Inspection on 31/10/07 for The Willows Nursing & Residential Home

This inspection was carried out on 31st October 2007.

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

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

Other inspections for this house

The Willows Nursing &... 12/02/08

The Willows Nursing &... 16/03/07

The Willows Nursing &... 09/11/06

The Willows Nursing &... 07/12/05

The Willows Nursing &... 10/06/05

The Willows Nursing &... 11/01/05

The Willows Nursing &... 21/06/04

The Willows Nursing &... 16/02/04

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Applegarth

Trevayler Residential Care Home

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

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

CARE HOMES FOR OLDER PEOPLE The Willows Nursing & Residential Home 105-107 Coventry Road Market Harborough Leicestershire LE16 9BX Lead Inspector Keith Charlton Unannounced Inspection 31st October 2007 08:45 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.V351945.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. The Willows Nursing & Residential Home DS0000001934.V351945.R01.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.V351945.R01.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 16th March 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 provides care for up to 57 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 weekly fees are from £319 to £700 depending on care needs – this information was provided in March 2007. This fee is all inclusive of toiletries. There are additional costs for individual expenditure such as hairdressing, The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 5 newspapers etc. A Statement of Purpose and Service Users Guide to the services the home offers and the last Inspection Report is available on request, to enable prospective residents to make an informed choice as to whether they wish to live at the home. The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced Inspection. The Registered Manager, Mrs. Jackie Riddett, was on duty. Planning for the Inspection included reading the notifications of death, illness or other events sent to the Commission for Social Care Inspection and the last Inspection Report, plus the Annual Quality Assurance Assessment, which provides information as to the services the home provides. There have been a number of complaints made by the relatives of residents, investigated by relevant Agencies since the last inspection. These have been noted by the Commission for Social Care Inspection in order to look at issues important to residents welfare. The Inspection took place between 08.45 and 15.30 on day one and between 08.45 and 18.45 on day two. The inspection included a tour of the building, inspection of records and indirect observation of care practices. The Inspectors spoke with twelve residents (though this was limited in some instances due to the communication difficulties of residents with dementia), five members of staff, four visitors, and the Registered Manager. There were eight surveys sent to the Commission for Social Care Inspection from relatives – all were generally very positive regarding the care the staff provide to them. There were some comments as to how the care needs to improve, these include – staffing, meals could sometimes be better and some difficulty with overseas staff communication. A relative commented that there should be disinfectant gel for visitors to prevent the spread of infection, however the isnpector is satified that these matters are adequaltely managed on the home. What the service does well: There were a range of issues which covered residents needs – residents spoken to were generally satisfied with the care they received from staff, they thought that the food was good, that there are a range of activities provided and that the home in general and their bedrooms were kept clean and tidy. The inspectors also observed that staff were generally friendly and helpful in their dealings with residents. Residents said visitors are made welcome, which was also confirmed by visitors, and residents feel that the management would act on any issue they raise. The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 7 Regular activities are provided and residents asked in Residents Meetings as to their preferred activities. Residents said that they were generally free to do what they wished to do. Most bedrooms were homely and personalised with residents stating they were happy with them and they could bring in their personal possessions. Staff training is encouraged so that staff carry out most essential training and they are encouraged to undertake National Vocational Qualification training to add to their care skills. Staff are asked to read the Policies and Procedures of the home so that they know what to do and are consistent in their work. What has improved since the last inspection? What they could do better: Residents needs would be covered more effectively by ensuring that: Care is taken to ensure that all relevant referals for additional medical or nursing input are swiftly made to the appopriate health professional. Care Plans should fully detail residents needs, e.g. continence management. Ensure that staff read residents full Care Plans so that they are always aware of residents full care needs and are consistent in their work. The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 8 The Registered Managers need to ensure that residents privacy and dignity is respected by providing locks to all toilets (as a minority do not have) and that all bedrooms are odour free (a small number were found to have a problem). Procedures need to ensure that out of use medication is swiftly returned to the pharmacist. Staff all need to be aware of the full Vulnerable Adults procedure. Malodour needs to be eliminated from areas of the home as identified in this Report. Review staffing levels and the way in whcih staff are deployed in the home and ensure that these enable residents needs to be met at all times. Employement processes must ensure that all essential statutory staff checks must be in place before staff commence employment. Health and safety systems need to be tightened to ensure that water is kept at a non scalding temperature, that fire safety is fully assured by all staff understanding the full fire procedure and that there is a fully detailed fire risk assessment in place for the home, that access to all Control of Substances Hazardous to Health is restricted, and that all communal facilities are kept clear of equipment. 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.V351945.R01.S.doc Version 5.2 Page 9 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.V351945.R01.S.doc Version 5.2 Page 10 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): 3,6. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The admission process does meet the needs of all residents. EVIDENCE: Residents spoken to by inspectors said that management visited them before their admission into the home and talked about their care needs, and that they had the option of visiting the home prior to their admission. The Inspectors looked at residents files, which contained relevant information in terms of medical, physical and social needs of residents. The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 11 Pre assessment and assessment processes include considering nutritional assessment, however it was identified that cultural needs could be more explicitly detailed. Although the pre admission assessment form does not currently detail specific information regarding a residents medical checks, last optical and dental checks, these are included within the homes care planning processes. The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 12 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 adequate This judgement has been made using available evidence including a visit to this service. Care plans contained relevant information about service users needs, however could be further improved to ensure sufficient detail in all aspects. The medication system needs to strengthened to ensure that medication no longer required is returned swiftly to the pharmacist. EVIDENCE: No residents said that they were aware of Care Plans. It is recommended that residents or relatives (with residents permission) be reminded that they can see Plans and ask for changes if they do not feel they are accurate. Care plans inspected were found to contain relevant information regarding residents needs. There are also Risk Assessments so as to manage any area of risk to residents. Generally there was sufficent detailed information regarding The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 13 residents appointments with GPs, and evidence of a medication review with the GP. The Registered Manager has set up a form so that staff record what personal care that staff provide to residents, though there were gaps on some forms regarding mouth and nail care and teeth being cleaned. On one record, from a wide range of nineteen daily personal care tasks aspects to complete, only two were signed off by staff as being completed for Monday 29th October, so there was little evidence of consistent care being provided. The Registered Manager said that she was in the process of updating Care Plans and that the new system of recording personal care had some inevitable teething problems. There was a discussion with the Registered Manager regarding the need for all Care Plans being more specific as to the frequency residents with continence difficulties needing to be taken to the toilet based on their assessed needs, as a resident only appeared to be toileted during the day by use of changing the pad rather than taking him to the toilet at regular assessed times. There were also other comments received that staff do not routinely take residents to the toilet based on their needs. The Registered Manager said this was not the case and that proper toileting is carried out and residents not just having their pads changed. She said that she would ensure that Care Plans would reflect that all residents with continence problems have proper toileting programmes in place. The Registered Manager subsequently wrote to the Commission for Social Care Inspection stating that the residents, plan may not have reflected the care that this resident had been receiving though he was shortly to have a review and new paperwork was being introduced. There was an issue just prior to the inspection visit regarding why a dressing had been applied to a residential client and why this had not been referred to the District Nursing Service. The registered manager has discussed this with the nursing services and an agreement has now been formalsied. One resident related his experience of care in the home: he said that there was no key in the chair lift and he found it a struggle to walk up the stairs and did not want to go in the main lift as he gets claustrophobic. Inspectors explored this further and found that the key was accessible when required, that this resident often used the lift and they satified that his movements and access to areas of the home was not being restricited. The resident stated that he never goes out with staff although he would like them to go out with him to keep him company. He also stated that he was not shaved everyday, that he has a bath once a week but if there is no staff available he sometimes does not get one at all. Inspectors explored these The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 14 areas in detail and found no evidnece of residents hygiene needs beign neglected. He wanted his dentures repaired and did not know where they were, although he kept asking the staff, he had to wear his old glasses as his newer ones have broken. This service users views were feedback to the registered manager and the Inspectors were satisfied that many of these issues were an individual pespective. Another resident was observed to have shoes that were too big for her, therefore there was a risk of her falling, and the shoes were heavily stained. There were a number of male residents who had not been shaved and a staff member informed an inspector that the same razor was used to shave residents. The Registered Manager said this issue would be followed up though she said it was not policy for residents to share shaving equipment and she doubted this occurred. Care records were kept on a daily basis and were detailed as to residents care needs though there was a problem with the legibility of some handwriting. The Registered Manager said this would be followed up. There is a personal history section in Care Plans to ensure residents are seen as individuals with a valued past. This is a good practice though staff said they had not read all the Care Plans, which is needed to help to ensure that all relevant information is available for staff to meet residents needs. Monthly reviews of plans had been carried out on some Care Plans though not all. This needs to be done to ensure they were still relevant to residents needs. There is now a new system to invite relatives to monthly reviews. This is a good idea though this needs to be with the approval of residents, if they are able to consent. Records show that if residents have serious wounds or potentially serious falls that these are not always referred to Medical Services. It was evident in the care records for a resident, with a wound in