Inspection on 25/03/09 for The Willows

This inspection was carried out on 25th March 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Willows 21/09/09

The Willows 24/07/08

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 19/06/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE The Willows 2 Tower Road Barbourne Worcester Worcestershire WR3 7AF Lead Inspector Denise Reynolds Unannounced Inspection 25th March 2009 07:30 DS0000018692.V374585.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. DS0000018692.V374585.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address DS0000018692.V374585.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Willows 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.V374585.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. 24th July 2008 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.V374585.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 telling the home we were going. A key inspection is one in which we look at aspects of the service that are important to people using it and check the quality of the care provided. This was the second key inspection of the home during 2008/09; this was because the home was rated as 0 stars following the first inspection in July 2008. In the period between July 2008 and this inspection we issued statutory requirement notices about care planning, medication, recruitment practice, reviewing the quality of care at the home, informing us of incidents and accidents, health and safety and reports on the conduct of the service by the owner. The owners actions towards complying with these were monitored in a series of six further focussed inspections. We call these random inspections. Two inspectors did this inspection over the course of a day. Our inspectors arrived early so they would meet the night staff before they went off duty and stayed until after tea had been served. In our planning for the inspection we reviewed all of the information we have gathered since the last key inspection. This included the outcomes of the six random inspections since July. During the inspection, we met and spoke with a number of people who live in the home, some privately in their rooms and others in a small group in the dining room. We had discussion with the new acting manager, and with one of the owners of the home. During the day we observed the daily life of the home and how staff assist people living there. We made observations about things we saw around the building and looked at various records. These included care records, staff files and documentation to do with the running and upkeep of the building and equipment. What the service does well: We found similar positive things at the home as when we did the inspection in July. Staff were seen being polite and caring to people who live in the home and people we spoke to were positive about living there. One person said that staff are kindness itself and that she has always felt safe and well looked after at the home. DS0000018692.V374585.R01.S.doc Version 5.2 Page 6 When we spoke to care staff about some of the people living in the home they were able to tell us a lot of information about the care they need. Most rooms we saw including the sitting and dining rooms and some bedrooms were clean and tidy and the house felt fresh and welcoming. What has improved since the last inspection? What they could do better: Some improvements are still needed in the way that care is organised, recorded and monitored. For example we found instances of people who are at nutritional risk not having their weight or dietary intake supervised and monitored carefully enough. We also found that in some cases the care records did not include information about specific issues, for example one person has a DS0000018692.V374585.R01.S.doc Version 5.2 Page 7 lot of arthritic pain but this was not covered in her care plan to give staff guidance. The home also needs to make sure health issues are reliably followed up as we found an example of an intended return GP visit that did not happen and had not been chased up by staff. Whilst we found examples of a caring approach to people living in the home we also noted some use of negative and critical language in care records which showed a lack of understanding of a person centred and respectful approach to care. The acting manager had already picked this up and begun to deal with it. The office and the area of the home where medication is stored were untidy and cluttered. Both areas are quite small and need to be better organised and tidier to provide effective working environments. Some of the essential records required by regulation as a way of helping to keep people safe need to be improved. This includes those relating to staff, residents fees and spending money, and health and safety practices. The home needs to make sure there are the necessary written policies and procedures available, as some we wanted to look at, such as a safeguarding, and staff recruitment procedure were not in place. The use of an external company to do a health and safety audit was a positive step but the report on this audit had not yet been acted on by the owner even though some urgent things were highlighted in it. This is an example of a more planned and efficient approach to the running of the home being needed. The appointment of a new acting manager should improve the prospects for these improvements being made. This will be largely dependent on her being adequately supported by the owner and having a clear job description. There also need to be clear lines of accountability and budgetary control in place. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. DS0000018692.V374585.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.V374585.