Inspection on 24/07/08 for The Willows

This inspection was carried out on 24th July 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Willows 21/09/09

The Willows 25/03/09

The Willows 31/10/07

The Willows 11/05/07

The Willows 20/11/06

The Willows 09/05/06

The Willows 19/01/06

The Willows 28/06/05

The Willows 11/11/04

The Willows 13/09/04

The Willows 03/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 14/11/2008.

CARE HOMES FOR OLDER PEOPLE Willows, The 2 Tower Road Barbourne Worcester Worcestershire WR3 7AF Lead Inspector Andrew Spearing-Brown Unannounced Inspection Starting 24th July 2008 16:30 X10015.doc Version 1.40 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 DS0000018692.V368906.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 Older People. 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. DS0000018692.V368906.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Willows, The Address 2 Tower Road Barbourne Worcester Worcestershire WR3 7AF 01905 20658 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) mrkharb@aol.com Mr Tony Harborne Mrs Vivien Anita Harborne Mrs Lynda Jennings Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14), Physical disability over 65 years of age of places (14) DS0000018692.V368906.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The Home may also accommodate a maximum of 4 people over the age of 65 with a dementia illness The Home may also accommodate one person over the age of 65 with a learning disability The home may also accommodate one named person who has needs which fall within the category MD, ie mental disorder, excluding learning disability or dementia. 31st October 2007 Date of last inspection Brief Description of the Service: The Willows is a large, detached, adapted property situated in a residential area near to Barbourne Park in Worcester. The home provides accommodation and personal care to a total of 14 people who have needs related primarily to old age. Accommodation is located on two floors, with access to the first floor gained via a staircase and or a stair lift. Handrails are fitted throughout the home. Accommodation comprises of 14 single bedrooms, all of which have en-suite facilities. The home has one large lounge with a smaller room leading off it and a separate dining room. The home has a well maintained garden to the rear of the property. People using the service are able to use a patio area which can be reached from either the main lounge or dining room. Limited car parking is available to the front of the property. Information about fees charged at The Willows was not available in the Service User Guide at the time of the inspection. The reader should therefore contact the service directly for details. DS0000018692.V368906.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. We, the Commission, carried out this key inspection without any prior notice. A key inspection is one in which we look at all the aspects of the service that are most important to people using it. This key inspection took place during six separate visits to the home between 24 July and 27 August 2008, and it involved three regulation inspectors and one pharmacy inspector. The visits included one around teatime and one on a Saturday morning. Prior to this inspection the registered manager completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. The registered manager was present during one of our early visits but was not available during the later part of the inspection. The recently appointed deputy manager assisted throughout, and one of the registered providers was also available at times. This inspection takes into account information we have received since the last inspection as well as the visits to the home. Following the previous key inspection (October / November 2007) we issued a Statutory Requirement Notice in relation to staff recruitment procedures. We have, since that visit, carried out two random visits to assess compliance with the notice. During the lead up to this inspection we were told of some concerns regarding food provision within the home. This was looked at during our visit and we have made a recommendation regarding the choice available and the use of powered milk. During the inspection, discussions were held with the registered manager, the deputy manager, a number of staff members and some people using the service. We had a look around the home and observed what was happening. In addition, we viewed the care documents regarding some people using the service such as care plans, risk assessments and daily records. We also viewed medication records and staffing records. DS0000018692.V368906.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Information needs to be available within the home to ensure that people using the service are aware of the service and facilities they can expect. Pre-admission assessments, care plans and risk assessments need to be more detailed to ensure that staff are able to meet care needs in a safe and consistent way. The administering and recording of medication needs to always be carried out in a safe manner in order to safeguard people. As a result of our concern about this, we left an immediate requirement. A choice of menu would give people an increased range of food. There needs to be improved planning for meals and food purchases to ensure there are always sufficient stocks to deliver a varied and balanced diet. The use of powdered milk should be reviewed. DS0000018692.V368906.R01.S.doc