September 2007, that this was not reported to Medical Services at the time. It was also noted that in some cases where a resident had fallen and may have bumped their head that these are not always referred to Medical Services, e.g. following an fall in September 2007. It is acknowledged that registered nurse are availbale to make an initial assessment of a resident to consider whether ongoing referral is necessary and General Practitioners have since confirmed that they are appropraitely contacted. Medication records were generally found to be up to date, with only a small number of gaps on records. The Registered Manager said these would be followed up. Staff confirmed that only nursing staff or appropraitely trained staff administer medication. Nursing staff said that they attended refresher The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 15 training for medication administration and there was evidence that a training course had been booked. Medication is kept in locked and secured trolleys though one of the three trolleys inspected was not properly secured to the wall. There is a record for the recording of controlled drugs. This was checked and found to be correct though there were a number of out of use medications, stored in a locked cupboard, which should have been returned to the pharmacist from August 2007.Proper returns records for medication were seen to be in place. It was suggested that the Registered Manager may wish to talk to the pharmacist about printing medication issuing details on medication forms so that this is not carried out by the nursing staff. Staff were observed to be talking to the residents mainly with respect and friendliness, though inspectors observed an instances where they felt a staff were curt in their dealings with residents. There was also one comment from a resident that staff were not always gentle with her when assisting with her personal care. The Registered Manager said this would be taken up with staff and monitored. There were a small number of toilets without functioning locks, which does not protect residents privacy. The Registered Manager said this would be checked and attended to and has sinced confirmed that this has been addressed. The Willows Nursing & Residential Home DS0000001934.V351945.R01.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. Residents have opportunities to have a stimulating lifestyle, though this needs to be extended. EVIDENCE: Residents said that they were generally satisfied with the range of activities on offer and they liked it when staff had time to sit and chat with them, which residents said was not too often as staff were so busy. There is a full time Activities Organiser employed and residents activities were recorded in their Care Plans though this appeared sparse in some records, some of which consisted of childrens cartoons in some records, which did not appear appropriate for this age group, though the Registered Manager thought that these particular residents liked cartoons and it was therefore appropriate for their proper stimulation. The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 17 Residents meeting notes also recorded choices put forward regarding activities. Residents Meetings have been organised though because a number of residents have dementia and some find it difficult to communicate the Registered Manager has set up joint residents/relatives meetings to inform management as to suggestions/quality of life issues for residents. This is a good idea. It was also discussed as to the use of memory boxes, containing valued items, be used for residents, so as to provide valuable reminiscence material for residents with dementia. The Registered Manager said this already occurred to some extent as staff went through residents photographs with them. It is recommended that this be recorded in Care Plans. Residents said that visitors were made welcome by staff. Visiting relatives said staff were always welcoming and friendly to them. Residents said that they thought there were no rules and they could please themselves about things – getting up and going to bed times etc and that staff encouraged them to retain their independence, e.g. a resident using a syringe to give himself insulin and being able to clean his teeth. Residents said they thought the food was generally good and there were choices for meals. Some surveys said that food is liked ‘usually’ or ‘sometimes’. This needs to be followed up by the Registered Manager. There were some comments regarding peas being served too often and this was borne out by food records, which recorded peas being served four out of five days. The Registered Manager said she would review this provision. Food records were generally detailed though did not always record the variety of vegetables offered. Weight charts are kept. Inspectors recommended that an action column be added to this chart to indicate what occurs if there is significant loss or gain. A Care Plan was seen that indicated weight gain and the provision of food supplements. The food observed appeared to be of a satisfactory standard with two courses and choices of the main meal with two vegetables plus potatoes served. A soft diet was available to residents who needed this. Staff were seen to be assisting residents to eat though as there were a large number of residents needing this assistance not all residents were able to have this assistance as soon as the dinner was served. There appeared to be short staffing at this time, as one resident was seen to be struggling to eat her meal. However the inspectors noted that heated trolleys are used for those who may have to wait for assistance. Residents said there was a system that staff came The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 18 round to ask them what they wanted to eat the next day. This is a good system to enable choice. It was also recommended that a menu board be displayed to supply this information to residents. The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 19 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 poor. This judgement has been made using available evidence including a visit to this service. Staff awareness of the full abuse procedure needs to be increased to ensure protection of residents. The lack of statutory checks being in place for newly recruited staff meant that residents were at risk from potentially unsuitable staff. EVIDENCE: Residents and relatives spoken with said that they did not need to complain but if they did they thought the management would look into it properly if they ever needed to. A relevant local authority has investigated some complaints since the last inspection and thee have not yet been fully concluded. The Registered