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may move into the home will have their care needs checked first but this process may focus too much on problems and could make them feel that their views have not been taken into account enough. EVIDENCE: We wanted to check how arrangements are made for new people to move into the home and how they decide if they are able to meet a persons care needs. The acting manager told us that no one new has moved in since our last key inspection so we did not have the opportunity to look at this thoroughly. However, the acting manager had recently been to meet someone who may move in depending on a decision about funding for their care. She showed us information she had gathered when she went to find out about the level of DS0000018692.V374585.R01.S.doc Version 5.2 Page 10 care this person would need at the home. This contained adequate details to then develop a written plan to guide staff if the person does move in. There was no care information from a social work assessment but the acting manager said she knows about asking for this information. We advised that this should be requested before a decision about the person moving in is made. This is because the home will not have complete information about the persons care needs without it. Some of the information gathered by the acting manager had been filled in on a pre-printed form for the purpose. There were some shortcomings with this form which need to be dealt with. It does cover key areas of care but the emphasis is on problems and difficulties (especially about how people behave) and does not give scope to check what abilities, goals and aspirations a person may have. The form contains lots of questions to ask a prospective resident or relative. These questions focus on negative things and give an overall impression of people needing a service being seen primarily in terms of how difficult they will be. The form gives little sense of people being valued and respected as individuals or that the home is seeking to find out what the individual wants the home to provide them with. The form also contains a number of spelling errors and one word assaultiveness - that does not exist but is an example of people being viewed as problems. In some files we looked at, blank copies of this assessment form have been filed for people who have been at the home a long time. This is of little value to the information held about the person. In cases where there is no recent assessment of a persons care needs an up to date assessment needs to be done and the date of this clearly shown. DS0000018692.V374585.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are cared for by staff who generally work hard to provide the right care. At present the systems for making sure people can rely on their care needs always being met are not effective enough and need to be improved. EVIDENCE: There were 10 people living in the home on the day we did our inspection. We checked how staff at the home provide care by speaking to people who live at the home and to staff and we also looked at care records. In this section we describe some positive aspects of the care but also a number of areas where the records do not give a strong enough foundation to DS0000018692.V374585.R01.S.doc Version 5.2 Page 12 support staff and management in monitoring that the correct care is always given. In discussions the new acting manager showed a good understanding of the changes that are needed and we did see signs that she has already begun to do this. We learned that the care records are kept in the office and that staff know about them but do not necessarily read them regularly. It appeared that staff mainly looked at the information for people they are key worker for. For example, one carer we spoke to could not tell us about the contents of a persons care plan because she was not the key worker and said she was not familiar with the contents. However, the staff we spoke with were generally able to describe what care people need and told us that things are discussed at handover discussions at shift changes. The staff we interviewed came across as interested in their work and eager to learn how to do things better for the benefit of the people living in the home. In the care files we saw evidence that staff have considered if there are any risks associated with the care needs of people in the home. Some of this information was clear and informative but we also noted some details that need to be looked at and improved. Many of the risk assessments we saw had been done by a carer who has limited care experience and had only worked at the home for seven months. Staff involved in risk assessments need to have had appropriate training so that they have the necessary knowledge and skill for this role. We were concerned about the regular use of negative of language by some staff in the records eg Refusing to wash, shower or take a bath. She gets very aggressive when asked and point blank refuses to have one. Attempts are made at every opportunity by staff but she still refuses and is starting to smell. This indicates a lack of respect for the person concerned so we were pleased to see that the acting manager has begun to make changes in the care records to amend this type of entry, for example, she had amended Tendency to put up and shut up to does not like to ask for anything This care record went on to say that the issue would be discussed with the persons GP but we found no information to confirm that this had happened. We saw examples in the care records of plans to re-assess certain aspects of peoples care but often found it hard to find confirmation that this had then been followed up. This indicates that the home needs a system to help them monitor that reviews are being done and whether things have been followed up. DS0000018692.V374585.R01.S.doc Version 5.2 Page 13 Some older documentation is still filed with new information; this could result in staff taking their lead from the wrong instructions and could result in people not getting the correct care. The files need to be checked and out of date details either marked clearly to show this or archived. Risk