CARE HOMES FOR OLDER PEOPLE
The Willows Residential Home 89 London Road Hinckley Leicestershire LE10 1HH Lead Inspector
Mrs Kathy Jones Unannounced Inspection 23rd May 2007 09:00 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 Residential Home DS0000001713.V337619.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 Residential Home DS0000001713.V337619.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Willows Residential Home Address 89 London Road Hinckley Leicestershire LE10 1HH 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) 01455 615193 01455 616228 Southern Cross Care Centres Limited Vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (10), Physical disability of places over 65 years of age (10) The Willows Residential Home DS0000001713.V337619.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. No-one under 55 years of age, falling within category PD to be admitted to the home. Service User Numbers. No-one in category PD or PD(E) to be admitted to the home if 10 persons in total in these categories/combined categories are already accommodated within the home. 28th December 2006 Date of last key inspection Brief Description of the Service: The Willows is a care home providing personal care and accommodation for up to forty older people, which includes people who have a physical disability. The Southern Cross group of care homes owns the home. The home is located close to the town centre of Hinckley, close to shops, pubs, the post office and other amenities and is easily accessible by private or public transport. The home is a purpose built two-storey building with level entry access and access to both floors by use of the passenger lift or stairs. A range of amenities is available to residents’ namely washing, bathing and toilet facilities, which includes a choice of dining and lounge space. The home has thirty-one single bedrooms, twenty-six with en-suite facilities and five without. There are two double bedrooms one with en-suite facility and one without. The home has a garden to the rear of the building which is well maintained and which is accessible to all residents residing in the home. The following fees were provided by the Acting manager as being current at the time of the inspection on 23 May 2007: Fees range between £329 and £379 per week for residents funded by local authorities. A ‘top up’ fee is charged up to £30.50 dependent on ability to pay. The weekly fee for privately funded residents is £495. The fees include personal care, accommodation, meals and laundry. Chiropody (£6) and hairdressing services (£2 - £16) can be arranged and are charged separately. Other costs would include newspapers, clothing and toiletries. The Willows Residential Home DS0000001713.V337619.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Standards identified as ‘key’ standards and highlighted through the report were inspected. The key standards are those considered by the Commission to have a particular impact on outcomes for residents. Inspection of the standards was achieved through review of the information held by the Commission for Social Care Inspection as part of the pre-inspection planning and an unannounced inspection visit to the service. The preinspection planning was carried out over the period of half a day and involved reviewing the service history, which details all contact with the home including notifications of events reported by the home, telephone calls, letters, and details of any complaints and concerns received. The report from the last key inspection carried out on 28 December 2006 and the report of the random inspection, which was conducted on the 19 March 2007 were reviewed. The random inspection was carried out to monitor compliance with requirements made following the inspection in December 2006. The findings of the inspections were taken into account when planning this inspection. Prior to the inspection visit a pre-inspection questionnaire had been forwarded to the service for completion along with some questionnaires to be given out to residents and their relatives. Unfortunately there was a delay in this being received by The Willows due to the paperwork being damaged in transit. Given the concerns that had been identified at the last key inspection it was agreed to allow additional time following the inspection visit for resident and relative views to be taken into account. The unannounced inspection visit covered the morning and afternoon of a weekday. The inspection was carried out by ‘case tracking’ which involves selecting residents’ and tracking their care and experiences through review of their records, discussion with care staff and observation of care practices and the environment. The inspector spoke with several residents throughout the inspection, visiting relatives and staff about the care provided. Observations were made of residents’ general well being, daily routines and interactions between staff and residents. Records reviewed included a sample of staff files to check the adequacy of the recruitment procedures. Feedback on the findings of the inspection was given to the Acting Manager throughout the inspection. What the service does well:
The Willows Residential Home DS0000001713.V337619.R01.S.doc Version 5.2 Page 6 The staff team create a relaxed and friendly environment for residents and a relative said that even in trying situations staff always give their “all” and are very understanding. Residents spoken with, and those who forwarded completed questionnaires were happy with the care provided. Good links have been formed with the community nurses who have also provided some staff training, giving staff a better understanding of residents’ needs. Staff acknowledge and celebrate residents’ special events such as birthdays and a resident said that there is always someone to cheer them up. Visitors are made welcome by staff and are encouraged to visit, which helps to enhance the daily lives of residents. Residents’ were happy with the meals provided and discussions with the Chef identified that efforts are made to meet residents’ individual needs and preferences. What has improved since the last inspection?
