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Inspection on 12/02/08 for The Willows Nursing & Residential Home

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

This inspection was carried out on 12th February 2008.

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

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

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

The care plans reviewed were detailed and provided good information for nursing and care staff so that they were able to quickly identify and address residents` specific healthcare needs. The Registered Manager ensures that residents and relatives are fully informed and involved in the care planning process and invites relatives to reviews and meetings where this is appropriate. Staff were friendly and helpful towards the residents in a quiet and supportive manner. A relative and residents said that they were well cared for and specifically mentioned one of the senior nurses as very helpful, caring and well organised. Food was nutritious and well presented and all residents had nutritional assessments and had had their weight regularly monitored. Staff training is supported and carers are encouraged to undertake National Vocational Qualifications (NVQ) in Care to add to their care skills. Approximately 75% of care staff have gained an NVQ level 2/3.

What has improved since the last inspection?

The Registered Providers and Registered Managers have worked hard to improve and meet the requirements and recommendations made following the last inspection: Care plans have improved and are more detailed and reflective of the needs of the residents, and enable staff to more easily identify and address residents` healthcare needs. Medication, no longer in use, is returned promptly to the pharmacy. All lavatories now have locks to ensure residents` privacy. No staff are employed unless they have had a satisfactory Protection of Vulnerable Adults (PoVAFirst) and/or Criminal Records Bureau (CRB) check to ensure every effort has been made to safeguard the residents. There is an ongoing programme of refurbishment and redecoration; for example, new easy chairs have been purchased and old ones are being thrown away. Some rooms are being redecorated and new carpets have been laid. The lift has had sensors fitted to ensure that residents cannot be trapped in the doors. A new staffing policy ensures that one member of staff is in the lounges at all times when residents are present to ensure that they are safe. Hot water valves were being fitted to all sinks to protect residents from scalds.

What the care home could do better:

Requirements: (what the home must do to improve the service) Two rooms were identified to the Provider as areas of the home that must be free from offensive odours. This may require that flooring is replaced. Health and safety systems must be fully in place to protect residents from the risk of scalds. The providers were in the process of installing valves on all sinks at the time of inspection so that water temperatures can be controlled and this should now be complete. Cleaning liquids that may pose a danger to residents must be stored safely in a locked cupboard. Recommendations: (what the home should do to improve the service). All medicine trolleys should be attached to the wall when not in use to ensure that medicines are kept fully secured. Activity care plans and records could be more detailed to ensure an individualised approach to residents` activity needs and preferences. The Providers should consider replacing the small tables used by residents at lunchtime or use tablecloths to improve the dining experience for residents. The staff rota should accurately reflect the numbers of staff on duty at all times so that any shortfalls are easily identified and addressed. The results of quality audits should be published and made available to current and prospective residents and/or their relatives/representatives. All supervision of staff should be formalised, with written records maintained so that individual training needs are identified and addressed.