assessment records seen included a form for recording risks of Slips trips and falls. This was an off the shelf format aimed mainly at identifying and dealing with hazards in the environment rather than about factors related to the person. There also need to be individualised assessments for any person whose care needs mean that are likely to be at risk of falling. There was some inconsistency in the use of body maps to record injuries following falls and we found an example of a body map not being updated. It is important to keep body maps up to date in the same way as other records so they provide reliable information. The written plans to guide staff in the day to day care needed by people generally gave a good overview of the person and the level of attention they need from staff. We did note some examples of contradictory and unclear information and this could lead to staff not using the right approach or not giving the correct care. But some needed more guidance about specific aspects of care unique to particular people. For example, we learned that one person has a lot of pain but there was no written information to say how staff should take this into account when providing care. More broadly, the care records need to provide more information about a persons background, individual circumstances, views and preferences. This will contribute to staff having a good understanding of how to give someone the best possible care. The records showed us that staff are contacting health professionals like GPs and District Nurses when they notice a health problem. Staff said that GP and other appointments are put into the diary so that they are not missed but we found an example of a proposed follow up visit by a GP not happening but the home had not taken any action to chase this. Some of the records about health professionals visits were confusing due to duplication of forms with similar purposes in some files. Some people living at the home have problems maintaining their weight and need special attention with their nutrition because of this. We were concerned by the record of weights for one of these people because the figures recorded were so clearly wrong. They showed the persons weight fluctuating by as much as a stone from one week to another since the end of January. This should have been identified and acted on quickly. There was no indication in the records to show that the reason for the fluctuation had been identified or what has been done about it. On the day of the inspection no one was able to confirm what the persons correct weight was. During the day we were told that the problem was due to human error with a carer using the scales on carpets instead of on a firm floor. We also learned DS0000018692.V374585.R01.S.doc Version 5.2 Page 14 that several people have problems standing on the homes scales which were ordinary bathroom scales. We advised the owner that the home needs to have reliable means for monitoring peoples weights and that if people are unable to stand to be weighed, they need to provide sit on scales or explore other means of monitoring peoples body mass index. We were also concerned that the same person had no risk assessment regarding weight loss, no nutritional assessment and that there was no evidence that the weight loss had been discussed with the persons GP. During the day staff told us that the person eats well but the poor records provided no guidance for them or kitchen staff and no records were being kept to be able to reliably monitor what the person was eating and drinking. We spoke to the cook on duty briefly about how he serves food for people who need a soft diet. He described mixing all the items together into one. We explained that this is poor practice and that each item should be separately served on the plate so that the individual taste and texture of each food is preserved. This is to help people continue to enjoy their meals which in turn improves their overall nutrition. People we spoke to during the day were positive about the care they receive and spoke highly of the staff and owner. One person said staff are kindness itself and that nothing is too much trouble. DS0000018692.V374585.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Willows could be more involved in decisions about all aspects of daily life in the home including how they might prefer to spend their days, activities and food. EVIDENCE: We arrived at the start of the day before most people were up and about. We saw a carer going to peoples rooms with their breakfast trays and knocking on doors before going into their rooms. We heard her speaking to people in a friendly, pleasant tone. One person was up and dressed and we noted that the carer prompted her kindly to go back to her room as initially she was not fully dressed. This person then sat in the lounge and was brought breakfast to eat in her chair there. DS0000018692.V374585.R01.S.doc Version 5.2 Page 16 The care records we looked at contained almost no information about how people might like to spend their time or how staff at the home would assist them with this. For example, we met one person who had a lifelong love of a particular pastime and liked to watch television programmes about the subject; this was not mentioned in her care plan. This person was well able to make her own plans for this but other people may need more practical help from staff. It is therefore important for staff to have the information available to refer to. Similarly the care records limited give guidance to staff about supporting individual residents to take an active part in the life of the home and the wiser community. During the morning several people dozed in the lounge but at other times were awake and alert. We spoke to several people, both in private and in a small group. People said they like it at the home but had some mixed views about daily life as the following comments show Im happy, nothing much happens Its fine here, you