Inspection on 26/09/06 for The Willows Residential Home

This inspection was carried out on 26th September 2006.

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 Residential Home 30/07/09

The Willows Residential Home 23/05/07

The Willows Residential Home 28/12/06

The Willows Residential Home 30/01/06

The Willows Residential Home 22/02/05

The Willows Residential Home 24/08/04

The Willows Residential Home 03/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE The Willows Residential Home 89 London Road Hinckley Leicestershire LE10 1HH Lead Inspector Mrs Kathy Jones Unannounced Inspection 26th September 2006 9:30 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.V312967.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.V312967.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 Mrs Sylvia Ann Jones 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.V312967.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. 30 January 2006. Date of last 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 home is owned by the Southern Cross group of care homes. 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 registered manager as being current at the time of submission of the pre-inspection questionnaire on 4 August 2006: • Fees range between £269 and £465. 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.V312967.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Most of the 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. Some of the key standards were not inspected during this inspection and will be inspected during a random inspection, which will take place to monitor compliance with the requirements made. Inspection of the standards was achieved through review of information held by Commission for Social Care Inspection, inspection planning, an unannounced inspection visit to the home and drawing together all of the evidence gathered. The pre-inspection planning was carried out over the period of 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 complaints and concerns received. A pre-inspection questionnaire submitted by the registered manager, four comment cards from residents, one from a relative and two from health professionals. The information gathered assisted with planning the particular areas to be inspected during the visit. 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 them, the care staff and observation of care practices. The inspector also spoke with other residents’ who were not part of the case tracking process. The lead pharmacy inspector accompanied the lead inspector on this inspection and focussed on the management of residents’ medication. The main findings are incorporated into this report. A sample of staff files were reviewed to check the adequacy of the recruitment procedures. Communal areas and a sample of residents’ bedrooms were viewed and observations were made of residents’ general well being, daily routines and interactions between staff and residents. Feedback on the inspection findings was given to two temporary managers throughout the inspection. An immediate requirement was made during the inspection regarding medication and timescales for addressing the immediate The Willows Residential Home DS0000001713.V312967.R01.S.doc Version 5.2 Page 6 concerns agreed with the operations manager in a telephone call. Subsequent telephone conversations have taken place with the operations manager about the actions taken to address the immediate requirement made. What the service does well: What has improved since the last inspection? Review of the last inspection report identified that there were no requirements or recommendations made. The findings of this inspection identifies that there has been deterioration in standards of care. The Willows Residential Home DS0000001713.V312967.R01.S.doc Version 5.2 Page 7 What they could do better: The main concerns at the time of this inspection related to the management of medication, monitoring of residents’ healthcare conditions such as diabetes, planning of residents’ care, staffing levels, staff recruitment and staff training. Medication was poorly managed, with occasions where residents were not given medications as prescribed with no explanation. This included pain relief, anti-depressants and medication for diabetes and antibiotics, which should be given regularly. Practice in relation to the administration of medication was poor with infection control risks, medication not being given at regular times with inadequate gaps between doses. Residents in some cases did not have sufficient assistance with their medication and were left without support creating a risk of medication being dropped or spilt or taken by someone else. Due to the level of concerns and the discrepancies identified an immediate requirement was made for all medication records to be checked to ensure that all residents were receiving medication as prescribed. Confirmation has since been received that this was carried out and requests for medication reviews are being made to all residents’ general practitioners’. Care plans are not reflective of residents’ current needs and there are indications that appropriate and timely referrals for healthcare have not always taken place. For example the care plan for a resident identified that they wear dentures. The dentures were found in a container in the resident’s en-suite bathroom. Staff informed the inspector that the resident had lost weight and the dentures no longer fitted. Action is now being taken in relation to residents experiencing weight loss and dental services have been arranged. The routines for residents who are dependent on staff for assistance, particularly those who required two staff for assistance were not based on their preferences at