Inspection on 27/06/07 for The Willows

This inspection was carried out on 27th June 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Willows 19/06/08

The Willows 22/06/06

The Willows 13/09/05

The Willows 25/04/05

The Willows 19/10/04

The Willows 04/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Willows (The) 72 Boreham Road Warminster Wiltshire BA12 9JN Lead Inspector Sally Walker Unannounced Inspection 27th June 2007 09:05 Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Willows (The) Address 72 Boreham Road Warminster Wiltshire BA12 9JN 01985 215757 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) karen@exalon.net www.exalon.net Exalon Care Homes Ltd Cherry Whiting [proposed manager] Care Home 10 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (1) of places Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users who may be accommodated at any one time is 10 22nd June 2006 Date of last inspection Brief Description of the Service: The Willows is registered to provide care to up to ten people with a learning disability. It is owned by Exalon Care Homes Limited. The Willows is a large detached Victorian property with a large enclosed garden to the rear. Two sitting rooms, a dining room, kitchen, utility and office accommodation are on the ground floor, whilst the service users bedrooms are located on the first and second floors, together with shared bathrooms with toilets. Some of the accommodation is in a recently completed and registered extension. The home is situated a walk away from the centre of Warminster, with shops and amenities close by. As well as the home having its own car for the use of residents, there are very good public transport links to neighbouring towns and further a field. Weekly fees are in the range £1170.00 to £1390.00. Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 27th June 2007 between 9.05am and 5.40 pm and on 28th June 2007 between 9.55am and 2pm. Mrs Cherry Whiting, proposed manager was present during both days. Mr Dykes from Exalon Care Homes Limited was present at the end of the first day. The inspector spoke to four residents and 3 staff. A tour of the building was made including one resident showing their bedroom. The case files, daily reports, medication records, residents cash accounts, staff records and environmental risk assessments were inspected. As part of the inspection process the home was sent comment cards to distribute to residents, families, staff and healthcare professionals. Comments are to be found in the main body of the report. There was also a Random inspection on 16th November 2006. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: The home carries out thorough pre-admission assessments with all potential residents. Information is gained from the resident and all those involved in their care including families and healthcare professionals. Relevant documents have been or are to be produced in Widget, a pictorial format, for ease of reading. It was clear from discussions with residents and staff that those residents who were able, could make decisions about their daily lives. However this was not recorded in either their care plans or in the daily reports. The home provides a précis of residents care needs for agency staff. This was sometimes more informative than the care plans. The home has 2 vehicles that support residents to do different activities in the locality. Staff were very aware of all the local facilities and attractions for residents to visit. All residents have either a holiday or special daily visits as part of the fee. Residents have access to the internet although it was not evident that all residents had been supported to use it. Residents are consulted about the meals provided. Although snacks are provided at lunchtime, the main meal is taken in the evening. This is cooked from fresh ingredients by staff. Residents have access to a good service from healthcare professionals. Residents have their medication regularly reviewed. Care plans were detailed in the support and monitoring of epilepsy. Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 6 Systems were in place for residents, families and staff to comment or complain about the service. The responsible individual from the company talks to residents and staff at their unannounced visit so they can raise any issues. A robust recruitment process is in place for the protection of residents. No new staff start work without a negative POVAFirst confirmation. All new staff are inducted into their role although the records did not always show that the induction had been signed off. Staff have good access to NVQs and mandatory training. What has improved since the last inspection? What they could do better: The care files need to be rationalised so that only up to date information is readily available. Mrs Whiting had already identified this as an area for development. Care plans must contain information relevant to each resident’s care needs. They must show guidance and methods for monitoring how needs are to be met. Healthcare needs must be identified in care plans. This should include which healthcare professional is monitoring their care and who to call in an emergency. If staff develop strategies for supporting residents with any aspect of their care, they must form part of the guidance in the care plan so that all staff are working to a common agreed plan. Staff must discuss any goal planning firstly with the manager and care manager, as residents may be encouraged to seek unrealistic or false hope in unachievable goals. Staff must Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 7 record observations and conversations rather than their own projections in the daily report. Those residents who were described as non-verbal had little guidance in their care plans as to how they were encouraged to communicate