couldnt get much better Nothing much happens I read there are books available I cant complain The home organises weekly activities and information about these was displayed on board. They included exercise, dominoes, Weakest Link games, scrabble, charades and cards. The information said that 10.30 and 3.30 are the activities times but the stated activity for the day we were at the home (a tea dance) did not happen. The information was in small print which may be a problem for people with poor eyesight. Staff we spoke to said that it can be hard to organise activities for people who have dementia and confusion. Staff had suggested they would benefit from training in this area. Staff had also identified that for many people, one to one time spent with staff was more enjoyable but that there is limited time available to be able to provide this. This view was echoed by a resident we spoke to who said they had enjoyed speaking to the inspector; she said the staff do try and sit with her briefly but that she does get lonely at times. In addition to things people living in the home said to us we also saw some thank you cards dated December 2008. These contained positive comments such as Thank you for all the care and attention you gave my aunt Thank you for all your loving kindness The residents and individuals and are part of the family There is a cook working each day from 9am until 2pm. This means that breakfast and tea are prepared by the care staff. We have some concerns DS0000018692.V374585.R01.S.doc Version 5.2 Page 17 about this because it has an impact on staff time for their main role in providing personal care. It also has implications for health and safety and food hygiene in the kitchen. The main meal on the day we inspected was lamb casserole which smelled appetising. There is a 4 week menu cycle and daily menus are displayed on a board outside the lounge; this was also in very small type. People we spoke to said that the food is good and they enjoy their meals. DS0000018692.V374585.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home know they can tell the owner if they are not satisfied with their care and staff are aware of how to recognise abuse. However, the home does not have strong procedures to make sure protection arrangements are dealt with correctly and people using the service cannot be confident that staff are recruited a way that keeps them safe. EVIDENCE: We have not received any complaints about the service in the period since our last inspection and the acting manager told us they have not had any made direct to them. The home has a complaints procedure but staff did not know where they could obtain a copy of a complaints form to give to anyone wanting to raise a concern. People who use the service told us they would tell the owner if there was something they are not happy about at the home. The acting manager confirmed that staff have had or will soon be having training about safeguarding (adult protection). Staff we spoke to were able to describe different forms of abuse and understood that abuse can be subtle and not always something really obvious. One person gave serving cold food and DS0000018692.V374585.R01.S.doc Version 5.2 Page 19 staff not washing their hands as examples of these more subtle types of abuse; this indicated a good level of understanding of the subject. Staff we spoke to could tell us the right action to take if they suspected abuse or neglect was occurring. However, not all staff knew where the safeguarding procedure is kept or where to find phone numbers to report concerns. The acting manager did not know about the named contact people in Worcestershire council who are the lead officers for safeguarding matters in the County and provide training based on local procedures. When we spoke to the owner and acting manager they confirmed that they have a copy of government guidance about safeguarding arrangements for adults, but they have not got an in house operational policy and procedure or a copy of the Worcestershire multi agency procedures. Privacy and confidentiality were not being given sufficient attention. In particular we found named records relating to people living in the home in a pile of miscellaneous paperwork. This was in an area fully accessible to people living in the home and to visitors. We saw other confidential information left out on the desk and selves in the unlocked office. We handed the named documents and care related information found in this pile to the acting manager to be dealt with and safely stored. We have raised concerns previously that the home has not informed us about certain incidents (such as serious injuries or illness), as the law requires. We saw in staff meeting minutes that staff have been told about this at a recent staff meeting, however, not all the staff we spoke to knew about this. The content of the minutes was not detailed enough to give people who werent there clear guidance. DS0000018692.V374585.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service live in a comfortable house however they cannot be confident that their home is maintained or managed in a safe way that safeguards them from some preventable risks. EVIDENCE: The house is comfortable with a large lounge, dining room and garden with patio access. Some people have personalised their rooms and some rooms have photographs of the person on their doors. However while the house is DS0000018692.V374585.R01.S.doc Version 5.2 Page 21 small we feel more could be done to help people find their way around and to create a more homely atmosphere. For example, the clock in the dining room had stopped, there is no signage to assist those with short-term memory loss or cognitive impairment, and the seating in the lounge is arranged so that the chairs are around the edge. This does not help people speak to and get to know each other. There is no alternative seating area to the lounge and some people prefer to sit on chairs in the hall where