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Inspection on 28/12/06 for The Willows Residential Home

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

This inspection was carried out on 28th December 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

What the care home does well

The home was clean, comfortable and in reasonable decorative order providing a pleasant environment for Residents. Residents were happy with the standards of cleanliness in the home and there was a festive appearance with decorations having been put in place on the approach to Christmas. A recreational and activity record for a resident showed that some activities which included a concert, singing, television, board games and puzzles had taken place in the main, five days a week. Residents said they were generally satisfied with the meals, which on the day of inspection was roast pork and vegetables.

What has improved since the last inspection?

Some improvements have been made in the management of medication in that action was taken to address concerns relating to specific residents medication. Four staff had received medication training and the treatment room where medication is stored was more organised.

What the care home could do better:

Care plans, which are tools to guide staff in the actions they need to take to meet residents` needs, were not fully reflective of residents needs and did not contain sufficient information. Examples were identified which included insufficient information about residents` nutritional needs, needs relating to diabetes and movement and handling needs. It is of particular concern that requirements relating to these areas had been made at the last inspection and the commission for social care inspection have been informed that they have been met. Although some improvements had been made to the management of medication additional shortfalls were identified which put residents at risk. These included residents not receiving prescribed medication, a resident receiving a duplication of prescribed medication on her return from hospital, which did not appear to have been adequately checked or dealt with. Care staff are currently administering insulin which is essentially a nursing task and while the inspector has been informed that staff have received training from the district nursing team, there is no evidence of this or of an assessment of competence from the nurse delegating the task.Residents continue to have concerns that staff and equipment are not always available to assist them to the toilet as and when needed. Arrangements for meals need to be reviewed to ensure that meals are served at an appropriate temperature. On the day of inspection, plated meals were left on a trolley while care staff were busy assisting residents to the toilet. Better recording procedures and systems are required for the management of complaints to ensure they are properly investigated and that the findings of complaints are acted on. Staff training was another area where it was difficult to access information to establish what training staff have undertaken. Failure to address shortfalls identified at the inspection carried out in September 2006 and comply with all of the statutory requirements made are a cause for serious concern about the management and oversight of the home.