Considerable improvements have been made since the last key inspection in December 2006 in many areas. Fifteen statutory requirements were made following that inspection covering areas such as the planning and meeting of residents’ needs, management and administration of residents’ medication, management of complaints, staffing levels, staff recruitment and training and quality assurance. These requirements have now all been met reducing the risk and improving standards of care to residents. Care plans are now more reflective of residents’ needs providing staff with more accurate information about the care they need to provide. Staff have also received additional training to help them meet residents’ needs. The overall management of medication and practices for administration have improved making this safer for residents’. Monthly medication audits are carried out by the Acting Manager which enables staff practice to be monitored and any identified shortfalls to be addressed, reducing the risk to residents. Staffing levels in relation to residents’ needs have improved enabling residents’ needs and preferred routines to be met. A programme of staff training has also been established to ensure that staff receive the necessary training to meet residents’ needs. Recruitment practices have been improved to ensure that satisfactory checks and references have been received before staff work with residents’, helping to provide residents’ with some protection. Although there is no registered manager in post at the present time, the Acting Manager has been managing the home since November 2006. This has
The Willows Residential Home DS0000001713.V337619.R01.S.doc Version 5.2 Page 7 provided some continuity and stability and improved standards of care to residents’. Quality audits have been implemented and are carried out monthly by the Manager and alternate months by the Operations Manager helping to identify and address any shortfalls in the care provided to residents. 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. The Willows Residential Home DS0000001713.V337619.R01.S.doc Version 5.2 Page 8 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 Residential Home DS0000001713.V337619.R01.S.doc Version 5.2 Page 9 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, std 6 was not assessed, as intermediate care is not provided. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process provides assurances that the needs of residents entering the home can be met. EVIDENCE: The admission process was reviewed through discussion with the acting manager about a recent enquiry about admission, as there have been no recent admissions and none since the inspection carried out in September 2006. The Acting Manager advised that prospective residents and their families are encouraged to visit where they are able. Information is provided to them verbally and is then supported by written information in the form of a brochure, a statement of purpose and a service user guide, which give information about the services provided.
The Willows Residential Home DS0000001713.V337619.R01.S.doc Version 5.2 Page 10 Completed questionnaires were received from four residents who all confirm that they had sufficient information about the home before they moved into help them decide if it was the right place for them. Information including inspection reports is also made available to current residents. The organisation has a thorough assessment process, which includes carrying out an assessment of prospective residents needs in order to establish if they can be met. The Willows Residential Home DS0000001713.V337619.R01.S.doc Version 5.2 Page 11 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. The overall care and management of residents’ medication is good with health care services being accessed as appropriate. EVIDENCE: Observations during the inspection, discussion with residents’ and visitors and feedback in questionnaires confirmed that the standard of care to residents’ has improved since the last inspection. The Acting manager acknowledged the need to monitor standards of care to ensure that improvements are sustained. Improvements in the care planning were identified in that they were more reflective of residents needs and the actions required of staff to meet the needs. While discussion with staff indicated that they were aware of residents’ current needs, there was some evidence that further work is required to ensure that all of the plans are specific about the actions required to meet the needs of the individual and that staff understand the importance of ensuring
The Willows Residential Home DS0000001713.V337619.R01.S.doc Version 5.2 Page 12 the information in each record is accurate. For example, there had been an incident where a resident was choking, however the daily record stated “---had settled day all care given”. Unless the records are accurate, there is a risk that staff may not be aware of residents changing needs. There was evidence that residents’ and their families are aware of and involved in the care planning process. The plans are reviewed monthly and appeared to reflect current needs. Healthcare services care services are accessed where required for residents’. Their records showed the involvement of health professionals such as the General Practitioner and District Nurses, with advice being sought as appropriate. Good links have been formed with the community nurses who have also provided some staff training in meeting residents’ specific healthcare needs. A relative confirmed that chiropody visits are arranged. A sample check of residents’ medication and observations of a staff member administering medication confirmed that medication practices have improved since the last inspection reducing the risk to residents. The Acting Manager carries out monthly audits of medication in order to monitor practice. Staff were observed to speak to and treat residents’ with respect and to be mindful of their dignity. The Willows Residential Home DS0000001713.V337619.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, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements have been made to the daily lives of residents in that they are receiving assistance according to their needs and routines. Residents’ visitors are encouraged and welcomed into the home and residents’ are happy with the quality of food provided. EVIDENCE: Observations during the inspection identified that residents were receiving assistance as and when they needed it according to their individual needs and routines. This was an improvement since the last inspection when residents’ were in some cases waiting long periods for assistance. A relative confirmed the improvements. There is a programme of activities, which is detailed on the notice board. They include some in house activities such as bingo and outside entertainers such as a pianist who visits monthly. Three relatives have said that there are always activities that they can take part in, while one has said there usually are. A
The Willows Residential Home DS0000001713.V337619.R01.S.doc Version 5.2 Page 14 relative suggested that improvements could be made, by having more interactive activities. Staff acknowledge special events such as residents’ birthdays. It was a residents’ birthday on the day of inspection and all staff at some point during the day made a point of going to wish her a happy birthday and the chef had made a birthday cake for her. A questionnaire from a residents stated “when I need cheering up there is always someone to raise my spirits”. A Church of England service is held monthly for those residents’ who wish to attend and the Salvation Army visit monthly. Visiting arrangements are flexible and residents’ confirmed that they are able to receive visitors as and when they wish. The Chef on duty on the day of inspection advised that they have a four week rotating menu, which is adapted according to residents’ comments and requests. At the time of the inspection there were no residents requiring special diets to meet religious or cultural needs. However discussions confirmed that the Chef is aware of residents’ dietary needs and preferences. Residents’ said that they are happy with the meals. A questionnaire received from a resident stated, “There is plenty of variety and choice, meals are excellent. The Willows Residential Home DS0000001713.V337619.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, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ and relatives are satisfied that concerns and complaints are dealt with appropriately and staff receive training in safeguarding adults, which helps to protect residents’. EVIDENCE: The Commission for Social Care Inspection (CSCI) have not received any complaints about the service since the last inspection. Review of the record of complaints in the home identified that no complaints have been received since the last inspection. Residents and relatives confirm that they know how to make a complaint. Relatives spoken with confirm that the Acting Manager has taken any concerns seriously and responded appropriately. The Acting Manager advised that some staff have just received training in safeguarding adults and more staff are booked to attend. A resident spoken with had no concerns about the way that staff treated residents and discussion with staff has confirmed that they are aware of their responsibilities in safeguarding the vulnerable adults in their care. The Willows Residential Home DS0000001713.V337619.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, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have a clean and comfortable home to live in. EVIDENCE: A sample check of the shared lounges and dining rooms and a residents’ bedroom was carried out during the inspection. All areas were clean and comfortable. Residents’ spoken with during the inspection were happy with their rooms and the standard of cleanliness. Questionnaires received from four residents confirm that the home is always fresh and clean. Residents’ said that they are able to choose whether to spend their time in their rooms or the shared lounges. Residents’ can also see their visitors in the privacy of their rooms if they wish.