Version 5.2 Page 7 Although improvements have taken place in relation to training, some staff have not received training in areas which help to safeguard people from the risk of injury, harm or abuse. Staff recruitment procedures were found to be insufficient to ensure that staff employed are suitable to work with people. An immediate requirement was issued regarding the lack of suitable evidence that checks had taken place in relation to one person. Improvements are necessary to ensure that equipment used for lifting people is tested and maintained to ensure it is safe. An immediate requirement about this was issued at the time of the inspection. Management systems need to be reviewed to ensure that the quality of the service is audited and necessary improvements identified. We have issued a total of five Statutory Requirement Notices in relation to shortfalls identified where the home was not complying with the Care Homes Regulations 2001. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000018692.V368906.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000018692.V368906.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3 and 5. Standard 6 is not applicable as The Willows does not provide intermediate care. Quality in this outcome area is poor Information about The Willows is not freely available to people residing within the home. People cannot be confident that staff will have sufficient information to ensure their care needs will be met when they move in to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We viewed the pre-admission assessments of two people using the service. Both were scant in detail providing only basic information and, therefore, failing to fully demonstrate that the home would be able to meet identified care needs. Gaps in information included eyesight, dentures or oral care, skin condition and care of toe nails. The lack of information could place people at risk of harm, as staff might not have enough information to enable them to DS0000018692.V368906.R01.S.doc Version 5.2 Page 10 provide the care needed. The assessments were not dated. We were told that one of the registered providers and the deputy manager intend to attend training on pre – admission assessments during September 2008. We did not see any copy of the current service user’s guide available for people to refer to other than one held within a file containing policies and procedures. One person recently admitted to the home stated that she had not seen any information about the home since her admission. One person did confirm that she had visited the home for the day before her admission. During our visit on 12 August 2008, we were informed by the Deputy Manager that the home was not accepting admissions at the time and that she and the provider had arranged to undertake pre-admission assessment training in September. DS0000018692.V368906.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is poor. People are treated with respect for their privacy and dignity and are supported by staff in a kind and sensitive way. However, some needs and risks associated with health, personal care and activities are not being taken into account. Medication is not being managed in a way that ensures people receive their treatment safely and as prescribed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The newly appointed deputy manager has introduced a new format for care planning. As part of this inspection we viewed a number of these records as well as risk assessments and daily records. Due to the introduction of the new care plans the files of people using the service contained both the previous handwritten ones and the new format which were either partially or fully generated on a computer. DS0000018692.V368906.R01.S.doc Version 5.2 Page 12 There was evidence that some people using the service had seen their care plan although one was not signed by either the person concerned or their representative. The deputy manager stated that she had completed one care plan in conduction with the service user and her family. A duplicate copy of the care plan is held in the manager’s office. The care plans lacked the level of detail needed in order that staff are able to carry out care in a consistent style. For example, one plan simply stated ‘needs assistance to get cleaned up’. The nutritional assessment of another person was incomplete although the care plan stated that the individual had a poor appetite and was prone to weight loss. We noted that a discharge letter highlighted a Persons care need which was not incorporated into their care plan. We were informed of the professional advice sought by the home in relation to this care need. We saw one care plan which failed to give staff written guidance as to how to best meet identified needs while another failed to indicate certain behavioural triggers and how staff should defuse the situation. Some risk assessments were in place but not all elements of risk were suitably assessed or identified. Risk assessments were not in place regarding two people who use the stair lift and no risk assessment was in place regarding somebody who had recently fallen on two separate occasions. Elements of risk were not identified at the point of the pre-admission assessment. Although we did not find that people using the service had come to any harm, we were concerned that people were not being adequately protected against some identifiable risks. Staff on duty were able to give detailed information