or make choices. There was little evidence in their daily reports of staff communicating with them. There was no evidence that the computer, with internet connection, had been considered as a means of communication for these residents. Whilst most residents had a full activity programme, consideration had not been given to a timed, predictable daily programme, which often benefits people with Autism Spectrum Disorder. Staff must ensure that they put their food hygiene training into practice when preparing and providing meals to residents. Staff’s continued competence to administer medication after their initial assessment, must be regularly reviewed and recorded. Medical preparations with a limited shelf life should have the date they are opened recorded for monitoring purposes. If medication is prescribed to be taken only when required, the care plan must record the circumstance for when the medication is given. Staff must be provided with training that is relevant to the needs of current residents, for example, Autism, diabetes and mental health. 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. Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential residents and their families can see what the home intends to provide in the statement of purpose. The assessment process ensures that potential residents have all their care needs assessed before a placement is offered. EVIDENCE: The home’s statement of purpose and service users guide have been updated. These were available in widget format and there were plans to provide the documents in audiotape and DVD. The documents set out all the facilities and services offered by the home. A new format was being used to assess all potential residents needs. Thorough assessments are made with all potential residents before the home can decide whether their needs can be met. Potential residents and their families are encouraged to visit the home to meet the other residents and staff. Overnight stays are also encouraged as part of the admission process. One of the residents talked about their admission to the home and how well they had settled in. Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are put at risk by not having all their current care needs stated in their care plans. Guidance on how to meet residents’ needs is not always documented. Although residents are encouraged to make decisions this is not always recorded in their care plan or daily report. Most risks had been addressed in residents care plans. EVIDENCE: Each resident had a file that contained their care plan together with other information current and historical. Care plans were produced in Widget where necessary. On talking with one resident about their care plan, it was clear that some of the guidance information related to a previous placement and was not relevant to the residents, current needs as they had significantly progressed. The inspector observed strategies developed by a member of staff and a resident for support with some aspects of grooming. These were not identified in the care plan. The inspector discussed the outcome for the resident if these Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 11 strategies were not followed by other staff because they were not included in the care plan. More structured daily programmes advised at Safeguarding Adults meetings for those residents who had Autism Spectrum Disorder were not in place. Risk assessments formed part of the care planning process and included risks in the home and in accessing the locality. [See also Section 3]. A daily report was recorded in individual residents’ diaries. The reports did not necessarily show how staff were supporting residents with often complex care needs, communication needs or maintaining independence. Some of the reports stated “verbally aggressive”, “inappropriate behaviour” and “…came home with mixed emotions”. The inspector advised that staff should be recording what was observed or said rather than their own conclusions. Care plans had recently been reviewed. Mrs Whiting had introduced monthly keyworker reports. These were presented to the monthly team meetings to ensure all staff should be aware of changes. It was clear from discussions with residents and staff that residents were encouraged to make decisions about their daily lives. However this was not necessarily always evident in care plans or daily records. Some residents had communication needs and although there were statements about how they were non-verbal, there was no evidence in the daily reports that staff were communicating with residents in their preferred manner. Mrs Whiting said that the care planning files needed to be rationalised so that only up to date information was readily available. Historical information would be archived. The requirement that external professionals should agree residents care plans had been actioned. This requirement also stated that care plans had written strategies for addressing individually assessed behaviours that could cause distress to themselves or others were written in a consistent format. However the recommendation that care plan goals should include reduction of factors that give rise to behaviour, management strategies and individual risk assessments had not been actioned. Some of the guidance and structured daily planning advised at Safeguarding Adults meetings were not always evident in care plans. This related to reducing behaviours and working with people with Autism Spectrum Disorder and communication. Although the funding authority had given advice on care planning, communication and behaviour management, there was little evidence that staff were putting the advice into action. The recommendation that minutes of residents meetings should demonstrate that meetings started with a review of matters arising from the minutes of previous meetings had been actioned. Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 12 In a comment card one of the relatives said “We are extremely pleased with the care and support that [the resident] receives.” With regard to reviews another relative said “I am included as necessary”. Another relative said “The life [the resident] sometimes chooses is not practical or safe and I am happy and confident the Willows staff guide [them] appropriately.” One relative said “Personal hygiene is a challenge for [the resident] and this is not well managed. How they can address this is the skills and experience part”. Another relative said “Treats every service user with the same level of care. Respects and understands needs of service users. Promotes a ‘family’ feel at the house.” Another relative said “My family and I and especially [the resident] are very happy with the care [the resident] receives at The Willows. [The resident] is safe in a supportive environment and is confident and relaxed in the Willows.” Another relative said “I feel that the level of care is quite good and also you have to take into account the type of people the staff have to deal with.” Another relative said, “[The resident] has complex needs…this agency has assisted [them] to understand events and actions and to feel better about [themselves] – not an easy task. This has been accomplished in a sensitive manner. More importantly the agency has worked with me…There are some staff who have struggled with relating to [the resident] but I have been able to highlight incidents with [their] keyworker who has then addressed it or taken it to staff meetings. I feel that if a person is respected then good practice should follow. The majority of staff have shown this in their ability to actively listen and validate they have heard what is said, even when this requires some sort of challenge. Overall I am pleased with how the ‘home’ has accommodated [the resident] during a particularly difficult time with understanding and support.” As a matter of good practice there was a guidance file for agency workers. This gave a short resume of residents care needs. On occasion these were more informative than the care plans. Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Opportunities for personal development are limited to those residents who could choose. Other residents had to rely on staff for what they did during the day. Residents were supported to maintain personal, family and sexual relationships. Some residents were put at risk by some staff acting alone in discussing goals that may be unrealistic or provide false hope. These goals were not discussed with management or care managers. Residents have good access to local facilities. The home aims to provide a healthy diet. EVIDENCE: Some of the residents had a weekly programme of activities. One resident attended college on an independent living skills course. Another resident went to a day service. Two other residents go to an activity centre. One resident talked about the voluntary work they did in a nursing home. Residents talked about what they enjoyed doing: going to the Gateway Club, a theme park, Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 14 swimming, out for meals, bingo, the cinema, a nature trail and horse riding. Residents said their keyworkers would take them out. Other residents said they regularly went into town on their own. Residents’ interests and hobbies are discussed at the initial assessment. During the inspection staff were taking residents out in one of the vehicles. This was when staff had errands rather than any planned meaningful activity for individual residents, as they returned within a short time. One resident was reported to have a structured timetable, often benefiting people with Autism Spectrum Disorder. However when this resident came regularly to the office to check with staff about what was happening, staff pointed to their bedroom where the timetable was kept. The inspector advised that a copy should be kept in the office for staff reference to support this resident. Discussions were held with a member of staff about goal setting and providing different life experiences with residents. Although this member of staff was encouraging residents to make plans, the inspector advised them to consider whether they were being unrealistic or risking false hope for the residents. The inspector also advised that in any case all goal setting must first be discussed with the manager and in certain circumstances, the resident’s care manager. This had not taken place. Staff must have a more professional approach to goal planning. Residents were supported to maintain personal, family and sexual relationships. One of the sitting rooms had internet access for residents use. One of the residents was using this. There was no evidence that other residents had been supported to use the equipment. The home has two vehicles for residents to access the wider locality. Staff kept brochures for local venues and attractions on the notice board in the office. Residents have a yearly holiday as part of the fee. Residents choose where they want to go. This year some residents went to Ireland. Other residents went to Butlins. Other residents had chosen not to go away but to have day trips. Later in the year a cottage had been booked for a holiday. In comment cards residents were asked what they were looking forward to doing. Comments included: “Holiday to Ireland, Jethro Tull, Gateway Club, cinema more”, “Going to day centre”, “Ireland holiday, college, drive lessons, support living, having a paid job”, “Moving on, holiday” and “Holiday at Butlins, trips, walks”. One of the relatives said “Good at giving people outside interests i.e. holidays, fishing, cinema, pubs, entertainment venues. Also proper diets and a listening ear.” The home provides a 3 week menu, which