The Willows Residential Home DS0000001713.V337619.R01.S.doc Version 5.2 Page 17 The Acting Manager advised that a re-decoration programme is due to commence, which will include painting residents’ bedroom doors in different colours to make them more individual and easily recognisable. The Willows Residential Home DS0000001713.V337619.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, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing arrangements meet the needs of residents. EVIDENCE: At the time of the inspection there were sufficient staff on duty to meet residents’ needs. Comments from residents received in the questionnaires confirmed that staff were available when needed. The majority of comments received from residents and relatives about the staff team were very positive. One relative said that “even in trying situations the staff always give their all”. Staff said that the improved staffing levels and the reduced reliance on agency staff has meant that residents’ are able to get up and go to bed when they wish and also that they have been able to establish improved routines for meeting residents’ needs. Discussion with staff identified that training is being provided and arrangements are being made to enable staff to achieve a National Vocational Qualification (NVQ) in care. A sample check of records confirmed that staff are receive training appropriate for meeting the needs of residents.
The Willows Residential Home DS0000001713.V337619.R01.S.doc Version 5.2 Page 19 The file of a recently recruited member of staff was reviewed to check the adequacy of the recruitment process. This identified that references and criminal record bureau clearances had been obtained prior to staff starting work, which provides some protection to residents The Willows Residential Home DS0000001713.V337619.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, 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is being managed in the best interests of residents. EVIDENCE: Standard 31 relates specifically to the registered manager and their experience and qualifications. At the time of the inspection there was no registered manager in post therefore this standard was not inspected as such. However the adequacy of the current management arrangements are discussed as they are considered a key aspect of ensuring that residents receive appropriate care. The Willows Residential Home DS0000001713.V337619.R01.S.doc Version 5.2 Page 21 At the time of inspection the registered manager had just left following a period of sick leave. There was however an Acting Manager who had been in post since November 2006 which has provided some continuity and stability to the management arrangements. The recruitment process for a permanent manager has commenced. Staff and relatives have confirmed that the Acting Manager is approachable and has worked hard with the staff team to address the shortfalls and improve standards of care for residents. As part of the quality assurance system the Acting Manager is carrying out monthly audits, which include the management of residents’ medication, review of care such as the management of any pressure sores, review of any complaints and the building maintenance. On alternate months the Operations Manager carries out another audit to validate the findings. This process should help the organisation to monitor and maintain the standards of care provided to residents. While the standard of record keeping has improved, as detailed in the health and personal care section additional work is required to ensure that records are accurate and that information within the care records links together to support residents’ care. Advice was also given to monitor the communications book to ensure that data protection requirements are adhered to, as in some cases this contained confidential information about individual residents. Staff have received training in safe working practices such as movement and handling, food hygiene and some have received first aid training. Health and safety training has also been booked. Staff were observed to be carrying out safe movement and handling practices when assisting residents’ to transfer from chairs to wheelchairs. There was evidence that the Acting Manager reviews the accident records regularly in order to identify any patterns or any changing needs of residents. Following review of residents’ records, advice was given to record any investigations and the findings in relation to injuries where the cause is unknown. This will help to identify any changing needs of residents’ or poor staff practices, helping to protect residents’. The Willows Residential Home DS0000001713.V337619.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 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 X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score N/A X 3 X X X 2 3 The Willows Residential Home DS0000001713.V337619.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. Standard Regulation Requirement Timescale for action 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 OP28 Good Practice Recommendations The planned programme of training should continue to include National Vocational training or equivalent in care, to ensure that staff are fully equipped to meet the needs of residents. Care should be taken to ensure that all records comply with data protection requirements maintaining residents’ confidentiality. 2. OP37 The Willows Residential Home DS0000001713.V337619.R01.S.doc Version 5.2 Page 24 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
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