CARE HOMES FOR OLDER PEOPLE The Willows Residential Home 89 London Road Hinckley Leicestershire LE10 1HH Lead Inspector Mrs Kathy Jones Key Unannounced Inspection 28th December 2006 09:30 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.V323907.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.V323907.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.V323907.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. 26th September 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.V323907.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 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 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 complaints and concerns received. The report from the last inspection carried out on 26 September 2006 was also reviewed and the findings taken into account when planning this inspection. The information gathered assisted with planning the particular areas to be inspected during the visit. Information gathered through a pre-inspection questionnaire and questionnaires received from residents, relatives and health professionals were incorporated into the inspection report of 26 September and therefore has not been included within this report. 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 two 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 the current acting manager throughout the inspection. The Willows Residential Home DS0000001713.V323907.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Care plans, which are tools to guide staff in the actions they need to take to meet residents’ needs, were not fully reflective of residents needs and did not contain sufficient information. Examples were identified which included insufficient information about residents’ nutritional needs, needs relating to diabetes and movement and handling needs. It is of particular concern that requirements relating to these areas had been made at the last inspection and the commission for social care inspection have been informed that they have been met. Although some improvements had been made to the management of medication additional shortfalls were identified which put residents at risk. These included residents not receiving prescribed medication, a resident receiving a duplication of prescribed medication on her return from hospital, which did not appear to have been adequately checked or dealt with. Care staff are currently administering insulin which is essentially a nursing task and while the inspector has been informed that staff have received training from the district nursing team, there is no evidence of this or of an assessment of competence from the nurse delegating the task. The Willows Residential Home DS0000001713.V323907.R01.S.doc Version 5.2 Page 7 Residents continue to have concerns that staff and equipment are not always available to assist them to the toilet as and when needed. Arrangements for meals need to be reviewed to ensure that meals are served at an appropriate temperature. On the day of inspection, plated meals were left on a trolley while care staff were busy assisting residents to the toilet. Better recording procedures and systems are required for the management of complaints to ensure they are properly investigated and that the findings of complaints are acted on. Staff training was another area where it was difficult to access information to establish what training staff have undertaken. Failure to address shortfalls identified at the inspection carried out in September 2006 and comply with all of the statutory requirements made are a cause for serious concern about the management and oversight of the home. 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.V323907.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.V323907.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): Standard 6 is not applicable, 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. Information is provided to enable service users to make an informed choice before being admitted to the home. EVIDENCE: At the last inspection 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. At the last inspection due to concerns that had been raised through complaints, priority was given to considering how the needs of existing residents were being met and a review of the assessment process was not The Willows Residential Home DS0000001713.V323907.R01.S.doc Version 5.2 Page 10 undertaken. This key inspection has again focussed on the needs of current residents’ and the actions taken to address identified shortfalls. No new residents have been admitted to The Willows since the last inspection carried out on 26 September 2006 and the home have been operating with some vacancies which should have allowed some capacity to address the identified shortfalls. The organisation has a thorough assessment process and the adequacy of how this is implemented in practice will be inspected at a future inspection. The Willows Residential Home DS0000001713.V323907.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 poor. This judgement has been made using available evidence including a visit to this service. The shortfalls in the planning and delivery of care and the management of medication put residents’ at risk. EVIDENCE: Requirements were made as a result of the findings of the last inspection in September 2006. Care plans which should be working tools to guide staff in the actions they are required to take to meet residents assessed needs were found not to be reflective of residents needs. Given that the inspection findings have been raised verbally and also within the inspection report and an action plan has been received from the organisation confirming the requirements would be met by 15 November 2006, it is of serious concern that continued shortfalls were identified. Some examples are: Care records were reviewed for a resident who was described as having lost weight at the last inspection, the care plan relating to meals contained no The Willows Residential Home DS0000001713.V323907.R01.S.doc Version 5.2 Page 12 indication of any weight loss even though weight records showed a recent loss of weight. And although a care plan evaluation record stated “diabetic controlled diet ongoing” there was no mention of a diabetic diet within the care plan. Weight records were spasmodic with no record of any checks between 14/09/06 and 10/11/06, checks since then have been either weekly or fortnightly though there is no guidance for staff regarding the frequency. A copy of a review carried out by social services on 13 December 2006 identified that the resident would like to have more snacks; again this was not included in the care plan. The inspector spoke with the resident during the inspection, she was asking for something to eat, which staff willingly brought however the expectation would be that arrangements for encouraging additional food are carefully detailed within the care plan and linked with a care plan for the management of diabetes. Records for another resident identified that he had been to the hospital to see the dietician, the entry in the daily notes just stated “everything fine”. There was no entry in the record of professional visits of this visit to the dietician. There was some general literature on the residents file from the hospital dietetic service however there was no guidance for staff regarding the specific advice given for the resident and the care plan just stated, “eat well with small appetite”. A copy of an assessment carried out by social services dated 18 September 2006 listed some of the actions required by The Willows to meet the resident’s needs which included the need to have food and fluid intake charts which were monitored. These were not in place. Records indicated that health care services such as from the general practitioner and the district nurse were accessed however records did not in all cases detail the reason for a visit or the outcome and such entries were sometimes written in different records making it difficult to monitor health care changes. There was no proper plan in place to address a resident’s movement and handling needs. It just stated, “transfer by hoist”. There was no indication of the type of hoist or size of sling or number of carers or of any particular health issues that needed to be taken into account. Medication management including storage and administration had improved in some areas since the inspection in September 2006. However only two of the eleven medication requirements made at the random inspection had been fully met. Medication management was still inadequate and unsafe and residents’ were at risk of not receiving medication as prescribed and of not having individual health needs met. This judgement is based on the following findings. The Willows Residential Home DS0000001713.V323907.R01.S.doc Version 5.2 Page 13 Some improvements had been made with medication administration records but there were still inaccuracies and evidence that issues affecting the health and care of residents’ were not managed appropriately. Residents’ were not always receiving medication as intended by the prescriber. For example one resident was prescribed a medication to be given five times day and was receiving it four times a day with two doses together in the morning. This meant that symptoms of their condition would not be managed appropriately. A record for one resident who was prescribed a controlled drug showed that on one occasion there was a four-day interval rather than the prescribed threeday interval. This meant that their pain relief may have not been adequate. There was a pharmacy bag containing an unopened tube of antibacterial cream with a date of dispensing of 12.12.06 and instructions to apply twice