they can watch the comings and goings of the house. The last key inspection and subsequent random inspections identified some concerns about the maintenance and upkeep of the house, and health and safety practices. These included the quality of the furniture and carpets, and monitoring of water temperatures. The registered provider does not keep a schedule of maintenance or renewal to maintain the quality of the building or the furnishings. During our visit we noted that one bathroom did not have a toilet roll holder, another did not have a soap dispenser or paper towels, and another bathroom held large bottles of bath and shower products. As the bathrooms are being used communally, these present a risk of spread of infection and show poor hygiene practice. In an open cupboard we found two sharps boxes, one full and one half full, which were open so that a hand could fit inside. This presents a serious health and safety concern. In the same cupboard we noted a large number of unrelated items such as sun cream, an empty urine sample bottle, denture cleaner, and nail polish remover. In the same area with open access from the house, a large pile of papers contained personal information about people using the service, which had not been filed. This indicates poor housekeeping and little consideration for storage. We were unable to find evidence that bath and shower temperatures are being recorded on each occasion. In one bathroom the records only show 25 entries in three months, however personal care records show that people are having baths or showers more frequently than this. Staff said that water temperatures are not tested in one bathroom because the water doesnt get very hot. Testing of water temperatures before immersing a person in bath or shower water is essential to make sure the risk of scalding is minimised. Reliance should not be placed on thermostatic controls as the sole means of protection. DS0000018692.V374585.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service cannot be confident that staff are recruited or trained in a way that keeps them safe or meets their needs. EVIDENCE: There have been ongoing concerns regarding recruitment practices, staffing at night, the lack of domestic staff and quality of training for staff. At the last random inspection visit the service had complied with regulations relating to safe recruitment practices. However there were concerns relating to the quality of references and application forms, and the lack of policies and procedures for recruitment. Following this last visit, we received a letter from the acting manager telling us that recruitment files had been audited and that there would always be a waking female member of staff on duty at night. DS0000018692.V374585.R01.S.doc Version 5.2 Page 23 We arrived at the house while a female member of night staff was on duty. She confirmed that there is always a female waking night staff, and rotas for March and April support this. The rotas show that there are three male staff who sleep in, and staff confirm that they sleep in the flat upstairs. Staff told us that there are two members of staff on shift during the morning and the evening. During the time of our visit the house was not full and there was no one who needed two staff to support them. Staff said that when they are full or during busy times it is difficult for two staff to manage medications, laundry and personal care in the mornings. If someone falls, or is ill, staff find this difficult to manage. Staff said that this does not affect the quality of support for people however staff feel pressured, despite support from a domestic and a cook who also work during the day. Staff told us the afternoons are less pressured but there is still very little time for one to one work and activities. This was echoed in some of the things people who live in the home told us about time staff have to spend with them. We observed staff throughout the day. Staff were caring and attentive and people did not wait for assistance. However there was no evidence of any social activity and staff spent little time sitting with residents. Some comments from staff such as all right darling, all right sweetheart could be seen as patronising towards those people although people using the service did not raise this as a concern. At the time of our inspection no new staff had been recruited since we visited in January 2009. We saw from staff files that the new acting manager has audited them and followed up some outstanding background checks and references. However we still have concerns about the quality of information held about staff employed by the service. We found gaps in information provided on applications forms; no interview records; insufficient information for pending applications; insufficient information for when staff have started in their role; no proof of identity; no contracts or job descriptions. The acting manager confirms that the service does not have a recruitment policy and procedure which makes it very difficult to make sure staff are recruited safely. Staff told us that they have done recent training, for example positive communication, NVQ3, moving and handling, protection of vulnerable adults, medications, dementia, and infection control. Files of recently recruited staff show that some training has been done but not all their certificates were available. The staff notice board showed medication training is being planned. The acting manager told us that there is no training plan or matrix to identify what training has taken place and future training for staff. She said she has arranged a skills analysis for the staff which will lead to this being set up, as well as support for NVQ qualifications. DS0000018692.V374585.