CARE HOMES FOR OLDER PEOPLE The Willows Nursing & Residential Home 105-107 Coventry Road Market Harborough Leicestershire LE16 9BX Lead Inspector Mrs Carole Burgess Unannounced Inspection 12th February 2008 10:00 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 The Willows Nursing & Residential Home DS0000001934.V359617.R02.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. The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Willows Nursing & Residential Home Address 105-107 Coventry Road Market Harborough Leicestershire LE16 9BX 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) 01858 463177 01858 434772 Mr James Frederick Cooper Mrs Mary Violet Cooper, Mrs Jacqueline Marie Riddett, Mr John Frederick Cooper Mrs Jacqueline Marie Riddett Mrs Mary Violet Cooper Care Home 57 Category(ies) of Dementia (9), Dementia - over 65 years of age registration, with number (9), Mental disorder, excluding learning of places disability or dementia (9), Mental Disorder, excluding learning disability or dementia - over 65 years of age (9), Old age, not falling within any other category (57), Physical disability (36), Physical disability over 65 years of age (57), Sensory impairment (36), Sensory Impairment over 65 years of age (36), Terminally ill (36), Terminally ill over 65 years of age (36) The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No person falling in categories TI(E) & TI to be admitted to the Home when 36 persons of that category/combined categories are already accommodated Service user numbers No person falling within categories MD, MD(E), DE, DE(E) may be admitted to the Home when 9 persons in total in these categories/combined categories are already accommodated within the Home No person falling in categories PD(E) & PD to be admitted to the Home when 57 persons of that category/combined categories are already accommodated in the home No person falling in categories PD may be admitted into the Home where there are 36 persons of category PD already accommodated within the home No person falling in categories SI(E) and SI to be admitted to the home when 36 persons of that category/combined categories are already accommodated No one under the age of 55 falling within categories MD or DE may be admitted to the Home Named person To be able to admit a named person under 55 years of age and falling within category LD named in variation application No. 58114 dated 13/11/03 31st October 2007 3. 4. 5. 6. 7. Date of last inspection Brief Description of the Service: The Willows Nursing and Residential Home is situated close to the centre of Market Harborough. It can provide care for up to fifty-seven older people with a range of needs including physical disabilities, dementia, and sensory impairment. Registered nurses are on duty in the home at all times. The accommodation consists of two older buildings linked by a new wing. Bedrooms are on two floors accessed by both passenger and stair lifts. There are four sitting rooms and one dining room. The home stands within secluded gardens and there is car parking at one side. The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 5 The Statement of Purpose, Service Users Guide & Inspection Report are available on request (these provide information on how the home is organised and what services they provide). The Statement of Purpose and Residents’ Guide are provided for all new residents. At the time of the inspection the weekly fees were £388 to £875 depending on care needs. This fee is inclusive of toiletries. There are additional costs for individual expenditure such as hairdressing, newspapers etc. The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The focus of the inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. The site visit was unannounced and took place over six hours. The inspection was a key inspection and reviewed the progress in meeting the requirements and recommendation made following the last inspection in October 2007. The Inspector selected three residents and tracked the care they received through a review of their records, discussion with them (where possible), other residents, relatives, the care staff, and observation of care practices. The Inspector spoke with staff members regarding training and support. Planning for the Inspection included assessing notifications of significant events sent to the CSCI by the home. Two complaints/safeguarding issues are being looked into by the LCC. This had resulted in the LCC suspending admission to the home. There seems to have been some disagreement between the LCC and the Registered Providers and Registered Managers as to whether these were initially complaints or safeguarding issues. And what information was given to the home by the LCC when they were judged as safeguarding. However, Mr Cooper, Provider, during the inspection stated that the home would and did co-operate fully with the LCC with any identified safeguarding issues relating to any resident in the home. Subsequently, there has been a multi-agency, adult conference, attended by representatives of the CSCI. The outcome was that there would be no further action in relation to the safeguarding issues and were satisfactorily resolved. The Providers gave their assurances that they would continue to co-operate with Social Services and the Primary Care Trust (PCT). All suspensions on admissions have now been removed. The Registered Provider (a person registered with the CSCI), and other staff spoken with were constructive and helpful during the inspection. Mr Roger Bluff, Regulation Manager, CSCI was present for part of the inspection. The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? The Registered Providers and Registered Managers have worked hard to improve and meet the requirements and recommendations made following the last inspection: Care plans have improved and are more detailed and reflective of the needs of the residents, and enable staff to more