regarding current care needs. Staff told us that they believe people using the service receive a good quality of care. The deputy manager acknowledged the shortfalls in both care planning and risk assessments and gave her commitment and assurance to improve them and bring them up to the necessary standard. In order to do this it is vital that she has available to her a copy of both the standards and the regulations. The care records and practices seen during our visits demonstrated that the home seeks medical attention for people as necessary. We received questionnaires back from G.P’s who indicated no concerns regarding the service provided stating that the service seeks advice and acts upon it. A care manager (social worker) told us that staff are caring and sensitive to care needs. During our visit on 24 July 2008, we observed staff administering medication. Staff had dispensed prescribed medication from the system supplied by the pharmacy into small plastic ‘pots’. The pots were not marked with people’s names and were all placed onto a tray together. We call this secondary DS0000018692.V368906.R01.S.doc Version 5.2 Page 13 dispensing and it is potentially dangerous practice because it could mean that people are given incorrect doses and types of medication. We observed Medication Administration Record (MAR) sheets on the day and found that the vast majority of medication was signed by the carer as having been given before attending to this task. This is also unsafe practice. We found one record where the pre-administration signing had not happened on the day. This was later brought to the attention of the carer who then signed it. MAR charts should always be signed as the medication is administered. The carer concerned told us that she had not received any medication training. We were told that training is scheduled to take place in the near future. Due to our concerns we issued an immediate requirement saying that the practices we witnessed must cease. We were also concerned that the medication trolley was left open when the front door was answered to us. Staff were recording the date of opening on new containers of medication and balances of medication were being carried forward onto new MAR sheets, which helps to ensure that accurate balances of medication can be counted. We did, however, note a small number of gaps on the sheets whereby nobody had signed to show that the medication was given or entered a code as to why it was omitted. We carried out an audit of some painkilling medication and found it to balance. Some of the MAR sheets were handwritten however they did not always contain a second signature to demonstrate that somebody else had checked that the record was correct. During our visit on 25 July 2008, we observed the registered manager and a carer administering medication directly from the drugs trolley. The pharmacy inspector was told during a subsequent visit on 12 August that the trolley is taken to people using the service in order to administer their medication. Staff were seen to be signing the MAR sheet appropriately. The pharmacist inspector also saw medication being administered safely and with care to the people using the service. We viewed the storage and recording of controlled medication. We had some concern regarding entries within the CDR (Controlled Drugs Register). The balance of some liquid medication appeared to balance with the actual amount remaining. However, on one occasion the CDR stated ‘Refused to take meds’, the record was not signed but the medication was deducted from the total held. On viewing the person’s daily notes we obtained some additional information but it still did not give us details of what happened to the medication. We were also concerned about a considerable number of tablets that were handed over to somebody’s representative. The record did not indicate who had handed the medication over and the register did not contain a signature of a member of staff. The CDR indicated that some medication remained in the home however it was believed that these tablets were also handed over to the same representative. DS0000018692.V368906.R01.S.doc Version 5.2 Page 14 The deputy manager had informed us early in the inspection that she had found a large quantity of medication stored in an unused cupboard and also a filing cabinet. We were shown the medication on 12 August. It had been kept, in order for it to be documented and returned to the pharmacy for destruction. The medication, labelled for various people, was dated from between January to July 2005. It was of concern that this medication had not been stored appropriately or returned to the pharmacy. Safe procedures had not been followed. However it is commendable that on discovering the medication the deputy manager took immediate action. The situation was handled correctly and safely in ensuring that the medication was locked in a safe cupboard ready for return to the pharmacy. Comments made by people using the service included ‘Absolutely marvellous, the people are so gentle and kind’ and ‘I have no complaints at all’. One person described the staff as ‘very kind’. People using the service appeared well cared for. People were suitably dressed taking into account gender and the warm weather. Staff were seen to be kind when caring for people although care needs to be taking regarding the use of some terminology such as ‘good girl’ ‘chick’ and ‘darling’. DS0000018692.V368906.