the time of inspection. This meant that residents sat at the breakfast table for a long time waiting for staff to assist them to a comfy chair and one resident was not assisted with washing and dressing until 11-30am and had not had breakfast. Some residents didn’t have their morning medication until very late. The inspector has been informed following the inspection that staffing levels have been increased as a result of these findings, however it is vital that arrangements are in place to monitor the adequacy of staffing levels in meeting residents needs. Staff training, recruitment procedures and staffing levels were not providing adequate care and protection for Service Users. For example staff had not received training in the organisations medication policies and procedures, poor practice in relation to the management of diabetes identified a lack of training in residents healthcare conditions, which was in the process of being addressed by the district nursing team. While appropriate checks appeared to have been The Willows Residential Home DS0000001713.V312967.R01.S.doc Version 5.2 Page 8 made for some staff employed it was identified that there was no criminal record bureau clearance for a member of staff. Difficulties were identified in locating some records in the absence of the registered manager however at the time of writing the report no evidence that this has been obtained has been received. The lack of up to date movement and handling plans puts residents and staff at risk. 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 Willows Residential Home DS0000001713.V312967.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 Residential Home DS0000001713.V312967.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, std 6 is not applicable, as the home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using all the available evidence including a visit to the service. Information is provided to enable service users to make an informed choice before being admitted to the home. EVIDENCE: Comments received from four residents confirm that they have a contract and that they had received sufficient information about the home before moving in to decide it was the right place for them. The adequacy of the assessment process would normally have been reviewed at this key inspection to ensure that care is being taken to ensure that the needs of people entering the home were being met. Due to the priority of considering how the needs of current residents’ are being met this standard was not inspected. The organisation does however have a thorough The Willows Residential Home DS0000001713.V312967.R01.S.doc Version 5.2 Page 11 assessment process and the adequacy of how this is implemented in practice will be inspected at a later random inspection. The Willows Residential Home DS0000001713.V312967.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. This judgement has been made using all the available evidence including a visit to the service. The shortfalls in the planning and delivery of care and the management of medication put residents’ at risk. EVIDENCE: Three out of four residents who commented said that they always get the care and support that they need. Only one completed questionnaire was received from relatives and this confirmed that they were satisfied with the care provided. They confirmed that they are kept informed of important matters and consulted about the care. Conversations with residents and observations during the inspection identified that the residents who are more dependent did not always get the help and support they needed when they needed it. This issue is also covered within the staffing section of the report. The Willows Residential Home DS0000001713.V312967.R01.S.doc Version 5.2 Page 13 Following complaints and concerns which have recently been raised about the care of some residents’ Southern Cross, have confirmed that an audit of resident care has been carried out. As part of the audit it was identified that some residents had lost weight. Records show that regular weight checks have now been implemented and that residents have recently put on weight. Care plans are not reflective of residents’ current needs and there are indications that appropriate and timely referrals for healthcare have not always taken place. For example the care plan for a resident identified that they wear dentures. The dentures were found in a container in the resident’s en-suite bathroom. Staff informed the inspector that the resident had lost weight and the dentures no longer fitted. A temporary manager informed the inspector that several residents had recently been identified as requiring dental treatment and this has now been arranged. Care plans are in place, which are intended to be tools to guide staff in providing care, which is appropriate to the needs and preferences of residents’. Review of a sample of residents’ plans identified that the information contained within them was not always, reflective of their current needs, sufficiently detailed or appropriate in the guidance given. For example it was identified that the blood sugar levels for one resident were very unstable and the inspector was informed that the resident was not compliant with a diabetic diet. There was no information in the care plan about non compliance with diet, no information about the normal range of blood sugar levels for that individual or guidance for staff as to the actions that they should take if the blood sugar levels were outside the ‘normal’ range. There was also no evidence that the resident had been involved in the development of their care plan. Comments received from two residents were that they always get the medical support they need while two said they usually did. One