easily identify and address residents’ healthcare needs. Medication, no longer in use, is returned promptly to the pharmacy. All lavatories now have locks to ensure residents’ privacy. No staff are employed unless they have had a satisfactory Protection of Vulnerable Adults (PoVAFirst) and/or Criminal Records Bureau (CRB) check to ensure every effort has been made to safeguard the residents. There is an ongoing programme of refurbishment and redecoration; for example, new easy chairs have been purchased and old ones are being thrown away. Some rooms are being redecorated and new carpets have been laid. The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 8 The lift has had sensors fitted to ensure that residents cannot be trapped in the doors. A new staffing policy ensures that one member of staff is in the lounges at all times when residents are present to ensure that they are safe. Hot water valves were being fitted to all sinks to protect residents from scalds. What they could do better: Requirements: (what the home must do to improve the service) Two rooms were identified to the Provider as areas of the home that must be free from offensive odours. This may require that flooring is replaced. Health and safety systems must be fully in place to protect residents from the risk of scalds. The providers were in the process of installing valves on all sinks at the time of inspection so that water temperatures can be controlled and this should now be complete. Cleaning liquids that may pose a danger to residents must be stored safely in a locked cupboard. Recommendations: (what the home should do to improve the service). All medicine trolleys should be attached to the wall when not in use to ensure that medicines are kept fully secured. Activity care plans and records could be more detailed to ensure an individualised approach to residents’ activity needs and preferences. The Providers should consider replacing the small tables used by residents at lunchtime or use tablecloths to improve the dining experience for residents. The staff rota should accurately reflect the numbers of staff on duty at all times so that any shortfalls are easily identified and addressed. The results of quality audits should be published and made available to current and prospective residents and/or their relatives/representatives. All supervision of staff should be formalised, with written records maintained so that individual training needs are identified and addressed. The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 9 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. The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 10 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 The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 11 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): 1, 3 & 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with good information about the home, and have their health, welfare and social care needs assessed, so that they can be fully met once they move into the home. EVIDENCE: The home provides prospective residents and their relatives with a Statement of Purpose and Service Users Guide (both give information about the home) to help them decide if the home is the right one for them. The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 12 Residents said that they were visited at home before admission and that they had the opportunity of visiting the home prior to their admission. Copies of residents’ contracts are kept in the home in a separate file and residents, or their relatives, are provided with a copy. The three residents’ care plans reviewed contained a satisfactory preadmission assessment to show that the home could meet their specific health, welfare, and social care needs. It included personal details, relative and GP contact numbers, a past and present medical history, current health care requirements and medications, personal preferences, social interests and hobbies to ensure that the home could meet all of a prospective resident’s needs. The assessment paperwork has been recently revised with additional information regarding specific cultural needs (as recommended in the previous inspection report) and provides clearer information for nursing and care staff. The home does not provide intermediate care. The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 13 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 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are looked after in respect of their health, personal and social care needs. EVIDENCE: Residents’ care plans give nurses and carers good information about the health, personal and social care needs of the residents. The care plans had recently been reviewed and improved to provide more detail so as to clearly identify concerns (as required following the previous inspection): for example, there were now separate contact sheets for relatives, and for healthcare professionals with details of actions and outcomes. Care The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 14 plans reflected that residents with continence problems had toileting programmes in place and where required, pressure care and continence management issues were discussed with the Tissue Viability Nurse to ensure that they were managed appropriately. There were new daily records for carers to complete to show that residents have received their identified care needs, such as bathing and oral hygiene. Carers have been provided with guidelines on how to complete the daily reports and what they must report to the trained staff so that concerns are quickly addressed and residents’ healthcare needs are appropriately met. Care plans had been signed by the resident and/or their representatives to show that residents and their relatives were involved in and agreed with their personal plan of care. A visitor said that s/he had been consulted about the plan of care for their relative, who