, an event which was already common knowledge among staff, yet which was unrecorded. Staff spoken to agreed that there was a need to develop a culture where significant events or achievements get recorded soon after they occur, combined with a debrief at the end of shifts to ensure appropriate recording is completed. This would still enable the sleep-in person to carry out general day summaries, but on the basis of more complete knowledge. Information already recorded elsewhere, for example in an incident report, need not be reiterated but should be signposted in the daily record. Some service users would undoubtedly like to be included in this process, to reflect on their experience of a day as positive or not, and to be reassured as to the nature of records being made. The review Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 26 and evaluation of care plans would also be enhanced by daily records fuller, but not necessarily any longer, than those seen. Night staff were already providing a good quality of recording. Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 2 26 X 27 3 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X 2 3 X Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13 (2) Requirement There must be a care plan in respect of any medication prescribed “p.r.n.”, describing the protocol for use of the medication and signed if possible by the prescribing doctor. Notifications to the Commission and to care managers must be made by the most senior person on duty within 24 hours of the event being notified. All bedrooms must be furnished in line with the National Minimum Standard. Action must be taken to ensure all parts of the home are kept clean, with high risk areas cleaned to recognised infection control standards. Timescale for action 31/08/06 2. YA23 12 (1)(a) 37 22/06/06 3. 4. YA25 YA30 16 (2)(c) 13 (3) 23 (2)(d) 31/08/06 22/06/06 Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA8 Good Practice Recommendations Minutes of residents’ meetings should demonstrate that the meetings commence with a review of matters arising from the minutes of previous meetings. Consider inserting copies of significant medications information, such as special procedures or “p.r.n.” guidance, with individual MAR sheets. Incident reports should show to whom they have been copied, and when. Seek opportunities to include team leaders in care reviews, strategy meetings and other situations where they can learn more of the wider context of placements in the home. Explore ways to ensure daily records provide a true reflection of the daily experience of service users. 2. 3. 4. YA20 YA23 YA37 5. YA41 Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Willows (The) DS0000028543.V298318.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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