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Inspection on 25/10/06 for The Willows Nursing Home

Also see our care home review for The Willows Nursing Home for more information

This inspection was carried out on 25th October 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents of The Willows, their relatives spoken with, and the survey responses, all made positive comments about the home. Staff were described as "very helpful and understanding", "willing and compassionate", "patient" and "kind". A relative said the resident was "well cared for". One resident said "I`m very happy here". There was a committed and competent staff team who were knowledgeable about the care needs and preferences of residents. The meals provided were of a good standard with choices offered at every mealtime. Menus were changed regularly to reflect residents` tastes and preferences.

What has improved since the last inspection?

There were 3 requirements and 2 recommendations made at the previous inspection. All had been met, demonstrating the home`s commitment to improving the service provided to residents. A new activities coordinator had been appointed, working for 20 hours per week. A good range of activities was being developed, including involvement in a local community project.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Willows, The Nursing Home 7 Norbriggs Road Woodthorpe Mastin Moor Chesterfield Derbyshire S43 3BW Lead Inspector Rose Veale Unannounced Inspection 25th October 2006 10:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Willows, The Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Willows, The Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Willows, The Nursing Home Address 7 Norbriggs Road Woodthorpe Mastin Moor Chesterfield Derbyshire S43 3BW 01246 280539 01246 280799 the.willows@craegmoor.co.uk info@craegmoor.co.uk Parkcare Homes Limited 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) Helen Joan Hopkinson Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places Willows, The Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th February 2006 Brief Description of the Service: The Willows is located in the village of Woodthorpe, near to Staveley where there are amenities including a supermarket, church, post office and library. The home provides accommodation in single rooms, some of which are en suite. There is a dining room, lounge and conservatory on the ground floor and a dining / lounge room on the first floor. There is access to the enclosed garden and car parking space is provided to the front of the building. The fees range from £374.90 to £467.90 per week for residents assessed as needing nursing care, and from £298.20 to £328.20 per week for residents assessed as needing personal care only. This information was provided in the pre-inspection questionnaire received on 29/08/2006. Willows, The Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and took place over 6 hours. The inspection visit focused on assessing compliance to requirements made at the previous inspection and on assessing all the key standards. There were 31 residents accommodated in the home on the day of the inspection, including 19 residents assessed as needing nursing care. Residents, visitors and staff were spoken with during the visit. Some residents were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Records were examined, including care records, staff records, maintenance, and health and safety records. A tour of the building was carried out. A questionnaire and surveys had been completed and returned prior to the inspection and information from this has been included in the body of this report. This inspection was carried out following recent adult protection procedures involving the home. The registered manager was available and helpful throughout the inspection. What the service does well: What has improved since the last inspection? There were 3 requirements and 2 recommendations made at the previous inspection. All had been met, demonstrating the home’s commitment to improving the service provided to residents. Willows, The Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 6 A new activities coordinator had been appointed, working for 20 hours per week. A good range of activities was being developed, including involvement in a local community project. What they could do better: 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 Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 7 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 Willows, The Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was a comprehensive needs assessment process so that residents were confident the home was able to meet their needs. EVIDENCE: The care records of 4 residents were examined. All the records seen included assessment information from the care manager, hospital or funded nursing care team as appropriate. The record of 2 residents recently admitted included the pre-admission assessment carried out by the home. There was also assessment information collected on or soon after admission, including risk assessments. In each of the records seen, the assessment information was used to produce a care plan. Residents and their relatives spoken with said that their needs were met at the home. The home did not confirm in writing to prospective residents that the home was able to meet their needs. Willows, The Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 9 Standard 6 did not apply to this service. Willows, The Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were detailed care records and effective staff training so that residents’ health and personal care needs were met, including protection of their privacy and dignity. EVIDENCE: The care plans of 4 residents were examined, including 2 residents assessed as needing nursing care. All the care plans included risk assessments with clear details of the action required by staff to reduce the risks to residents. Risk assessments included falls, moving and handling, tissue viability, and nutrition. The care plans seen covered all the assessed needs of the residents, including their emotional, social, and spiritual needs. The care plans had clear details of the action required by staff to meet residents’ needs. 