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is adequate People using the service are able to keep in touch with family and friends. Activities are provided by care staff working in the home. People enjoy the food but there has been no menu choice and stocks of food have not been reliably maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw a number of visitors during our time in the home. Visitors were made welcome and seemed to be at ease with staff. The Willows does not have a dedicated activities coordinator. No outside organisations visit to provide stimulation to people using the service. A list detailing activities scheduled to take place each morning and afternoon was on display near to the main lounge. The activities include draughts, dominos, movie time and ballgames. We did not see any activity taking place during our visit. Staff assured us that activities do take place but stated that people preferred to sit outside and enjoy the warm weather. We consulted a small DS0000018692.V368906.R01.S.doc Version 5.2 Page 16 number of people using the service who confirmed that activities such as light exercise take place. We saw a newsletter on display primarily aimed at relatives requesting items to be brought in to the home in order that staff can create scrap books with people. Staff were seen knocking on bedroom doors before entering. On the first day of the inspection, we enquired upon what was available for tea. The items provided did not match what was recorded on the menu. People received either chicken spread or pork and beef spread sandwiches and home made cake. On enquiring, we found that this was not an isolated occasion; for example, no egg salad was given due to having no eggs earlier in the week. We were told that the menu was repetitive with a lot of sandwiches at tea time. Following our first visit and initial feedback about this, the registered manager told us that cup-a-soup was available as an alternative at tea time, if people wanted it. The registered provider stated that he did not limit the budget on provisions. The deputy manager told us that she intended to produce new menus to ensure that people had a choice. On the second day of the inspection, the midday meal was fish, chips and peas. During our third visit, which coincided with lunch time, the meal was either faggots or a sausage with mashed potato and peas. People using the service commented that the food is ‘very good’ ‘pretty good’ while somebody else said ‘It’s lovely’. By our next visit on 12 August, the deputy manager told us that she was producing a new menu and that people were assured choices. We observed the menu for the week and confirmed that it did provide a choice of balanced nutritious meals, four times a day. Although fresh milk was seen within the home this is brought in by and used by members of staff. People using the service are given powdered milk. We enquired why this was the case, one of the registered providers answered that it was ‘more convenient’. As we can not see how this would be more convenient for people using the service this must mean that it is more convenient for staff or management. DS0000018692.V368906.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is adequate People are aware of how they can make complaints and can be confident that these will be addressed. The home makes efforts to safeguard people from abuse and takes some action if allegations are made. Staff knowledge about their responsibility is reasonable but this needs be improved to help ensure that people are fully protected from neglect and abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information about complaints was displayed on the door of every bedroom. The size of the type was in many cases small although we did see example of when this had been increased. The information directed the complainant to the registered persons; it did not make any direct reference to the Commission. We saw additional information about complaints within a copy of the service user’s guide. We asked people about what they would do if they had any concerns about the home. One person said ‘Would go to Lyn (registered manager) she gets things done’. DS0000018692.V368906.R01.S.doc Version 5.2 Page 18 We asked for records regarding complaints. The deputy manager had recorded two concerns / complaints raised by relatives during the previous three weeks. The record indicated how the matters were investigated and action taken as a result of the comment. The registered manager had not recorded any other concerns or complaints since our last key inspection. We were aware of concerns raised via the local PCT (Primary Care Trust) which had been addressed by the County Council under local safeguarding procedures. The outcome of the investigation was that staff training needed to be arranged in relation to infection control. Infection control training has taken place recently but the registered persons failed to arrange this within the timeframe set by the safeguarding strategy meeting. We have previously had concerns about the lack of training provided for staff members about safeguarding people from risks of neglect and abuse. Following our previous inspection, training did take place but this did not involve all members of staff. Since the training carried out towards the end of last year no other training on safeguarding has happened for either established members of staff or new employees. One member of staff who has not had any specific training was able to demonstrate an understanding