resident said that the doctor is always called if needed. Comments received from health professionals have varied; two completed questionnaires stated that they were satisfied with the overall care provided. However other health professionals have expressed concerns about the management of residents’ health care needs, and diabetes in particular. Concerns have been expressed that staff do not always know when residents’ have had their last meal and the routines of the home do not take account of the need and importance of diabetic residents having meals at regular intervals. Concerns had been previously identified by the organisation about the management of medication in the home and there was evidence that some action had been taken. For example, action had been taken to put in place photographs for each resident to assist in identification and information about known allergies. Improvements were noted in the checking and signing for administration of controlled drugs. Policies and procedures were available The Willows Residential Home DS0000001713.V312967.R01.S.doc Version 5.2 Page 14 however the staff member on duty had not had the opportunity to read them or received training in using the policies from the current owners of the home. However continuing serious concerns were identified. Records and medication being returned to the pharmacy showed a high level of missed doses in the monitored dosage system and unused packs of medication such as inhalers, insulin, lactulose Medication not being given as prescribed resulted in one resident not having adequate pain relief on at least three occasions. Another resident was not receiving anti-depressants as prescribed and was described by staff as being low in mood. Records indicated that doses of medication had not been given without any explanation recorded, this included medication for diabetes and antibiotics, which should be given regularly. Practice in relation to the administration of medication was poor with staff not checking medication had been taken or residents’ given appropriate assistance creating a risk that medication is not taken, or taken by others. One resident was observed with a pot containing several tablets and another due to her condition having difficulty holding a glass of soluble tablets. To reduce risk to residents it is important that medication is not left unattended unless there is a self administration policy in place and individual risk assessments have been completed. There was a partly used bottle of temazepam liquid with a torn label, which meant that the name of the medication, resident and dose could not be read. Instructions on paractemol were unclear (Two to be taken twice a day (boxed for pink/yellow and orange/blue doses)). Staff did not know what this meant. There was very poor practice in the home for managing waste medication and for ordering medication. Large quantities were found for July, August and September. The large quantities of medication being returned unused indicated that medication was not being administered as prescribed and, or, that too much medication was being ordered and that unused medication was in some cases being needlessly returned at the end of the month. This included medication for diabetes and asthma. The large amount of pain relief medication and medication for constipation which were prescribed for regular use but were being refused indicated the need for medication reviews. There were also large quantities of inhalers and diabetic medication, which indicated that these conditions were not being managed as intended by the prescribers’. All medication in use at the home needs to be reviewed as a matter of urgency and very urgently for all residents suffering from asthma, diabetes and those requiring pain relief. The inspector was informed that letters were going to be sent on 29 September 2006 to all general practitioners requesting medication reviews. Some of the medication administration records did not appear to be an accurate record of prescribed medication and administration. For example The Willows Residential Home DS0000001713.V312967.R01.S.doc Version 5.2 Page 15 labelled medication was found that was not recorded on the medication administration record including medication for angina for two residents, a vitamin B12 injection, and a pain relieving cream. One of the temporary managers contacted the relevant General Practitioners’ to check these residents’ medications during the inspection. Evidence at the time of the visit indicated that the management of diabetes was of a poor standard. One resident said that they felt that staff were not very aware of the condition and that they were more knowledgeable about signs of deterioration than the staff. There was no evidence in this residents’ care plan of an assessment of their ability to self medicate or the level of support this resident required with the management of their condition. Insulin devices were kept without adequate labels in a tray in the trolley with eye drops and there was a potential risk of contamination because of this practice. Two residents had the same type of insulin pen but the two pens in the trolley were not labelled although one had a name taped on. Blood glucose testing strips were not recorded on medication administration records and results of tests were not available in the clinic room. There was a plastic box on top of the trolley with one blood glucose-testing device and a box of testing strips with blood on it. There were also tissues with blood on them. This suggested poor practice relating to infection control. A tablet-cutting device was in use to cut some medication in half. The device was old, dirty and contained a lot of tablet dust. This would put residents with allergies