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be confident that their service is being managed well. Systems are unsuitable for protecting peoples finances and health and safety. Records are insufficient for monitoring the quality of the service. EVIDENCE: The registered manager of the service has been off work since the summer of 2008. The service provider has recently appointed an acting manager to assist DS0000018692.V374585.R01.S.doc Version 5.2 Page 25 him in running the service. Staff told us that they have noticed many improvements since the acting manager started, comments including, she is very professional, an asset, staff can speak to her about anything. Does everything properly, efficient, much nicer. We saw evidence from staff meeting minutes that the acting manager is sharing issues relevant to improvements with the staff. We discussed with the service provider and acting manager how responsibilities are being shared for the management of the service, as the provider is present at the service for three to four days per week. The provider says he deals with maintenance and the acting manager says she has focused on peoples care records and staff recruitment files, which we were able to see. The manager has also started regular supervision with the staff. However the provider was not able to clearly describe their individual responsibilities, and the acting manager informed us that she does not have a job description or a contract. We identified during our visit that significant policies and procedures necessary to manage the service, for example medication, complaints and protection, hygiene and control of infection, finances and recruitment, are not readily available. The acting manager told us I have not seen any up to date procedures. To address this, the registered provider and acting manager have engaged a consultancy firm to assist with developing health and safety practices, employment practices and policies and procedures. We saw letters from this consultancy firm indicating that work is due to start at the service. Although the acting manager told us that care plans and medications are being regularly checked, the service is not regularly monitoring the quality of the service. Questionnaires have been sent to people using the service but have not been collated. The service provider is carrying out monthly visits, records of which show that he is following up key issues and concerns. The manager said that she does not have an action plan for improvements and that the service would benefit from a more structured approach. The registered provider confirmed he is the appointee for one person using the service, which involves receipt of benefits and management of finances. Although a reference is made to this in the persons care file, there is no formal documentation relating to this or to the decision making process on the persons behalf. We also noted that documents relating to this persons benefits were visible on the office desk, which is freely accessible to everyone entering the home. Records regarding the receipt of fees paid, and money held or spent on behalf of people using the service are not kept. The registered provider says he has bank statements and receipts of purchases made, however these are not held appropriately, for example some receipts are kept in the providers personal wallet. DS0000018692.V374585.R01.S.doc Version 5.2 Page 26 Some improvements have been made to health and safety practices. We saw notes from a staff meeting to show that staff had been briefed about when to notify the Commission about events in the home. Staff confirmed they understand this process. Records confirmed that regular fire safety checks are being carried out and a risk assessment carried out. The safety checks in the kitchen are being carried out and the service received a good rating following a recent food hygiene inspection. However we also note some areas of concern. As described earlier in this report, the service is failing to carry out water temperature checks. Accidents are recorded but should be more detailed and record whether care plans have been updated. Accident forms were being left in the book - this means that people wanting to look at their records would have access to other peoples information. The forms need to be filed so that confidentiality is protected. The service has recently purchased a health and safety inspection carried out by an independent consultant. The report made recommendations to be carried within 14 days of the report, relating to training, hazardous substances, asbestos, fire safety, gas safety, and electrical safety. This time span had passed by the time of our inspection and the tasks had not been completed. The acting manager and registered provider were not clear who is responsible for taking action following the health and safety advice. DS0000018692.V374585.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 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 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 1 X X 1 DS0000018692.V374585.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 OP8 Regulation 12(1) Requirement You must make sure that people whose health is at risk because of at nutritional and/or weight loss concerns are identified and receive the care needed to reduce these risks. This includes having a system for monitoring weight and seeking specialist health care input where needed. Timescale for action 30/04/09 2 OP8 12(1) This is so that people living in the home have their nutritional needs dealt with correctly. If people in the home have 30/04/09 specific health care needs you must make sure that these are included in the written plans for their care, that staff are aware of what they are and that the correct care is provided and/or arranged. This is so that staff have the information they need to provide people with the correct care and people get the correct care. You must have a reliable system for following up health related care issues such as doctors appointments. DS0000018692.V374585.R01.S.doc 3 OP8 12(1) 30/04/09 Version 5.2 Page 29 This is so that people receive the health care input that they need. 4 OP18 