of the action she would need to take in the event of actual or suspected abuse taking place within the home. The same member of staff was aware of people outside of the home who would need to be aware of any allegation. The deputy manager gave a good account of the actions she would take. The registered manager is also aware of persons she would need to contact within the local authority. We have received some positive comments regarding how staff have managed a more recent safeguarding referral. The registered manager’s knowledge regarding how to make a referral for possible inclusion onto the PoVA (Protection of Vulnerable Adults) was not sufficient. The registered manager was able to supply us with the home’s procedure in dealing the safeguarding. It was noted that the procedure detailed how to contact the Adult Protection Coordinator within the local authority. It also made reference to the Commission. During this inspection we became aware of an incident which was reported to the local authority. However, we were not informed about it. We have previously brought to the registered person’s attention the need to have a copy of the local procedures available within the home. Despite highlighting this fact in the past the procedures were not available at the time of this inspection, the deputy manager undertook to obtain a copy of this document. A poster regarding safeguarding is however on display within the manager’s office. The home’s recruitment procedures are not sufficiently robust to safeguard people using the service against potential abuse. Reference to recruitment is made elsewhere within this report. DS0000018692.V368906.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 Quality in this outcome area is adequate The home is comfortable, clean and tidy. Improvements have taken place regarding infection control in order to protect people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Willows has two lounges, one primarily used for receiving visitors or as a quite lounge. Both lounge areas are pleasantly furnished although the arms on many of the easy chairs are worn or stained. A separate dining room is provided which is equally pleasant. Additional seating is provided in the entrance hall. The seating in the hall continues to be a popular area for people using the service to relax and watch the comings and goings in the home. The décor in communal areas is in good order. DS0000018692.V368906.R01.S.doc Version 5.2 Page 20 The carpet in the hallway and ground floor communal areas is showing signs of wear and tear and is stained in places. Redecoration was taking place in one currently empty bedroom. We were told that two bedrooms have had a new carpet fitted. Low energy bulbs are used throughout the home. The lighting in the communal lounges and dining room was sufficient however a corridor area near to a small number of steps is not well lit. Bedroom doors are lockable. Some bedrooms do not have lockable facilities such as a draw where people can keep personal items secure. The registered manager stated on the AQAA that over the next 12 months lockable units will be put in place in all rooms where one is wanted. All bedrooms are single and offer en-suite facilities. People using the service consulted stated that they were satisfied with their bedrooms. It was evident that individuals are able to personalise their own rooms. Individual toiletries were seen to be within the en-suite areas viewed. Communal toilets are appropriately located within the home. These are in sufficient numbers and are easily accessible. We have also previously reported on very hot water being delivered to handbasins in bedrooms, which potentially could cause scalding. As part of this visit we saw a written notice in one bedroom (currently not in use) saying ‘Not suitable for residents scalding water. May be hot water.’ The hot water in this room was very hot. The registered manager believed that the water to this room was turned off and said that she would bring it to the attention of the owner. Radiators throughout the home were covered in order to prevent accidental scalding. Food hygiene practice was based on the guidance document entitled ‘Safer Food – Better Business’ as recommended by Worcester City Council Environmental Health (EHO). Antibacterial hand wash was seen in communal bathrooms and toilets as well as the staff toilet. Bars of soap were also seen within these areas, these can present a risk of cross infection. The deputy manager has introduced a system whereby staff record when toilets are cleaned. The laundry is located in the cellar; the washing machine does not have a sluice facility. Wash hand facilities in this area remain insufficient to be in line with infection control procedures. Staff are provided with antibacterial hand gel as an infection control measure. We also saw ample supplies of disposable gloves and aprons around the home. We are aware of a recent outbreak of an DS0000018692.V368906.R01.S.doc Version 5.2 Page 21 infection within the home. We were informed of this outbreak and the home took reasonable steps to prevent it spreading further. This outbreak did however follow a previous concern which was looked at under safeguarding procedures when a lack of training was highlighted. The majority of staff members have recently attended infection control training. During our time within The Willows no offensive odours were noted and areas seen were clean and tidy. A patio area can be reached via both the dining room and the main lounge. The slabs are in need of attention as they move under foot and could therefore present a potential hazard. The deputy manager has recently had them ‘jet cleaned’ to enhance the appearance of the garden. The lawn and other parts of the garden are well maintained. DS0000018692.V368906.