to certain medications at risk if the device contained residues of medication they were allergic to, there was a risk that the powder from one medication could contaminate another and be given to a resident who was not prescribed it. The device was dirty and an infection control risk. Medication for asthma and angina that may be required quickly by residents such as inhalers for when required use and GTN spray for angina were found in the trolley and were not available for immediate use. A comment received from a resident prior to the inspection identified that there have been problems in receiving medication at regular intervals as prescribed. This was supported by inspectors’ observations during the inspection. The morning drug round had only just started at 9.30am and did not finish until around 11.15 am. The lunchtime round started at around 1.15pm. It is important to give medication at the times prescribed with adequate intervals between doses. Staff of all designations were observed to treat residents with dignity and respect and expressed commitment to meeting their needs. The Willows Residential Home DS0000001713.V312967.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a visit to the service. The routines of the home do not support residents’ needs or preferences and in some cases put them at risk. EVIDENCE: Comments received from residents in questionnaires said that there are usually activities they can join in with the other two said there were sometimes. A resident told inspectors that entertainers come into the home to sing to them however there are not many opportunities to take part in discussion or activities that are mentally stimulating. The routines for residents who are dependent on staff for assistance, particularly those who required two staff for assistance were not based on their preferences at the time of inspection. Residents reported that they had been sitting waiting at the breakfast table for long periods for staff to assist them to a comfy chair. It was also reported that a resident was not assisted with washing and dressing until 11-30am and had not had breakfast. As detailed in the staffing section the Commission for Social Care Inspection have been The Willows Residential Home DS0000001713.V312967.R01.S.doc Version 5.2 Page 17 advised that staffing levels have been increased in the mornings to address these shortfalls. A relative confirmed in a questionnaire that staff/owners welcome them into the home at any time and that they are able to visit in private. Residents’ spoken to were happy with the meals provided and the lunch time meal on the day of inspection looked appetising. Residents’ confirmed that they are given a choice of meal. Improved monitoring of residents food intake has been implemented and staff are responsive to individuals. For example a staff member was observed taking time to listen and gently encourage a resident to have some lunch. Flexibility was given about where the meal was taken and the resident was eventually persuaded to have a portion of lemon sponge and custard, which they said they had enjoyed. The main concern in relation to meals is that if some residents are not receiving breakfast until after 11-30am, there is a long gap between the last meal the previous day and lunch will be served almost immediately after breakfast. The Willows Residential Home DS0000001713.V312967.R01.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a visit to the service. Complaints are taken seriously with the findings of investigations being acted on, however additional monitoring of the effectiveness of any actions and more rigorous recruitment procedures is required to safeguard residents’. EVIDENCE: Since the last inspection the organisation have investigated serious concerns about the care of residents’, which include concerns about the management of medication, pressure area care, and unsafe movement and handling of residents. The concerns were substantiated. Some actions have been taken by the organisation to address the concerns raised however this inspection has identified ongoing concerns about the management of medication and residents’ healthcare needs. A complaint received by the Commission for Social Care of inspection about changes of routines affecting residents’ mealtimes (late breakfast), late administration of medication and a high number of staff going off sick was referred to the organisation for investigation. No evidence was found of a change of routine and only one occasion of late administration of medication identified. The fact that staff are on sick leave was acknowledged and conformation given that shifts are being covered by agency staff or staff from other homes. As detailed in this report a resident was found not to have had The Willows Residential Home DS0000001713.V312967.R01.S.doc Version 5.2 Page 19 breakfast until after 11-30am and medication was administered late on the morning of the inspection. This highlights that although complaints are acknowledged and investigated there is a need for ongoing monitoring of concerns raised. The Commission for Social Care Inspection have also recently referred two relatives to the placing authorities for investigation of complaints about the care of their relatives. Responses from residents indicate that they know who to talk to if they want to make a complaint. A relative advised that they had not had to make a complaint but were not aware of the procedure for making complaints. A temporary manager advised that due to the level of concerns that had been raised that she had been pro-active in ensuring that residents and their relatives had information and the opportunity to raise any concerns. A complaints record had been set up to enable actions taken to address the concerns to be tracked. As detailed in the staffing section there was no evidence of a criminal record bureau check having been undertaken for one member of staff putting residents at risk. The Willows Residential Home DS0000001713.V312967.R01.