takes into account residents preferences and a healthy diet. Mrs Whiting planned to provide a system so that non-verbal residents could choose different meals. Most of the lunches Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 15 were prepared by a member of staff; either sandwiches, beans on toast or “pot noodle”. However some residents did make their own sandwiches. It was noted that some sandwiches were being made from some cold meat that had been part of the menu 2 days previously. The inspector advised the member of staff that this practice did not comply with food hygiene guidance. The inspector asked whether “pot noodle” was considered part of a healthy diet. Staff explained that the resident did not always have this but it was a snack treat. This was confirmed by the daily record and the small stock of this product in the store cupboard. The daily records showed what each resident had eaten each day for monitoring of a healthy diet. The main meal was taken in the evening. Staff prepare a meal from fresh ingredients. Staff eat the main meal with residents in the dining room. They said that they talk about what residents have done during the day. Residents said they would have a different kind of takeaway meal each week. Takeaway menus were posted on the office notice board. One resident said the staff would pick up the meal. They also said they went out for pub meals. Residents said they could make drinks in the kitchen anytime they wanted. A resident went with a member of staff to do the weekly shopping. The kitchen had been relocated as part of the extension. It provided more space, new fridge and a dishwasher. Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have good access to healthcare professionals. Healthcare needs were being met but this was not always evident in care plans or daily reporting. None of the current residents managed their own medication. Systems were in place for staff to administer medication. EVIDENCE: Residents had good access to GPs and specialist healthcare professionals. Residents confirmed that they could access appointments at local surgeries with staff support as needed. The inspector advised that the arrangements for supporting any resident with managing diabetes must be recorded in their care plan. One care plan stated ‘a healthy diet’ but did not enlarge on what this meant. There was however a risk assessment stating that the resident monitored their own blood sugar levels. Although it could be assumed that the resident was well able to manage their own wellbeing, there was no guidance for supporting them to do this. There was also no guidance for monitoring or what staff should do in an emergency. There was no information as to whether the diabetic nurse was involved. A risk assessment identifying a Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 17 potential for behaviours putting the resident at personal risk for their safety and wellbeing was not identified in the care plan. However there was good information in one resident’s epilepsy profile for supporting them with seizures. Residents were regularly weighed. Food supplement drinks were available for some residents if needed. One resident said they were going for more walks as they had put on weight. Residents said they were called to the office to receive their medication. None of the current residents had been assessed as able to administer their own medication. Residents had signed an agreement to say that staff could administer their medication. This was also signed by their care manager. All staff give medication following training. The inspector advised that although staff were assessed as competent to administer medication, their continued competency should be regularly assessed and recorded. Only senior staff order and check medication as it is received into the home. Residents medication was regularly reviewed with either their GP or consultant psychologist. The inspector advised that topical creams, drops and sprays with a limited life once opened, should be marked with the date of opening for monitoring purposes. The requirement from the inspection of 22nd June 2006 the protocol for use of any medication prescribed to be taken only when required had not been actioned in full. The inspector advised that the care plan must state what prompts an administration. One file contained a letter dated 2 months previously, asking the GP for details of when a medication should be given. The GP did not respond. Further investigation showed that the lack of response had not been followed up with the GP. Times for medication administration were colour coded. Some handwritten entries of new or changed medication had not always been witnessed, signed or dated. Written confirmation had been received from one resident’s care manager and consultant psychologist for medication to be covertly administered with a banana to support swallowing difficulties. The recommendation that significant medications information, such as special procedures or for medication prescribed only when required was put with medication administration records had been actioned. The medication administration record file contained a list of prescribed medication and possible side effects. Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems were in place for residents, families and staff to make their views known about their experience of the service. The home works to the local Safeguarding Adults procedure for reporting allegations of abuse. EVIDENCE: The home has a complaints, suggestions and comment book by the front door. The procedure is published in the service users guide. The procedure has been produced in Widget format. It is proposed to produce an audio version of the procedure. The home works to the company’s whistle blowing policy. The complaints log showed how complaints were responded to, with evidence of investigation and outcome response to the complainant. In one comment card a resident stated, “Any problems I have, I will deal with it myself.” A relative said “[The home has dealt with complaints] to my satisfaction. It may not always be to [the resident’s] satisfaction though… I feel it is difficult at times when the service user has unrealistic expectations. However I have witnessed the staff discussing this in an attempt to help [the resident] understand when [their] wishes cannot be compiled with.” The requirement that notifications to the Commission and to care managers must be made by the most senior person on duty within 24 hours of the event had been actioned. However Mrs Whiting was advised that if for any reason minimum staffing levels are not achieved, the Commission must be informed. Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 19 The recommendation that incident reports should show when and to whom they have been copied had been actioned. The home works to the local Safeguarding Adults procedure. A copy of the booklet entitled “No Secrets in Swindon and Wiltshire” was available in the office. Staff were familiar with the reporting of allegations of abuse. During the monthly unannounced visits by the Responsible Individual from the company, residents and staff were asked to raise any concerns they had. The home kept small amounts of residents’ cash for safekeeping. Records and receipts were kept of all transactions. Only designated staff had access to the safekeeping arrangements. Staff were required to witness transactions on behalf of those residents who could not sign for themselves. However 2 signatures were not always recorded in the records. Team leaders made daily checks of the arrangements. The company’s general manager regularly audited the accounts. Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Over the past year the home has been extended and refurbished to provide a modern, comfortable and clean environment for residents. EVIDENCE: Significant efforts have been made to improve the environment for residents. The extension has provided 2 ensuite bedrooms and a larger modern kitchen. The requirement that all bedrooms must be furnished in line with the National Minimum Standard had been actioned by the Random inspection of 16th November 2006. The home has been redecorated and new furniture provided. New tables and chairs had been ordered for the dining room. One of the bathrooms was due to be refurbished. One of the residents showed the inspector their bedroom. The room was large and personalised. The requirement that action was taken to ensure all parts of the home are kept clean, with high risk areas cleaned to recognised infection control standards Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 21 had been actioned by the Random inspection of 16th November 2006. All staff had received training in infection control. The home was cleaned to a good standard. Mrs Whiting was in the process of setting up cleaning schedules. Residents said they were involved in some chores; laying the table for meals and clearing the tables. One of the staff was due to take up a combined post of cleaning and gardening. The company intended to upgrade the garden area with seating areas, patio and planting. One of the residents had been involved in the design. The requirement that locks fitted to toilet and bathroom doors must be of a design that allowed opening from outside the room had been actioned. One of the downstairs sitting rooms was identified as a smoking room for residents. Mrs Whiting intended to provide an industrial fan for the room which was also used as a pool and music room. Mrs Whiting was advised to view the guidance on the Department of Health website regarding care homes and the smoke free regulations which were due to come into force that week. The home has a newly fitted, designated laundry room. Residents were involved in doing their own laundry. Staff support was available if needed. The inspector advised that consideration should be given to secure storage for staff possessions whilst they are on duty. As part of the independent quality review, consideration was being given to closing off one of the doorways to the office. This would mean that residents using the main sitting room would not be disturbed by continual access to the office by this route. The office was still accessible from the other side. Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Mrs Whiting is aware of the need to develop the staff team in working for the benefit of residents. Although staff have good access to NVQs and mandatory training, other more specialised training related to the needs of current residents is lacking. A robust recruitment procedure is in place for the protection of residents. Staff will now benefit from a structure programme of supervision. EVIDENCE: There was a notice board by the front door with photographs of which staff were on duty that day. The home works to 1 shift leader and 3 care staff on duty on each shift. At night there is one waking and one sleeping night staff. The home employs 2 bank staff. There were 10 permanent staff. Three staff were awaiting employment on the receipt of a negative Criminal Records Bureau certificate. Mrs Whiting was recruiting to fill the last 2 vacancies. On the first day of the inspection there was a period of time when staffing levels were reduced to 2 care staff and the manager. Difficulties were Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 23 experienced in getting emergency cover for sickness and the relief staff was not able to start work until 10.00am. The inspector advised that the Commission needs to be informed if staffing levels fall below the minimum for any reason. Mrs Whiting said that she was considering the current staffing rota provided to