Manager has set up an Action Plan to cover issues raised to date. In line with the latest procedure, the homes Complaints Procedure should be altered to give the complainant the choice at the initial stage to go to the investigating body – the local Social Service Department - now the lead agency for investigating complaints – as well as the home. The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 20 Staff members were asked about their understanding of the adult protection procedures, and demonstrated a generally good understanding of the in house procedure though they struggled on knowing all outside agencies to contact if the in house procedure failed. The Registered Manager said that staff had attended Protection of Vulnerable Adults training held by the home but this would be further followed up to ensure the whole procedure is known by staff. Criminal Records Bureau checks were not in place for three staff at the commencement of their employment (Certificates were on file but were received by the home after the commencement date). An Immediate Requirements Notice was served to ensure that this does not occur again as it is a statutory Requirement to ensure the protection of residents from unsuitable staff. The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 21 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): 19,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A generally clean environment is provided to residents though there needs to be a consistent approach to ensuring malodours are eliminated. EVIDENCE: Residents all said that they liked the home’s facilities and that the home was kept clean and tidy. They said they could have their bedrooms in the way they wanted and could bring in their own furniture and other personal possessions or not as they so choose. This was confirmed by the manager. The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 22 Facilities were found to be generally clean though there were a small number of bedrooms, which were malodouress, and some bedrooms with carpet stains. Some carpets may need replacing. Facilities are generally light and well decorated and there was a decorator present during the inspection who said he was painting communal areas and some bedrooms. The Registered Manager said that there was a rolling programme to deal with all maintenance and refurbishment issues, and carpets were due to be replaced as planned, and there is a maintenance person who can attend to issues that arise. Some easy chairs in a lounge were found to be worn and needed repair/replacement. There was discussion with the Registered Manager as to the use of tables in front of residents chairs, in that there were not appropriate in terms of residents feeding themselves due to the gap between the resident and table, and it would be better for residents health – pressure area care etc. if they were encouraged to go to the dining table for meals. If it is residents choice to remain in their easy chairs this needs to be recorded on Care Plans. The home has an intercom system, which may be considered intrusive by some and detract from a homely atmosphere, so it is recommended that this system and its use be reviewed by management. There was a discussion with the Registered Manager as to signing the environment for residents with dementia – e.g. colour coding doors to bathrooms, pictures on bedroom doors etc. The Registered Manager said this would be looked into though some bedroom doors already had this signage. The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 23 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 adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels and deployment should be reviewed to meet the supervision and care needs of all residents. Recruitment processes need to be strengthened to ensure the protection of residents from unsuitable staff. EVIDENCE: There were a number of comments received that residents said that they usually had to wait too long if they needed help though staff shortages. One resident said there was a long wait to obtain a painkiller. There is a usual staffing ratio of five care staff on each floor for morning shifts with four awake night staff members on duty at night. In addition there are usually two to three nursing staff on duty for each shift. The Registered Manager stated that staffing levels were high enough to meet residents needs but said that she would review them as at present there were a large number of nursing staff on shifts, and she needed to check their tasks so that there are enough staff able to be able carry out all personal care tasks needed by residents. There were other comments received by the inspectors that staffing levels were not always sufficient and other information which supported this position The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 24 in the Quality Assurance Survey of 2007, in that there are a high number of residents who need the assistance with personal care – over twenty according to the Annual Quality Assurance Assessment and over thirty residents with continence needs. Inspectors observed that there were no staff supervising lounges for some periods and in one such period there was a resident trying to get out of her chair and was at risk of falling. There are also residents who try to get out from the home when they are not safe to do so. With this level of need there would appear to be a need to increase staffing ratios to ensure residents have their care needs fully met and are available to take residents out for walks or for other activities – chatting with them etc. This appears to be particularly the case for the evening periods when there may only be three Care Assistants on the floor from 5pm to 9pm. Staff records were inspected and it was found that statutory Criminal Records Bureau checks had not been obtained for three staff at the commencement of their employment, though they had been obtained after this date. The Registered Manager acknowledged this and said it would not reoccur in the future. An Immediate Requirements Notice was served so that this situation does not happen again and that residents are protected from unsuitable staff. Staff said that training is provided and that there is encouragement to complete National Vocational Qualification training. The Registered Manager stated that sixty one per cent of staff had National Vocational Qualification level 2 or 3 training and this would be more in the near future when staff passed the courses they were studying – this exceeds the fifty per cent benchmark stated in the National Minimum Standard. There were training certificates on file to validate training and there is a core training programme for staff – e.g. for Health and Safety, First Aid, Dementia, Moving and Handling, Infection Control, confidentiality, Residents Rights, Fire, Mental Capacity Act etc, though not all staff had received this training. There is an induction programme, which covers relevant topics. The Registered Provider said that the recognised Skills for Care induction booklet is currently being used for newly recruited care staff. The Willows Nursing & Residential Home DS0000001934.V351945.R01.