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 at least once during a 12 month period. 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 all the available evidence including a visit to the service. The home was clean, comfortable and in good decorative order providing a pleasant environment for Residents. EVIDENCE: Residents are accommodated on two floors with communal lounges and dining rooms on each floor. Some residents choose to spend their time in their rooms rather than use the communal lounges and some residents were seen to have their meals served in their rooms. All areas were comfortably furnished and in good decorative order. A sample check of residents’ bedrooms and en-suite facilities and the communal areas of the home identified that there were no unpleasant odours. All four residents who responded in questionnaires and those spoken with The Willows Residential Home DS0000001713.V312967.R01.S.doc Version 5.2 Page 21 during the inspection were happy with the standard of cleanliness within the home. The Willows Residential Home DS0000001713.V312967.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using all the available evidence including a visit to the service. Staff training, recruitment procedures and staffing levels were not providing adequate care and protection for Service Users. EVIDENCE: At the time of the inspection the staff team were under a lot of pressure with several staff on sick leave. Staff from other homes and agency staff are being used to cover staffing shortfalls. Due to the pressure on staff and the need to ensure that resident care was not compromised discussions with staff were minimal. Staff on duty expressed a commitment to trying to ensure that the current staffing difficulties impacted on residents as little as possible. Three of the four responses from residents confirmed that staff listen and act on what they say. One said they didn’t always. One of the four residents’ felt there were enough staff while the other three said there usually were. One resident commented that sometimes they are too busy when they are short of staff but try to do their best. This was supported by inspectors’ observations. At the time of the inspection there were insufficient staff to meet residents needs. There were three care staff and a senior carer on duty caring for twenty nine residents. Twelve residents’ needed two members of The Willows Residential Home DS0000001713.V312967.R01.S.doc Version 5.2 Page 23 staff for movement and handling and were located on both floors of the home. During the morning the senior carer was administering medication and dealing with health professionals leaving three carers to provide residents with assistance with personal care and breakfast. Inspectors observed residents become restless and agitated waiting for assistance from the breakfast table, where a resident said they had been sitting for a long time. Another resident was very distressed waiting to be assisted to the toilet. The day after the inspection the Operations Manager informed the inspector that an additional member of staff had been allocated to the mornings. A temporary manager has also informed the inspector that it has been agreed that an experienced senior member of staff from another home has been seconded to the home for a two week period to provide some additional support for senior staff. It is encouraging that prompt action has been taken however it is vital that arrangements are in place to monitor the adequacy of staffing levels in meeting residents needs. The pre-inspection questionnaire submitted by the registered manager identified that only one member of staff held a National Vocational Qualification in care. However ten staff were working towards the qualification. The qualification provides staff with a basic understanding of care practices. Some records of staff training were on their personnel files however discussion with a staff member indicated that these were not up to date and did not include recent training. Information provided in the questionnaire stated that staff have received training in the safe handling of medication, diabetic management and care planning. Concerns about staff understanding and practices have been identified in all of these areas. A sample check of staff files undertaken to review the adequacy of the recruitment process identified that there was no evidence of receipt of an up to date criminal record bureau clearance or of the outcome of a check against the protection of vulnerable adults register. Due to the difficulty in locating some of the records in the absence of the registered manager it was accepted at the time of the inspection that the evidence could be forwarded prior to the production of the report. To date no evidence has been produced and it is assumed that there are no records to confirm appropriate checks have been made and residents properly safeguarded. The Willows Residential Home DS0000001713.V312967.