residents. Currently the staff work long shifts from 10.00am to 10.00pm, including sleeping in. Staff’s engagement with residents was variable. There were 2 instances when staff said “later” to a resident when they wanted their attention. Another staff was sitting with a resident and did not speak to or communicate with them. However there were other examples of good engagement, for example, explaining what was about to happen, entering into conversation about music and discussing the resident’s activities. As noted above not all staff were working to common professionally agreed goals for residents. Currently staff work in 2 different groups lead by a team leader. This system may create divisions and lack of cohesiveness for residents. Mrs Whiting was very aware of this historical way of working and was looking at different solutions for more flexibility. A robust recruitment process was in place. Potential staff were required to fill out an application form providing information about employment history, qualifications and declaration of any cautions or criminal convictions. All of the documents and information required by regulation were on file. Where referees had not replied, this had been followed up with telephone calls and notes taken. Mrs Whiting reported that she intended to involve residents in interviews of potential staff. The inspector advised that the form used to track employment information and documents should note the date of receipt rather than a tick. No staff commenced duties without a negative POVA first confirmation whilst the Criminal Records Bureau certificate was applied for. All new staff met with the manager on their first day of induction. They were shadowed by a designated member of staff for their first week. Night staff also worked with someone until they completed their induction. New staff were required to sign up to the company’s policies. All staff had a contract of employment setting out their terms and conditions. It was noted that some induction reports had not been signed off even though these staff had commenced duties a while ago. Mrs Whiting showed the training plan which was being compiled. The company has appointed a training and development manager. The plan showed mandatory training. All staff had undertaken training as fire marshals. Some staff had undertaken training in Makaton. It was reported that staff were to undertake training in equality and diversity. One of the staff said they had NVQ Level 2 and that they would like to do Level 3. They said they had trained in challenging behaviour, crisis intervention, medication administration, first aid and moving and handling. They said they would also like to do courses on Autism Spectrum Disorder, Makaton and Attention Deficit Hyperactivity Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 24 Disorder. Training needs were discussed at supervision. Four staff had NVQ Level 2 or above and 4 staff were undertaking Level 2 or above. The inspector advised that the training programme must include training in areas relating to the needs of current residents, for example, Autism Spectrum Disorder, diabetes and mental health. As part of the inspection process, comment cards were sent to the home for staff to fill in. Comments for improvements included: “Lack of communication between support workers. Cleanliness of the home. Furnishings very old and tatty”, “More communication with staff. To agree more”, “Improved communication, staff to use the communication book much more to handover important information” and “A less reactive approach from staff. More detailed and comprehensive incident recording”. Comments on what staff thought the home did well included: “Plenty of choice for the service users if they choose to do them. Food and menus”, “Activities work really well. All service users have a choice in what they would like to do”, “I feel staff have good relationships with the service users” and “Medication handling.” Other comments from staff included: “I think more regular visits from CSCI for the purpose of communicating with care staff in a relaxed manner, allowing staff to vent issues and discuss possible problems with a neutral and trusted party.” All of these comments were anonymously collated and shown to Mrs Whiting. Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 and 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Although new to the post of manager, Mrs Whiting is well known to residents, their families and staff. She is clear about areas for development and is well supported by the company. The company has sought independent quality review and has taken any recommendations into an action plan. Record keeping did not always support many of the good practice elements of the care provided. Systems are in place for maintaining a safe environment for residents and safe working for staff. EVIDENCE: Mrs Whiting has worked at the home for 5 years as a senior team leader. She has managed the home since 1st May 2007. Her application to register as manager is awaited. Mrs Whiting said that she was being inducted into post by Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 26 the general manager of the company. She had also registered to undertake the Registered Managers Award and NVQ Level 4. As well as mandatory training provided by the company, Mrs Whiting had recently undertaken training in employment law and the Mental Capacity Act 2005. Mrs Whiting talked about her plans for the future. She was clear about how she intended to develop the staff team to ensure more cohesive working, delegated tasks of responsibility, improved record keeping and relevant training. Mrs Whiting talked about her own training. The company director reported on how Mrs Whiting was to be supported to achieving the Registered Managers Award whilst settling into her role as manager. He was also