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): 31,33,35,36,38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Systems are not fully in place to protect the health and safety of residents. EVIDENCE: The Registered Managers are Registered Nurses and have a team of Registered Nurses to help meet the needs of nursing residents. As stated in this Report there are some important issues which the Registered Managers need to tackle to ensure that residents needs are fully met and their health and safety fully protected. The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 26 Residents monies records show that there is a record for each transaction and that two staff sign each transaction. There was evidence that ongoing Quality Assurance surveys are carried out with residents and relatives. It is recommended that this information is analysed and information is included in the Statement of Purpose. Quality Assurance includes Accident Reports having regular monitoring by the Registered Manager, the communication sheet in the care plan for staff to record any contact with relatives, the Record of Risk Assessment reviews, invitations for families to attend monthly reviews, open monthly surgeries with the Registered Manager (one took place upon the day of inspection) and Residents Meetings. Staff meetings are held with good records of relevant issues discussed. The Registered Manager said they are to be held more regularly now as there was over a five month gap between April and September 2007. There was information that staff receive supervision on a regular basis, and have an annual appraisal, though this appeared to be limited to supervising staff regarding specific care tasks. It is recommended that supervision is extended to include an assessment from management regarding other issues – individual performance, practice issues – e.g. full knowledge of the Protection of Vulnerable and individual training needs etc. The inspectors noted concerns as to some health and safety issues – sterident tablets were found in a residents bedroom, which could cause choking, there was equipment in a toilet on the first floor with a ladder found in another bathroom, which could have posed tripping hazards. There are Risk Assessments for safe working practices that have been carried out for issues that present risk for issues that may present a danger to residents and staff, though this was a tick system rather than a detailed assessment of risk, as current guidance recommends. There needs to be a more thorough system of checking risks as all issues were ticked as being managed yet inspectors picked up issues on the day of the inspection. The Registered Manager said she would review and extend this system to include all relevant detail. Fire Precautions: there was a fire door propped open to the library, the registered manager removed this immedaitely when brought to her attention. It was also noted that some bedroom doors were propped open, staff spoken to by the inspector were mostly aware of the proper fire procedure though one staff member was unsure regarding contacting the fire service. The Registered Manager said these issues would be followed up. Fire drills had been carried out at the required monthly intervals and there was a fire risk assessment for the home, to ensure that fire issues have been The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 27 considered and residents protected from fire. The Registered Provider agreed to revise this in line with more detailed fire service guidance. Emergency lighting testing was being carried out on the required monthly basis and fire bell testing was mostly carried out on the required weekly basis though for some entries this was over a week between tests. Hot water outlets – washbasins – accessible to residents in the staff toilet on the first floor and in bedroom 11 were a scalding risk, being measured at 60c and 50c respectively. The National Minimum Standard is close to 43c. An Immediate Requirements Notice was served to rectify this issue. A hot water outlet in a first floor bathroom was found to be 34c, which was lukewarm and would not provide a cosy bath temperature for residents. The Registered Manager said she would follow up these issues. There are radiator covers to protect residents from burning. The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 2 8 3 9 2 10 2 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 2 17 X 18 1 3 X X x X X X 1 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 1 The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? N/A 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 OP7 Regulation 15 Requirement All care plans must be sufficiently detailed to enable staff to provide residents health, personal and social care needs; and regularly reviewed. Timescale for action 29/02/08 2. OP9 13 Medication no longer in use must 29/02/08 always be promptly returned to the pharmacist. Residents privacy must be respected by the provision of locks to all toilets and bathrooms. Staff must be able to understand and operate the full Vulnerable Adults procedure. Identified parts of the home must be free from offensive odours. Staffing levels and deployment must be reviewed to ensure that residents needs and supervison rquirements are meet at all times. 29/02/08 3. OP10 12 4. OP18 13 29/02/08 5. OP26 23 29/02/08 6. OP27 18 29/02/08 The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 30 7. OP29 19 Staff must have Criminal Records Bureau checks in place before they commence employment. Health and safety systems must be fully in place and cover residents from the risk of scalding, ensure all fire issues are fully covered, that equipment is properly stored and there must be suitable safe arrangements for storing Control of Substances Hazardous to Health items such as steridant. 01/11/07 8. OP38 23 29/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP36 Good Practice Recommendations It is recommended that the supervision system for staff is made more comprehensive. The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 31 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 The Willows Nursing & Residential Home DS0000001934.V351945.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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