had dementia, and that s/he was regularly informed of, and invited to, the review meetings. The nursing staff review all care plans at least monthly so that residents’ care needs continued to be identified, updated and met. Contact with healthcare professionals such as GP’s, District Nurses, hospitals, Podiatrists and Community Psychiatric Nurses (CPN’s) were recorded to ensure that healthcare needs and treatments were addressed. Medication policies and procedures were satisfactory. Medication no longer required is returned to the local pharmacy on a frequent and regular basis, as required following the last inspection. One locked medication trolley had not been secured to the wall when not in use. The attachment appeared to be broken (this was noted at the previous inspection). Medicine trolleys not kept in clinical/treatment rooms should be secured to the wall to ensure that they cannot be removed. Only nurses administer medication. The nurses said that they receive medication training and one said that she was currently undertaking home study through Hinckley College. This ensures that residents receive their medication safely and as prescribed. Observation during the inspection showed that staff had a good awareness of how to protect residents privacy and dignity. Staff spoke to residents and visitors in a respectful, friendly, quiet and supportive way. It was noted at the last inspection that a number of lavatories were without functioning locks: this has been addressed and all lavatories now have locks to ensure residents’ privacy. Four residents, spoken with during the inspection, said that they were very well looked after and that staff were kind and caring. The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 15 A visiting relative said that the home had improved over the last few months and they had made a lot of recent improvements, and that the home provided a good standard of care for their relative, and that they would be happy to recommend the home to others. Ten local GP’s and a Community Matron had written a letter to Leicestershire County Council which stated; ‘they have not identified any major instances of poor care in recent months’, and were generally supportive of the home and the nurses ability to ‘undertake skilled nursing procedures’. The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 16 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 &15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff work to ensure that residents experience a safe, stimulating and homely life style. EVIDENCE: There is a part time activities organiser and resident’s activities were recorded in their care plan. These could be improved to provide a more rounded picture of what activities residents preferred, and responded to, especially for those residents with a degree of memory loss. On the day of inspection the residents were enjoying a board game led by the activities organiser and two of the care staff. The activities organiser had also The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 17 worked with a resident to make a Valentines card. She said that she organised events and trips out for small groups of residents. Two new notice boards were in place, one providing information for residents regarding such things as library times and church services, and another that showed the photographs and names of the staff. The provider said that this had been in response to the inspectors comments during the last inspection, and a nurse said that a resident had been interested in the staff photographs and this had been used to prompt conversation with the resident and explore recall. Residents said that they were able to have visitors at any time and a number of people came to visit during the course of the inspection. Staff support residents with making choices in their everyday life. All residents spoken with said they got up and went to bed when they wished, were able to choose what they wanted for their meals, breakfast in their rooms if they wished, and were well supported by caring staff. All meals were prepared in the home’s kitchen by the cook. A cooked breakfast was available if required and residents could take their breakfast in their own room at a time to suit them. There were choices at all main meal times. Drinks were available throughout the day, coffee and biscuits in the morning and tea and home made cakes in the afternoon. Special diets such as diabetic and soft diets were catered for. Residents were weighed on admission, and regularly where necessary, and had a nutritional assessment in their care plan to ensure that their dietary needs were met. The food provided for lunch looked nutritious, well presented and residents who required help with feeding were given this in an unhurried and discreet manner. Some residents choose to eat at individual tables that looked a little utilitarian (no table cloths/napkins etc). The nurse said that this was an individual choice but residents were asked and encouraged periodically to eat at the communal dining table, although there did not appear to sufficient space at the table should all residents take up this option. It was noted at the last inspection that if residents choose to remain in their easy chairs at meal times, rather than sit at the dining table, this should be to be recorded in their plan of care. Two residents and a relatives said that food was very good and that there were always choices, one resident said “too much” indicating that she had put weight on around her tummy. The home was inspected by Harborough District Council and was awarded ‘Three Stars’ (Good) for food hygiene in November 2007. The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for receiving and responding to complaints are satisfactory and protect residents’ rights. EVIDENCE: Residents and staff comments showed that people feel at ease discussing any concerns with the Registered Manager