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is poor People’s needs are generally met by the staff but there are risks to people’s health and safety. This is because not all the care staff are adequately trained for the work they do and, sometimes, staff have to do catering and domestic work instead of their care work. Recruitment procedures are in place but are not always sufficiently robust to ensure people are safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People using the service said that staff are friendly and kind. At the start of this inspection, we viewed a number of weekly rotas. During the daytime, two carers were on duty in addition to the registered manager. The deputy manager stated that she did not undertake any hands-on care work. This is of concern as it is the deputy manager who now sleeps-in and therefore needs to be able to assist the sole carer on duty at night if necessary. We were informed that no domestic staff are currently employed therefore care staff undertook these duties. We saw care staff hanging out washing and DS0000018692.V368906.R01.S.doc Version 5.2 Page 23 cleaning toilets, therefore taking them away from direct care provision during these times. As no staff were employed in the kitchen in the afternoon, carers also had to prepare the afternoon tea. Although staff were able to change plastic aprons, this practice does bring about cross infection concerns. Furthermore, the deployment of these staff in the kitchen again takes carers away from caring duties. We have previously had serious concerns regarding recruitment procedures at The Willows. Following the previous key inspection, we issued a Statutory Requirement Notice. We carried out a random inspection to check on the progress and found sufficient improvement to prevent us taking further legal action. During a later random visit we found evidence that systems were continuing to improve, although one shortfall was found. As part of this inspection we spent a considerable amount of time reviewing and assessing the documents held in relation to new employees. The records held were, in general, disorganised and gave us some renewed concerns. We found evidence that one member of staff had commenced work recently with only one verbal reference in place. Other files contained references from different people to those named on the application form and from employment not mentioned on the application form. We found evidence that the most recent employer in one case was not contacted for a reference. Character references had been written by the provider and others employed at The Willows and these were not always signed or dated. We were unable to evidence that a CRB (Criminal Records Bureau) disclosure was obtained regarding one newly appointed member of staff and no POVA first (Protection of Vulnerable Adults) check could be found. As a result of these concerns an immediate requirement was issued. The deputy manager sent us a copy of this CRB within 24 hours. On a later visit the original CRB was available and seen to be in order. Other new employees did have a CRB in place. There was however no evidence that a CRB disclosure was obtained regarding one long standing member of staff. We saw a total of 10 CRB disclosures that were over 3 years old and we recommended that, in line with good practice, new CRB disclosures were obtained in relation to these people. During this inspection we found evidence that suitable risk assessments were not carried out automatically in the event of anybody having received a conviction. As a result of our concerns about unsafe recruitment practices which could potentially place people using the service at risk we have issued a further Statutory Requirement Notice regarding recruitment and induction procedures DS0000018692.V368906.R01.S.doc Version 5.2 Page 24 The registered manager was unaware that one new employee was under 18 years old. The employment of people under 18 year olds is now permitted providing they either have or are undertaking the Apprenticeship in Health and Social Care, but this was not the case. The Willows is not carrying out staff induction in line with Skills for Care. A record regarding one new member of staff indicated that a briefing on fire safety had taken place but nothing else. We have previously highlighted concerns regarding a lack of staff training provided for staff members. Following our last key inspection training was put into place for staff. Due to having to maintain the service, annual leave and sickness it was accepted that not all staff could attend the sessions provided. We have previously requested ‘a detailed schedule of when staff who have not received training in moving and handling, safeguarding, basic food hygiene, fire safety and infection control’ would do so. We did not receive this schedule. No further training in these areas has taken place or been arranged. One member of staff who was preparing sandwiches confirmed that she did not hold a basic food hygiene certificate. The lack of training, for some members of staff, in these key areas is of concern and potentially places both people using the service and employees at risk of injury or harm. We saw evidence and were informed that medication training is booked to take place during July and First Aid during August. The deputy manager told us of other planned training including food hygiene and moving and handling. Training on safeguarding needs to be arranged. Fire marshall training is needed for people who take this responsibility in the home. At the time of this visit 6 out of 12 carers or 50 have achieved either a level 2 or a level 3 NVQ (National Vocational Qualification). We were informed by a number of people that it is intended to register all carers, who have not already achieved a level 3, at the end of July 2008. DS0000018692.V368906.