keen to support her in developing the home. More frequent quality assurance audits were planned. The company had used the services of an independent expert to audit its homes. An action plan was in place to address some of the recommendations together with an evaluation of the findings. Questionnaires had been given to residents and staff to comment on the service. Policies and procedures were available in the office. They were in the process of being reviewed. Consideration was given to producing policies and procedures in easy read format. Residents are reported to have the opportunity to attend monthly staff meetings. Issues from a residents meeting would be an agenda item for the staff meetings. Issues from all meetings would then inform the management meetings. Residents contributed agenda items for their meetings. Other items discussed at residents meetings included: complaints, activities, information about visitors due and family visits. Staff meetings had been booked for the coming year. Minutes were kept of all meetings. The recommendation that team leaders should be included in care reviews, strategy meetings and other situations where they could learn more of the wider context of placements in the home had been actioned by the Random inspection of 16th November 2006. Mrs Whiting had produced a guidelines file for senior staff for more continuity with some of the delegated responsibilities and to ensure that daily tasks and checks were achieved. The recommendation that daily records should provide a true reflection of the daily experience of residents had not been actioned. Much of the information in the daily reports did not relate to care plans, particularly in relation to communication needs and decision making. Some residents said that they would be involved in compiling the daily notes. This may be why staff are reluctant to report on all aspects of interventions. Mrs Whiting had set up a programme of staff supervision. She was also being regularly supervised. Supervision contracts were agreed with staff. Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 27 In a comment card sent to the Commission, one of the relatives said “It may prove helpful to have a monthly newsletter to update residents and family and friends of recent or proposed changes. This could also include articles or items the residents would find useful.” Another relative said “[The home could improve with] greater feedback.” One relative said “There may be scope for better communication with parent/carers which could be covered by a newsletter regarding what the current issues are for both staff and residents. This may also be helpful to residents.” There were generic risk assessments of the environment and use of equipment. Further local assessments have been completed which were pertinent to The Willows. Risks had been assessed both in the home and the locality. The assessments were regularly reviewed and revised as necessary. Risks assessments with residents could be found in individual residents’ files. Willows (The) DS0000028543.V339014.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 2 32 2 33 2 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 2 12 2 13 3 14 x 15 3 16 2 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 3 3 3 X 2 3 X Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 29 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13 (2) Requirement There must be a care plan in respect of any medication prescribed p.r.n., describing the protocol for use of the medication and signed if possible by the prescribing doctor. (In progress. Care plans must record triggers for an administration. If GPs have not responded to requests it must be followed up as to the reason). Timescale for action 27/06/07 2 YA6 15(1) 3 YA6 12(1)(a)&(b) 4 YA33 18(1)(a) & 37 The person registered must 30/09/07 ensure that care plans capture all the residents current care needs and record guidance on how those care needs are to be met and monitored. The person registered must 27/06/07 ensure that external professional advice is put into practice and records made of progress. The person registered must 27/06/07 ensure that the Commission is notified without delay if the minimum staffing levels are not achieved for any reason. Version 5.2 Page 30 Willows (The) DS0000028543.V339014.R01.S.doc 5 YA9 6 YA20 12(5)(a)&(b)& The person registered must 27/06/07 13(4)(b)&(c) ensure that residents are not put at risk by staff acting without professional and accountable advice in supporting residents to achieve their goals. 13(1)(b) & The person registered must 27/06/07 (2) ensure that any requests from GPs regarding specific information on residents medication is followed up if the GP does not reply. 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 2. Refer to Standard YA41 YA41 Good Practice Recommendations The person registered should consider rationalising the case notes files to ensure that only current information is readily available. Explore ways to ensure daily records provide a true reflection of the daily experience of service users. (Staff should avoid unclear statements such as ‘verbally aggressive’, ‘inappropriate behaviour’ and ‘came home with mixed emotions’.) Support plan goals should include reduction of factors that give rise to behaviour management strategies and individual risk assessments. The person registered should consult the Department of Health website to gain advice on the smoke free advice for care homes. The person registered should consider providing secure space for staff to store their person belongings whilst on duty. 3. YA6 4 5 YA28 YA28 Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Willows (The) DS0000028543.V339014.R01.S.doc Version 5.2 Page 32 - 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. 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