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a visit to the service. The lack of up to date movement and handling plans puts residents and staff at risk. EVIDENCE: Standard 31 was not assessed at the time of this inspection as at the time of the inspection the home was being managed temporarily by two managers from other homes. Standard 33 was not reviewed at the time of this inspection, as the immediate priority was to review the adequacy of the care provided to residents’. The quality assurance system will be inspected as part of a follow up random The Willows Residential Home DS0000001713.V312967.R01.S.doc Version 5.2 Page 25 inspection as an effective system is considered to be crucial in identifying any shortfalls in standards of care. Small amounts of money are held on behalf of residents’ to assist them with paying for things such as chiropody and hairdressing. The money is held securely and records of transactions kept. Computer records and paper records are kept. Unfortunately at the time of the inspection it was not possible to access the computer record and the paper record had been taken to head office for auditing. The management of residents’ monies will be inspected as part of a random inspection. The pre-inspection questionnaire provided some information about maintenance checks. Some gaps in the information were evident and therefore relevant records checked at the time of the inspection. This confirmed that appropriate servicing and checks are made on things like the lift, hoists, fire and electrical equipment to safeguard residents. Staff training records, including those for safe working practices were not up to date however discussion with a staff member confirmed that training had taken place including fire training and a recent update of movement and handling training. Information about movement and handling in a residents care plan was found to be out of date and the guidance to staff was not based on the resident’s current needs. The plan referred to the need to use a moving and handling belt which was not suitable equipment for this resident who required a hoist for all transfers. A staff member confirmed that staff were using the hoist. Failure to have properly assessed and up to date movement and handling plans to guide staff puts them and residents at risk of injury. The Willows Residential Home DS0000001713.V312967.R01.S.doc Version 5.2 Page 26 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 2 The Willows Residential Home DS0000001713.V312967.R01.S.doc Version 5.2 Page 27 No Are there any outstanding requirements from the last inspection? 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 12 (1) (a, b), 15 (b) 12 (1) (b), (2) Requirement Care plans must be regularly reviewed and be reflective of resident’s current needs including healthcare needs. Residents’ must where able be fully involved in their care planning and management of their healthcare conditions to reduce risks. A review of records relating to all residents’ medication must be carried out to ensure they are all receiving medications as prescribed. (Immediate requirement) All residents’ must receive medication as prescribed. Timescale for action 15/11/06 2. OP7 OP8 13/10/06 3. OP9 12 (1) (a, b), 13 (2) 27/09/06 4. OP9 5. OP9 12 (1) (a, b), 12 (1) (a, b), 13 (2) 12 (1) (a, b), 13 (2) 09/10/06 6. OP9 12 (1) (a, b), 13 (2) Residents must receive any 09/10/06 necessary assistance with their medication and staff responsible for administration must be satisfied that medication has been taken. Prescribed medication must not 09/10/06 be administered to residents unless it contains their name and the prescriber’s instructions, DS0000001713.V312967.R01.S.doc Version 5.2 Page 28 The Willows Residential Home 8. OP9 12 (1) (a, b), 18 (1) (a) (c) (i) 12 (1) (a, b), 13 (2) 9. OP9 10. 11. OP9 OP12 OP14 OP15 OP27 13 (2) 12 (1) (a, b), 18 (1) (a) 12. OP8 OP30 12 (1) (a, b), 18 (1) (i) 13. OP29 19 (1) (b) 14. OP38 13 (5) which match the administration record. Staff administering medication must have received adequate training and have been assessed as competent. Residents who are prescribed medication, which is regularly, refused, such as pain relief, and medication for constipation must be referred to the General Practitioner for review. Staff must receive training in the organisations medication policies and procedures. There must be sufficient staff on duty to ensure that residents’ do not have to wait long periods for assistance with washing and dressing, meals, medication or for assistance with movement and handling and can exercise choice in their daily routines. Staff must receive training and be assessed as competent in managing residents’ health conditions present in the home including diabetes, asthma and pain. Satisfactory criminal record bureau clearances must be obtained prior to staff working in the home to protect residents’. Movement and handling plans must be reflective of residents’ current needs. 09/10/06 13/10/06 13/10/06 13/10/06 30/11/06 09/10/06 13/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Willows Residential Home DS0000001713.V312967.R01.S.doc Version 5.2 Page 29 1. OP9 2. 3. 4. 5. OP9 OP9 OP9 OP28 OP30 Medication received for each new administration cycle should be thoroughly checked and any discrepancies identified in the records or medication held must be checked with the general practitioner and/or pharmacist. Effective practices should be implemented for ordering medication and returning unused medication to the pharmacy to reduce the risk of error. Practice in relation to the storage and use of any equipment should be reviewed to reduce the risk of infection. Medication administration times should be monitored to ensure that medication is administered at regular times with appropriate intervals between doses. An audit of staff training should be carried out to ensure that all staff have received adequate training to meet the needs of residents and the responsibilities of their roles. The Willows Residential Home DS0000001713.V312967.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 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 Residential Home DS0000001713.V312967.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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