and staff. Information regarding advocacy services was available if residents require independent support and advice. Two complaints/safeguarding issues were being looked into by the LCC. This had resulted in the LCC, and other local councils suspending admissions to the home. There seems to be some disagreement between the LCC and the home as to whether these were, initially, complaints or safeguarding issues. However, Mr Cooper, Provider, stated, during the inspection, that the home would and did co-operate fully with the Social Services and the PCT with any identified safeguarding issues relating to any resident in the home. The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 19 The home’s complaints process reflects the local agreed procedures for Safeguarding Adults ‘No Secrets’ policies. Although during the last inspection some staff were unclear about the role of outside agencies, staff had now been provided with appropriate training. One member of the care staff said that they receive information about safeguarding as part of the induction process and that it was discussed regularly as part of staff meetings. Other members of staff were able to show that they were aware of the correct procedures to follow to ensure the safeguarding of the residents. The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of accommodation is clean and provides residents with an adequate environment and identified improvements need to be completed to ensure that previous requirements are met. EVIDENCE: The home is clean, and warm and maintained with adaptations to suit residents’ specific needs. It is decorated and furnished to an adequate standard that creates a comfortable environment for the residents. The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 21 Many residents’ rooms have en-suite facilities, all have a ‘nurse call’, and were clean. Residents are able to bring items of their own furniture and possessions with them to personalise their rooms. Some residents’ rooms were well personalised but some were a little bare with a minimum of personal possessions, which made them look a less than ‘homely’. The Registered Provider said that there was a continuing programme to deal with all maintenance and refurbishment issues. One of the ground floor bedrooms was being redecorated, and provided with new flooring and vanity unit. The chairs in the smoking room looked stained but chairs and carpets had been, and were being, replaced as planned (see under What has improved since the last inspection?) to improve the décor for the residents. Two rooms were less than fresh, with an unpleasant odour. These were identified to the provider during a tour of the building. Flooring may need to be replaced in these rooms to eliminate odours as part of the ongoing improvements, thereby improving the environment and promoting the dignity of the residents. There are sufficient lavatories, bathing and assisted bathing facilities. New locks have been fitted to some doors where this had been required following the last inspection. One carer said that the provision of a ‘wet room’ would be helpful and enable residents to have a choice of bathing facilities. The intercom system, which could be considered intrusive, was used infrequently, and residents said that they were not really aware of it. But this should be kept under review to ensure that it does not become a nuisance to residents and their relatives. A relative and residents commented that the home was kept clean and tidy. The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff at the home are trained and sufficient in number to meet the current residents’ needs. The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 23 EVIDENCE: There were 34 residents (one being day care) at the time of the inspection. Staffing levels, at the point of inspection, were in line with those suggested by the Department of Health Residential Forum Guidelines and were sufficient to meet the current residents’ needs. During the day there were seven or eight staff, and ancillary staff such as administrative staff, cooks and cleaners, and at night there are four staff: there were always trained nurses on duty. On the day of inspection the Registered Manager was on rota as working but was actually on holiday. The Provider said that the rotas were printed, then amended, and this had been an oversight and was corrected at that time. There were not any shortfalls in staffing that day. The rota should always be reflective of the numbers of staff on duty so that shortfalls could be easily identified and a replacement found in good time. The last inspection identified times when resident were left unattended in the main lounge areas and could be at risk from falls. Staffing has been reorganised to ensure that an identified member of staff was in each lounge when residents were present to ensure they have staff support at all times and was observed during inspection. Residents and a relative said that there always seemed sufficient staff on duty. Three staff files were checked during the inspection and showed that there was a satisfactory recruitment process to ensure that residents are well protected. During the last inspection it was noted that a small number of staff had commenced work before the home had received their Criminal Records Bureau (CRB) checks. The Provider said that all staff will now have Protection of Vulnerable Adults (PoVAFirst) and/or CRB checks before starting to work in the home to ensure every effort is made to safeguard the residents. New staff carry out an induction programme and the Skills for Care induction booklet is currently being used for newly recruited care staff. Two of the senior nurses said they were Moving & Handling trainers and provided training for the staff, and staff receive mandatory, annual updates. Not all staff had received all of the mandatory training, but the Registered Manager is in the process