13(6) You must make arrangements to 30/04/09 provide managers and staff with the right information to use if they need to take action in the event that they suspect there has been abuse or neglect of a person living in the home. These must reflect the arrangements in place under local multi agency safeguarding procedures. This is so that the abuse or neglect would be identified and the right action taken to deal with it. You must make arrangements to control the spread of infection, in accordance with relevant legislation and published professional guidance. This will help ensure that people using the service are not at risk from infections as a result of poor hygiene practices. You must set up and regularly review policies and procedures and have them readily available to management and staff. This will support the safer running of the service and promote the health and welfare of people who use it. Records required by regulation must be maintained, up to date accurate and available for inspection. This includes those relating to staff, payment of residents fees, personal spending money held by the owner, and health and safety practices. This is for the protection of DS0000018692.V374585.R01.S.doc Version 5.2 Page 30 5 OP26 OP38 13 (3) 30/04/09 6 OP33 12 (1) (a) (b) 31/05/09 7 OP35 OP37 17 (2) Schedule 4 31/05/09 8 OP38 13 people using the service and for the effective and efficient running of the business. You must make arrangements to ensure that safe working practices are understood and followed by all staff employed at the home. This is to promote the health, safety and welfare of people using the service. 31/05/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations You should obtain assessments done by commissioning staff as part of the process of gathering information to check you can meet the needs of people planning to move to the home. Your assessment form needs to be improved to remove typing and spelling errors but, more importantly, to make the approach to assessment more respectful of individuals and more person centred. You need to make sure that staff know the content of care plans for all the people who live in the home, not just the ones they are key worker for. You need to continue the work on improving the care plans so they contain enough information to inform and guide staff in the right care to give each person. You needs to make sure that staff understand that it is important to be respectful to people who live in the home and that negative language in care records is therefore unacceptable. 2 OP3 3 OP7 4 OP7 5 OP10 DS0000018692.V374585.R01.S.doc Version 5.2 Page 31 6 OP7 Care records that have been replaced by updated versions should be clearly marked to show this and filed separately from those in current use. This is to avoid the risk of confusion and the wrong information being followed by staff. Off the shelf care record forms should be tailored to the needs of the home and the people living there. You need to avoid duplicating records about specific issues (eg healthcare visits, lists of current medication) so that it is clear where staff should write this information and to make sure the correct information is referred to. Staff involved in doing risk assessments need to be sufficiently experienced and trained for this role so they have the right knowledge and skills to do this work. You need to do more to find out what peoples social and leisure interests and preferences are and use this information to provide activities that people will enjoy. Information about activities, meals etc provided for people living in the home should be available in larger print and, if needed in other formats. You should produce and keep records of a programme of routine maintenance and renewal of the fabric and decoration of the premises. This will help you in planning and carrying out ongoing improvements to the building. Consideration should be given to the housekeeping, storage and tidiness of all areas of the house. This will ensure that people using the service have a safe and comfortable home to live in. You should make improvements to the house to help people who have sensory or cognitive impairment to help them find their way around the house and be better orientated; for example you should make sure that all the clocks always show the correct time. You should continue to improve the staff files so that recruitment information is readily available, well organised and up to date and provide evidence that you are now following correct recruitment procedures. You should continue to develop the staff training and DS0000018692.V374585.R01.S.doc Version 5.2 Page 32 7 8 OP7 OP8 9 OP38 10 OP12 11 OP12 12 OP19 13 OP19 14 OP19 15 OP29 16 OP30 development programme and keep clear records of this to provide evidence of the training staff have done. 17 OP27 You should consider that when the number of people who use the service increases, or when their level of need increases, staffing levels may need to be addressed. This will ensure that everyone using the service has their personal and social needs met. You should make sure that the acting manager has a job description which enables her to take responsibility for fulfilling her duties. There should be clear lines of accountability and responsibility for management so that people using the service can be confident the service is meeting its stated aims and objectives. You should set up an action and development plan for the service, which involves seeking the views of people using the service, and others such as relatives and professionals so. This will help you monitor the quality of the service you are providing and to act of the views of people receiving it. 18 OP31 19 OP33 DS0000018692.V374585.R01.S.doc Version 5.2 Page 33 Care Quality Commission West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway, Birmingham B1 2DT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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