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38 Quality in this outcome area is poor The home is managed in a way that values and respects the people living there but not always in a way that assures their health and safety. The registered persons have a lot of work to do to ensure that the home is run reliably and consistently in order to provide good outcomes for people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager informed us that she is awaiting final verification to determine whether she has successfully completed the Registered Managers Award (RMA). The RMA is a National Vocational Qualification (NVQ) level 4 in management and is in addition to the NVQ level 4 in care qualification which DS0000018692.V368906.R01.S.doc Version 5.2 Page 26 the manager already holds. The registered manager attends the in house training alongside carers and other staff. On the day this inspection started the registered manager was not on duty within the home as she was attending a training day about staff appraisals and company law. During our concluding visits to the home the registered manager was not available and the deputy manager and one of the proprietors were taking greater responsibility for running the home. Prior to the inspection we requested the completion of the AQAA (Annual Quality Assurance Assessment). This document was returned to us within the timescale given. However, it was brief and gave us little information about the home. There was a lack of understanding regarding the purpose of the AQAA. It failed to give us evidence of where the home believes it is doing well and gave us no information regarding the views of people using the service or equality and diversity matters. We had previously been told within an improvement plan that a Quality Assurance system would be in place by 31st August 2007. Despite this, the home still did not have a formal system to enable it to monitor the quality of the service provided. No annual development plan is in place to systematically plan improvements within the home. No business or financial plans exist. We were informed that it is envisaged that a questionnaires will be distributed during a forthcoming barbecue to which family and friends of people using the service are invited. We have issued a Statutory Requirement Notice in relation to the continual failure to have a suitable Quality Assurance document in place. Under Regulation 26 of the Care Homes Regulations 2001, a provider, when not in day to day charge of the home, must visit on a monthly basis and prepare a written report. The most recent report on The Willows was dated April 2008 and did not meet the expectation of the National Minimum Standard in relation to its content. This inspection has highlighted many management issues that the provider should have been addressing during these monthly visits and in subsequent reports to the manager. We have, therefore, issued a Statutory Requirement Notice in relation to the failure to provide adequate Regulation 26 reports. The Willows does not hold any money in safe keeping on behalf of people using the service. A certificate showing details of the home’s public liability insurance was displayed within the office. The home’s certificate of registration was displayed in the hallway. We have previously reported upon a lack of progress in introducing a formal system of supervision for carers. The registered manager told us that it remains the case that a system needs to be put into place. Carers confirmed that they do not receive supervision. DS0000018692.V368906.R01.S.doc Version 5.2 Page 27 The registered manager is aware that we need to be informed of certain events in the care home that affect the well being of people using the service. We have received a number of notifications since the last key inspection. It did however become apparent that we were not informed regarding a recent safeguarding issue or of developments in relation to this incident. As indicated elsewhere in this report, some records are not sufficiently up to date to ensure the effective and efficient running of the home. Many management systems are weak and lack organisation. We requested documents throughout the inspection, many of which could not be located without having to be searched for. The registered manager hopes that with the introduction of a deputy manager the situation will improve. The lack of progress following an initial effort to ensure staff receive necessary training is disappointing and potentially places both people using the service and staff members at risk of injury or harm. We have previously made requirements in relation to having safe systems in place to ensure that lifting equipment is safe. Although immediate action has always taken place to remedy the situation we found the same