3 of the care plans had the signature of the resident / their representative to indicate their involvement. All the care plans seen had been reviewed and updated monthly. Staff records showed that staff had received training in needs assessment and care planning. Willows, The Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 11 Some minor improvements to be made to care records were discussed with the manager, such as including the specific details of pressure relieving equipment used by individual residents in the relevant care plan, and ensuring all daily records included the time the entry was made. Residents and their relatives spoken with, and those who responded to the surveys, said that their needs were met at the home, and that staff were competent to meet their needs. The staff training records showed that staff had received a range of training appropriate to the needs of residents, such as moving and handling, oral health, dementia awareness, and protection of vulnerable adults. Staff spoken with were knowledgeable about the care needs and personal preferences of residents. It was clear from the records that residents had appropriate access to health care services. Records were kept of the visits and input of other health care professionals, such as GP, District Nurse, chiropodist, and care manager. There was evidence that residents’ health care needs were promptly and appropriately referred. For example, one resident noted to have developed swallowing problems was seen by the Speech and Language Therapist; one resident found to have a skin rash was seen by the GP the same day and appropriate treatment started. Residents and their relatives spoken with confirmed that they were able to see their GP as necessary. Residents and relatives spoken with, and the survey responses, all made positive comments about the staff. Staff were described as “very helpful and understanding”, “willing and compassionate”, “patient” and “kind”. A relative said the resident was “well cared for”. Residents and relatives said staff respected their privacy and dignity, for example, by knocking on doors before entering and addressing residents by their preferred name. Staff were observed giving assistance with eating and drinking in a sensitive way. There was a comprehensive policy for the safe handling of medication in the home, which had recently been updated. The registered nurses on duty administered medication for all residents in the home. Medication storage was satisfactory and there were good records were seen of the receipt and disposal of medication. The Medication Administration Records, (MARs), were seen and were generally correctly completed. Some MARs had handwritten entries which had not been signed by the person writing them or signed by another member of staff to show the entry had been checked as correct, as stated in the home’s medication policy. It was found that prescribed Paracetamol tablets had not been disposed of following the death of a resident but were being used as ‘stock’ for other residents. The Medicines Act 1968 clearly says that medicines must only be administered to the person for whom they have been prescribed, labelled and supplied. There was a fridge used to store medication with daily records kept of the temperature. The daily maximum and minimum temperatures should be recorded to ensure that medication is always kept at the correct temperature. Willows, The Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 12 Willows, The Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provided a good range of activities and a healthy, varied menu so that the lifestyle in the home met the needs and expectations of residents. EVIDENCE: The home had an activities coordinator working for 20 hours per week. The activities coordinator had been appointed approximately 2 months before the inspection visit and so was still in the process of finding out residents’ interests and preferences and putting together an appropriate activities programme. The activities coordinator had appropriate experience and was enthusiastic about the role. The weekly programme of activities was displayed in the ground floor lounge. On the day of the inspection visit residents enjoyed a game of bingo and then talked about old photographs of the local area. Recent activities had included a church service in the home, dominoes, chair-based exercises, making Halloween decorations, and manicures. Activities planned included an outing for a Christmas meal, an evening with a war-time theme, a visiting music therapist, and planting seeds. The home was taking part in a local community art project. On the day of the inspection visit preparations were being made for a birthday party the following day for 2 residents. Willows, The Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 14 Residents spoken with and those who responded to the surveys were pleased with the activities offered. One resident said they particularly enjoyed the exercises to music and visiting singers. Visitors spoken with said they were always made welcome by the staff, greeted and offered refreshments. Relatives were encouraged to become involved in social and fund raising events. Residents were encouraged to have personal possessions in their rooms and the bedrooms seen reflected this. Residents spoken with said that routines were reasonably flexible and that their choices were respected, such as choosing not to join in with a particular activity. The views of residents and their representatives were sought in regular quality assurance surveys, (see Standard 33). The menus were seen and appeared varied and balanced. The cook had recently revised the menus in consultation with residents and staff. The menus gave choices at all main meals. The meals served on the day of the inspection visit appeared appetising. Residents spoken with and those who responded to the survey were all pleased with the meals. Comments included “The food is very good”, “well presented and enjoyable”, and “there is always a choice”. Residents requiring assistance with eating and drinking were served with their meals first so that all staff on duty were available to help. During the inspection visit staff were observed helping residents to eat and drink. Assistance was given individually and in a sensitive manner. Willows, The Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were robust policies in place and good staff awareness so that residents were protected and their concerns effectively dealt with. EVIDENCE: The home had a complaints procedure in place which was included in the Service User’s Guide supplied to residents / their representatives. Residents and their relatives spoken with were aware of how to complain, but said they had never had cause to complain. The complaints book had no recent complaints, and no complaints had been received by CSCI about the home. The home had a comprehensive policy regarding safeguarding vulnerable adults and also a whistle blowing policy. The manager had completed training in safeguarding vulnerable adults and training records showed that most staff had also received training. Staff spoken with confirmed that they had received training in safeguarding vulnerable adults. The home had recently been involved in