Inspection on 27/10/08 for The Willows

This inspection was carried out on 27th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Willows 16/10/06

The Willows 14/11/05

The Willows 14/06/05

The Willows 08/10/04

The Willows 20/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Willows 33 Stade Street Hythe Kent CT21 6DA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kim Rogers     Date: 2 7 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: The Willows 33 Stade Street Hythe Kent CT21 6DA 01303266963 Telephone number: Fax number: Email address: Provider web address: willows.hythe@craegmoor.co.uk Name of registered provider(s): Name of registered manager (if applicable) Richard William Mott Type of registration: Number of places registered: Lothlorien Community Ltd care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home The Willows is registered to care for up to 6 people with a learning disability. The registered providers are Craegmoor Healthcare. All bedrooms are single and one has an en-suite facility. The home offered a full staff compliment at the time of the report and the owning company supports on-going and updating training. The home is close to the centre of town with transport links and a variety of shops and entertainment facilities. There is parking at the premises. Fees are in the range of #941-#1297. 6 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection. The last key inspection of this service was 16/10/06. An Annual Service Review was carried out by the Commission on 19/3/08. Copies of these reports can be obtained from the Provider. As part of the key inspection we carried out a site visit to the home. We spoke to service users and staff and made observations. Records were sampled including medication records and service user plans. The manager was not at the home during the inspection as she was on leave so staff assisted us. We looked at the information we have received about the home since the last inspection including the Annual Quality Assurance Assessment. (AQAA) Homes are now required to complete the AQAA every year. This gives information about what the Care Homes for Adults (18-65 years) Page 5 of 27 home does well, how they have improved and how they intend to improve outcomes for people who use the service. We found that the requirement made at the last inspection has been met. Service users were involved in the inspection and showed us around the home and talked about their lives and goals for the future. What the care home does well: What has improved since the last inspection? What they could do better: We found that some information about the home needs updating for example the Statement of Purpose names the previous manager. This means prospective service users will not have the most up to date information. We found service user plans have a note of personal goals but have no plans to support them. This means that staff will not know what they need to do to support people to achieve. This is also the case with skill development. Some people want to learn new skills and develop existing skills. Without good plans in place they will not get the support they need. The manager should apply to be the Registered manager so people who use the service know she is a fit person. Staff can work up to 15 hour long shifts. This means they may become tired or stressed and this may impact on outcomes for people who use the service. Therefore, this should be reviewed. Care Homes for Adults (18-65 years) Page 7 of 27 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that their needs will be assessed before they move into the home. Information about the home must be right so people have the most up to date information about the service. Evidence: We found that an assessment tool is used to assess a persons needs before they move in. This is done to ensure the home can meet the persons needs. We found that people have the opportunity to have trial stays and visits to help them decide about moving permanently into The Willows. There is some information about the home. We found that the Statement of Purpose has some old information like the previous managers name. The AQAA says they plan to update this so prospective residents have the most up to date information about the service. The Statement of Purpose is laminated with several pages displayed across the hallway wall with other information like the certificate of public liability insurance. You see this Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: as you enter the home and it does make it feel homely but like an obvious care home. Staff and a service user agreed and said they would talk to the manager and other service users about this. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Without detailed plans of support people will not achieve their goals, develop new skills and grow in independence. Risk taking is supported so that people are not restricted. Evidence: A service user plan was sampled in detail and we spoke to staff and service users. All plans look the same so none are individualised. Although people said their plans are read to them and they sign to agree it, we found people could be more involved in the review and development of their plans. We found that peoples needs and personal goals are recorded but there are no plans in place to say how staff should support goals, what they should do and by when. Without detailed plans of support people may not achieve their goals and learn new skills. For example one person would like a voluntary job but there is no plan to say how this will be supported. A recommendation from the last inspection was to record and support personal goals. Potential risks are identified and assessed so staff know Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: what to do to minimise risks. Risks assessments do not show when a risk last occurred. This means that some risks may no longer be relevant if something happened once a long time ago. We found a review and evaluation sheet with only dates on it. It is unclear who carries out the review, if and how service users are involved and how effective it is. We found that there is information about communication needs in service user plans. Information is available to service users presented in ways people can understand so they know who is on duty, menu choices, activity choices etc. Service users are involved in producing this information. People said they have support to make choices and decisions like how they spend their day, activity and holiday choices and meal choices. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have access to a range of activities. There are some opportunities for personal and skills development but without detailed plans people may not get the support they need to develop and learn. Relationships are supported and meals are varied and nutritious. Evidence: We found that there is a range of activities on offer that people have the opportunity to take part in. Most of the activities are provided by the company and held at a local community centre. Evening activities like discos are also offered and information is advertised on a notice board. Hobbies are supported. Each person has an activity planner covering seven days and evenings. We found that some of these need updating as some activities are no longer attended. We found that people have support to plan and book holidays. People who use the service said they recently enjoyed their Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: holiday to a holiday centre and have enjoyed past holidays to various destinations. We found that support to gain employment and further education is limited. One person said they want a job. This was recorded in the service user plan but we found no plan in place to support this. Without a detailed plan that is regularly reviewed of what staff need to do, people may not achieve their goals. We found that some people would like to develop skills like cooking and budgeting. We found no plans in place to support this so people may not develop these skills. We found that relationships are supported and people have opportunities to make friends. People have the support they need keep in touch with family and friends. We found that people take part in planning and preparing meals. People were making their own breakfast and drinks and had the time they need to enjoy breakfast. People said that the pace of life at the home suits them in that they all get on well and can have their own space when needed. Everyone is involved in the day to day running of the home and all take part in the household tasks like putting the rubbish out and washing up. The AQAA says they plan to involve service users more in planning and preparing meals. People have support to access the community like local pubs, shops, and cafes. Some people are members of the library and borrow films for the weekly film night. People said they use the local shops and some people use public transport. People said they like living close to the town, canal and beach. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know they will have the support they need to remain healthy. People have the support they need with personal care and medication practice is safe. Evidence: We found that personal care needs are recorded in service user plans. Service users said they are happy with the bathrooms and showers, which are close to bedrooms. All bedrooms have a wash hand basin and one room has an en suite WC. We found no plans in place to develop or increase peoples skills with personal care. This means that skills may not be developed so people have to continue to rely on staff We found that health needs are recorded with records showing what staff should do to support health needs. Everyone has a GP and people said they see their GP when they need to. We found that when a health need is identified staff take action to give the right support. We found clear guidelines to support one persons health need and good monitoring in place so that any change can be acted on quickly. We found that medication storage is safe and there are good records of receipt and administration of medication. We found that staff have training before they administer medicines. Staff Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: spoke with knowledge about medication practice. The AQAA says they plan to update health action plans and improve support for people when they attend appointments. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service know who to complain to and have confidence that their complaints will be listened to and acted on. People feel safe and are protected from harm and abuse. Evidence: We found that there is a complaints procedure displayed in the home. Everyone can use it, as it is meaningful to current service users. People said they have confidence that the staff and manager would address any complaints they have. We found that complaints are recorded and action taken to address the issues raised. We have received no complaints about the home since the last inspection. There is a safeguarding vulnerable adults and whistle blowing policy and procedure. We found that staff are aware of these policies and procedures. Staff attend training in safeguarding vulnerable adults. We found that staff know how to recognise and respond to suspected abuse, this protects service users. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and a pleasant safe place to live. Evidence: A service user showed us around the home. The home is well maintained and parts have been recently decorated. There are spacious communal areas and each bedroom is single with a wash hand basin. One bedroom has an en suite WC. People said there are enough bathrooms and showers for them and that they are happy with their rooms. Service users are involved in the household tasks and enjoy growing vegetables and taking care of the garden. There is unrestricted access to the back garden so people get fresh air when they want. Everyone has a key to their bedroom but not all have a front door key, this is supported by individual assessments. These assessments should be kept under review to ensure this restriction continues to be in service users best interests. There is a separate laundry and cleaning materials are stored safely. We found that some curtains have been taken down for the recent decorating but have not been put back up. This means that the sun gets in peoples eyes when they are eating and their privacy may be affected. Staff said the curtains would be put back up. We found no light shades on the landing but two exposed light bulbs. Staff agreed to get some light shades so it looks more homely. Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: On entering the home from the front door we found lots of company information laminated and displayed around the walls and on a door. This does not make the home feel homely and ordinary but like a care home. Staff and a service user agreed and said they would discuss this at the service user meeting to be held the same day. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough trained, supervised staff to meet service users needs. Recruitment checks are robust protecting service users. Evidence: We found that access to training is good and the induction is adequate. Some staff have attended training relating to service users needs like epilepsy and autism although training is person centred planning is limited. Most of the staff have a National Vocational Qualification in care. We found that recruitment checks are carried out before a person starts work at the home. The home employs some overseas staff and commissions a company to carry out the required checks on these staff. This protects service users. We found that there are usually two staff on duty during the day and one staff at night. Staff said extra staff could be called in for activities planned in advance. People said they like the staff and the staff are good. We found that staff work shifts of up to fifteen hours. Staff may become tired during this long shift so to ensure this does not impact on outcomes for service users this should be reviewed. Staff said that they have the opportunity to attend regular staff meetings and have regular one to one Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: supervision meetings with the manager. This means they can talk about issues like performance, development and training and get the mentoring and support they need. Staff spoke with knowledge and understanding of service users needs and were observed supporting people with respect. The AQAA says they plan to provide more one to one support for people. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed in service users best interests. Peoples health and safety is protected. Evidence: Since the last inspection there is a new manager. The manager was not present for the inspection as she was on leave so the shift leader and support worker assisted us. The manager has support from an area manager and has several years experience in managing services. The manager should apply to be the Registered manager to show she is a fit person. Service users said the manager is very nice and easy to get on with. One service user said she gets things done. Staff said the manager has some good ideas about improving the service and has lifted their spirits with these ideas. We found that there are some quality assurance systems in place. The manager completes weekly and monthly returns for head office. They also have the Investors in People award, which is an independent quality assurance assessment of the service. We found that service users meetings are held. A meeting was planned for the day of Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: the visit and an agenda was on the notice board. Service users said they discuss things like menus, holidays and outing ideas. This means that service users have the opportunity to air their views and make suggestions for improvement. Service users said they feel their views are listened to and acted on. The AQAA shows that health and safety checks are carried out. However there is no date for when the heating system was last serviced and this should be checked. We found that staff attend training related to health and safety including food safety and first aid. Staff said that regular fire drills are held. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 Each persons personal goals and aspirations should be recorded and a plan in place of how they are to be supported to achieve. So staff know what support is needed to support people achieve their goals. 30/11/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 33 37 Staff working 15 hour long shifts should be reviewed to ensure it does not impact on outcomes for service users. The manager should apply to be the Registered manager so people who use the service know that she is a fit person. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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