of introducing a training matrix to ensure all staff training needs were identified. Staff undertake training in specific areas such as fire training, first aid, moving and handling, food safety, infection control, and safeguarding adults and were able to show that they understood safeguarding procedures to ensure that residents were protected from harm. The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 24 Comments from the Registered Manager to the draft report indicated that there were three moving and handling trainers. The Registered Provider said that seventy-five percent of care staff had completed National Vocational Qualification (NVQ) in Care, Level 2/3 and that a number of other care staff had commenced NVQ’s. This and the training matrix should ensure that staff have the necessary skills to give safe care to the residents. The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Providers and Registered Managers provide a good standard of leadership for staff. Identified Heath and Safety improvements need to be completed to ensure that previous requirements are fully met. The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 26 EVIDENCE: The Registered Managers are first level nurses and works in a supervisory and management role in addition to nursing and care staff numbers. On the day of inspection there was good interaction between staff, residents and residents’ relatives. A relative said that there were regular resident and relatives meetings and that s/he was always invited to reviews, which ensured that there was a culture of openness in the home. The home conducts ongoing quality audit (satisfaction survey) for residents and relatives to complete. We recommend that the results be collated and actioned and written feedback provided in the Statement of Purpose and Service Users Guide (as indicated in the last report) to show that comments from residents and visitors help to improve the service. Staff are supervised by the Registered Managers and senior nurses in performing their nursing and care tasks. Staff receive annual appraisals but supervision (a regular review of staff’s personal and training needs in relation to their work) was not fully documented to show that this was being done. The implementation of the training matrix, and regular, recorded supervision, should make sure that staff have their training needs identified and that they have the necessary skills to provide a good service for the residents. Health and Safety Policy and Procedures, such as regular recorded fire drills, fire alarm tests and regular equipment maintenance had been completed and showed that the Registered Managers were mindful of their responsibilities to make sure that residents live in a safe environment. However, during the tour of the home skin cream (Sudacem) had been left out on a bedside cupboard (which was put away in a lockable draw), and a cupboard containing some cleaning sprays and bath foam had been left open. There was some discussion between the Provider and senior nurse as to whether the cupboard was kept locked but the nurse said that she would have items moved to a locked cupboard. Liquids and creams should be kept locked away when not in use as this could pose a danger to residents. And as previously mentioned, a medicine trolley needed to have the security attachment repaired. Following the last inspection the Provider has been installing valves at all sinks and monitoring hot water taps throughout the home. At time of inspection about two third had been completed - the rest were to be done in the next week or so to ensure that residents are protected from scalds. The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 27 Staff indicated that the recent improvements in care planning, and to the environment, had been welcomed by the residents, relatives and staff, and that staff felt very positive about the changes being made. The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 X 3 X X 3 X 2 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 3 X X X X 2 The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP26 Regulation 23 Requirement Identified areas of the home must be free from offensive odours, specifically residents’ rooms where flooring may need to be replaced (ongoing at the time of inspection). Outstanding requirement from the last inspection 29/02/08. 2. OP38 23 30/04/08 Health and safety systems must be fully in place to protect residents from the risk of scalds (ongoing at the time of inspection), and arrangements for storing liquids etc, which may pose a danger to residents, must be addressed. Outstanding requirement from the last inspection 29/02/08. Timescale for action 30/04/08 The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 30 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 Refer to Standard OP9 OP7 OP15 Good Practice Recommendations It is recommended that all medicine trolleys not kept in clinical/treatment rooms are secured to the wall when not in use. It is recommended that activity care plans and records are more detailed to ensure an individualised approach to residents’ activity needs and preferences. It is recommended that the Providers consider replacing the small tables used by residents at lunchtime and/or using tablecloths to improve the dining experience for the residents. It is recommended that staff rota should accurately reflect the numbers of staff on duty at all times. It is recommended that the results of quality audits are published and made available to current and prospective residents and their relatives/representatives. It is recommended that all supervision of staff is formalised, and that written records are maintained. 4 5 6 OP27 OP33 OP36 The Willows Nursing & Residential Home DS0000001934.V359617.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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. 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