shortfall as part of this inspection. The home could not demonstrate any system for the effective safe management of either the bath hoists or the stair lift. We saw people using the stair lift and both staff and people using the service confirmed that the bath hoists are regularly used. We issued an immediate requirement stating that systems need to be improved to protect against potential risk of injury or accident if equipment is not safe to be used. The deputy manager took immediate action and arranged for a service contract to be set up. Furthermore, the deputy manager intends to introduce a system whereby staff will have to undertake a visual check of equipment prior to using it. We briefly viewed the fire records which seemed to be in order. The fire risk assessment was dated February 2008. It was complete with the exception of a couple of questions which remained unanswered. We were informed that work was continuing to have in place an emergency plan for the home. DS0000018692.V368906.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 X 2 DS0000018692.V368906.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 14 (1) Requirement Assess the care needs of people prior to admission into the home to ensure that needs can be met. 1. Ensure that all care plans describe how the service users needs in respect of health and welfare are to be met. 2. That care plans are kept under review to ensure that staff are provided with up to date guidance about how to meet service users needs at all times and a system put in place to ensure that this is done as needed. The above requirement is similar to a number of previously unmet requirements. Statutory Requirement Notice issued. Carry out comprehensive risk assessments for any activities that service users participate in DS0000018692.V368906.R01.S.doc Timescale for action 30/09/08 2 OP7 15 (1) 30/09/08 3 OP8 13 (4) (c) 21/09/08 Version 5.2 Page 30 that may affect their health and safety. As far as practically possible, put measures in place to minimise the identified risks. This requirement replaces a similar requirement which was not met. Statutory Requirement Notice issued. Provide a safe system for 30/09/08 administering and recording of medication in order to safeguard people using the service. Make arrangements, through 30/09/08 staff training and robust procedures, to safeguard people using the service against potential abuse or neglect. 4 OP9 13 (2) 5 OP18 13 (6) 6 OP25 7 OP29 Previous timescales for arranging training for staff including 31/01/08 not met. 13 (4) (c ) Carry out a risk assessment in 30/09/08 relation to hot water supplied to wash hand basins. This is to identify and as far as possible eliminate any unnecessary risks to the safety of people using the service. 19 (1) 1) Ensure that people do not 21/09/08 work in the care home until two written satisfactory references have been obtained. 2) That POVA first checks are carried out prior to commencement of employment and CRB’s are obtained 3) Staff employed who are awaiting their CRB must be risk assessed and a programme of supervised practice must be developed. 4) That staff who have a DS0000018692.V368906.R01.S.doc Version 5.2 Page 31 criminal conviction must be risk assessed and monitored 5) Staff with no experience of working in the care sector must be supervised at all times until they have completed a suitable induction programme and are determined to be safe to practice. This requirement replaces a previous Statutory Requirement Notice which was not complied with. A further Statutory Requirement Notice issued. Ensure that monthly unannounced visits to the home are carried out in accordance with Regulation 26, a report is compiled and supplied to the manager and is available for inspection. The opinions of the service users and their representatives are obtained about the standards of care provided in the home and included in the report. 8 OP33 26 30/09/08 9 OP33 24 1 (a) (b) 3 Statutory Requirement Notice issued. Establish and maintain a system 04/10/08 for reviewing and improving at appropriate intervals the quality of care provided. Incorporate within the quality assurance system a means of consultation with service users and their representatives. Statutory Requirement Notice issued. Maintain equipment used within 30/09/08 the home in a safe condition. 10 OP38 23(2)(c) DS0000018692.V368906.R01.S.doc Version 5.2 Page 32 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 OP1 Good Practice Recommendations A copy of the service user’s guide which needs to cover all necessary areas should be readily available within the home. Records should indicate when a copy of this document is supplied to residents and or their representatives. A full review of the menu should take place to ensure that people have a varied diet and are provided with a choice. The use of powered milk should be reviewed. New CRB’s should be obtained for people who last had a check carried out over 3 years ago. A review of staffing deployment taking into account infection control should take place. A review of staff training needs should be carried out and an action plan devised regarding shortfalls identified. A system should be in place to ensure that staff supervision is carried out in line with the National Minimum Standards. 2 3 4 5 6 OP15 OP19 OP27 OP30 OP36 DS0000018692.V368906.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000018692.V368906.R01.S.doc Version 5.2 Page 34 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!