adult protection procedures and had taken appropriate action. Willows, The Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well equipped and generally well maintained so that residents lived in a safe, clean, comfortable and pleasant environment. EVIDENCE: A tour of the home was carried out, looking at some of the bedrooms, the communal areas, the laundry, bathrooms and sluices. The bedrooms seen were pleasant, comfortable and personalised with residents’ own possessions. The lounges and dining rooms were comfortable and homely. The lounges, dining areas and corridors were ready for redecoration, as they appeared ‘tired’ and dull. Staff commented that they felt the décor “let down” the home. The lighting in the corridors was a little dim, particularly for residents with sight and mobility problems. Staff commented that the lighting was dull around the ‘nurses stations’ which were situated on the corridors. Willows, The Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 17 All areas of the home were clean and free from offensive odours. Residents and relatives spoken with and responses from the surveys indicated that the home was always clean. The laundry was suitably equipped and well organised. Staff had received training in the control of infection. During the inspection visit staff were observed to wear disposable gloves and aprons when assisting with personal care, and disposable aprons when assisting with meals. Willows, The Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were robust recruitment practices, a good staff training programme and adequate staffing levels so that residents were protected and well supported. EVIDENCE: The rotas for the home were seen and showed that there were always 2 registered nurses on duty and usually 6 care assistants in the morning and 5 in the afternoon. At night there was always 1 registered nurse with usually 4 care assistants. Residents spoken with and those responding to the surveys said that there were enough staff on duty to meet their needs. Staff spoken with said that staffing levels were usually adequate, but if cover could not be found for staff sickness then the workload could be difficult to manage. For example, there were several residents on the first floor who needed help with eating and drinking, usually assisted by 3 care assistants. If there were only 2 care assistants available, this meant residents having to wait for their meals. Staff indicated that cover was often needed for weekend and night shifts and suggested that an improved rate of pay for weekends and nights would give encouragement for staff to cover these shifts. Staff records were seen for 3 members of staff. The records included all the required information, such as proof of Criminal Records Bureau disclosures, 2 written references, and a photograph. Willows, The Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 19 The training records showed that staff had received all the required training up to date, such as fire safety and moving handling. Staff had received other training relevant to the needs of the residents, such as oral health and dementia awareness. Staff spoken with said the training programme was good and that they were actively encouraged and supported to attend training. 50 of the care staff had already achieved NVQ Level 2 or 3 in care and other staff were working towards the qualification. Willows, The Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well managed and there were good systems in place so that the health, safety and welfare of residents was promoted and protected. EVIDENCE: The manager had completed training in safeguarding vulnerable adults and was working towards the Registered Manager’s Award. The manager is a registered nurse and had previous management experience before taking this post. Staff spoken with said the manager was approachable, involved and supportive. Relatives spoken with said they would be happy to go to the manager with any concerns. The quality assurance system included regular surveys of the views of residents and their representatives, monthly visits by the area manager, and Willows, The Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 21 in-house audits of the environment and health and safety matters. The providers had not produced a report to feedback the survey findings to residents and their representatives. An analysis of the findings with a report of the action taken to address any issues raised would demonstrate the provider’s commitment to improving the service for residents. Most of the residents had some personal money held by the home to pay for items such as toiletries, hairdressing and chiropody. There was a rigorous system in place, managed by the administrator, with records kept of all transactions. Residents / their representatives were provided with a monthly statement detailing all transactions made and the current balance. Money was kept securely in a safe with access restricted to the administrator and manager. Records relating to health and safety and maintenance were sampled. The records seen were well kept and up to date. There were 2 requirements made at the previous inspection relating to the emergency lights and the electrical wiring. Both requirements had been met. Willows, The Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 22 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Willows, The Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 23 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 OP9 Regulation 13(2) Requirement Medicines must only be administered to the person for whom they have been prescribed, labelled and supplied. Timescale for action 30/11/06 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. 3. 4. 5. Refer to Standard OP9 OP9 OP19 OP19 OP33 Good Practice Recommendations Handwritten entries on MARs should be signed by the person writing them and then signed by another member of staff who has checked the entry is correct. The daily maximum and minimum temperatures of the fridge used to store medication should be recorded to ensure storage is always at the correct temperature. The lounges, dining areas and corridors should be redecorated to provide a more pleasant environment for residents and staff. The lighting in the corridors should be improved to provide a brighter environment for residents and staff. The results of service user surveys should be made available and a copy of the report provided to the DS0000002092.V317020.R01.S.doc Version 5.2 Page 24 Willows, The Nursing Home Commission. Willows, The Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Nursing Home DS0000002092.V317020.R01.S.doc Version 5.2 Page 26 - 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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