a day for one week. The medication had not been put on the MAR or administered. This meant that their infection would not be treated as intended by the prescriber. Errors in medication administration were not dealt with appropriately for example: A resident whose medication was changed whilst in hospital was being given the medication they had before admission plus the altered medication on discharge for 16 days after returning to the service, which would result in increased side effects and excess medication for their condition. Records did not accurately detail how this situation had been managed. The manager was asked why the medication was duplicated for so long and said that company policies meant the service could not alter medication from a verbal message and had to wait for the GP to visit. It was a concern that the staff in the service did not manage situations where there were changes with medication appropriately and that company policies potentially hindered the management of such situations. The manager was asked to investigate this matter to ensure such a situation was not repeated. Care plans and protocols were inadequate in the management of diabetes. For example unlabelled blood glucose monitoring equipment was in use in the service, which was not suitable for use on more than one individual, and there was a risk of infection being passed between service users. There were still concerns about staff competency in the management of conditions such as diabetes and how changes in blood sugar levels would be dealt with. The evidence found during the visit indicated that residents’ were at risk of not receiving medication as prescribed and of not having their individual health needs managed adequately or appropriately because of inadequate care plans. There had been improvements in that the company medication policy was available on the trolley for staff to refer to. However it was a standard policy that did not reflect local practices and there was no policy relating to the management of diabetes. This was a concern because management of diabetes had been recognised as poor in the service previously and records of blood The Willows Residential Home DS0000001713.V323907.R01.S.doc Version 5.2 Page 14 levels for one service user indicated that staff were still not competent in managing residents’ with diabetes. Four staff have now received training in the management of medication and certificates to verify this were seen by the inspector. The inspector is also aware from discussions with the district nursing team prior to the last inspection, that they had provided training for some staff on the administration of insulin, and one member of staff was actually receiving training during the last inspection. However there was no evidence to confirm that staff had received this training or of confirmation of their competence to administer insulin from the accountable nurse. Records for medication received administered and disposed of had improved but there were still inaccuracies. This meant that it was not always possible to follow all medication in the service. For example where medication was prescribed as one or two tablets the actual quantity given was not recorded on the MAR and there were no records made of a controlled drug that had been prescribed in error and received by the home a month previously. Storage was tidier and there was much less excess stock than at the previous inspection. However eye drops requiring fridge storage were found in the trolley which meant that service users were at risk of receiving medication that may have become contaminated or altered due to incorrect storage temperature. Correct records were not being kept for all controlled drugs in the service for example a supply that had been received in error was not recorded anywhere and the quantity in the register for another controlled drug was incorrect. The absence of an audit trail for these drugs left them open to possible misuse while waiting to be returned, therefore an inspector witnessed the acting manager record the drugs in the register at the time of inspection. Daily notes for a resident identified that tablets had been found in their room indicating that staff were not checking that medication had been administered. Residents spoken with confirmed that staff are respectful of their privacy and dignity. The Willows Residential Home DS0000001713.V323907.R01.S.doc Version 5.2 Page 15 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 poor. This judgement has been made using available evidence including a visit to this service. The routines of the home do not support residents’ needs or preferences. EVIDENCE: Many of the residents’ are reliant on staff for all movement and handling and their routines are dependent on the availability of staff and equipment to assist them. The delays in residents’ receiving assistance were less noticeable than at the time of the last inspection however observations and discussions with residents’ indicate that this is still a problem. Residents were finding it quite distressing waiting for staff to try and locate a hoist and another member of staff to assist them to the toilet or to watch other residents requiring assistance. A sample check of the recreational and activity record for a resident showed that some activities which included a concert, singing, television, board games and puzzles had taken place in the main, five days a week. The Willows Residential Home DS0000001713.V323907.R01.S.doc Version 5.2 Page 16 The lunch time meal on the day of inspection was roast pork and vegetables, residents spoken with said they were generally satisfied with the meals. A relative advised that she had raised concerns on several occasions about the fact that her mother was not always given a soft diet which she required to reduce the risk of choking. The relative felt it was as a result of poor communication between staff about residents needs. On the day of inspection staff brought a soft diet and were aware that this was what was required. Observations of part of the service of the lunch time meal on the first floor identified that the plated meals were brought up on a trolley without any means of keeping the food hot. Some residents’ meals were left, at the very least, fifteen minutes before they were served as care staff were busy taking residents to the toilet, by which time the meal was cool. There is some flexibility for visiting however relatives said they have been told not to visit at meal times as there is insufficient room for them to be in the dining room. Meals are served in the dining room on the ground floor, in the lounge/dining room on the first floor or in residents’ rooms if they wish. The space is fairly limited particularly as a high number of residents are wheelchair users. Staff were observed to be having some difficulty due to space with movement and handling when assisting residents to the dining table on the first floor. The Willows Residential Home DS0000001713.V323907.R01.S.doc Version 5.2 Page 17 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. Lack of an effective complaints procedure and arrangements to act on concerns raised leaves residents without proper protection and puts them at risk. EVIDENCE: At the time of the last inspection there was evidence that complaints were being taken seriously and appropriate action taken to address the concerns raised. During the last inspection a temporary manager advised that due to the level of concerns she had set up a complaints record to enable the actions taken to address the concerns to be tracked. It was therefore of concern that when trying to track a complaint made by a relative, which was investigated by social services there was no record of this. The relative advised that social services had written to the home with the findings of the investigation detailing the actions the home must carry out to meet the resident’s needs. The relative said that it has been necessary for the relative to raise these issues again with the current acting manager in order for any action to be taken regarding the residents’ care. The Willows Residential Home DS0000001713.V323907.R01.S.doc Version 5.2 Page 18 The commission for social care inspection have received information from another relative raising concerns about the management of complaints, again there was no record of any complaints received from this relative on the complaints file. As detailed in the staffing section of this report shortfalls were identified in the recruitment process, which do not provide adequate safeguards for residents’. The Willows Residential Home DS0000001713.V323907.R01.S.doc Version 5.2 Page 19 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. The home was clean, comfortable and in reasonable 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 most areas seen in good decorative order, though paintwork on doors particularly on the first floor was quite scuffed possibly where caught with wheelchairs. The Willows Residential Home DS0000001713.V323907.R01.S.doc Version 5.2 Page 20 The two bedrooms seen were clean and there were no unpleasant odours in them or the communal areas of the home that were seen during the inspection. The home was decorated with Christmas decorations as this inspection took place just before Christmas. The Willows Residential Home DS0000001713.V323907.R01.S.doc Version 5.2 Page 21 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 poor. This judgement has been made using available evidence including a visit to this service. Staffing arrangements do not provide adequate care and protection for residents. EVIDENCE: An action plan received from the organisation following the last inspection confirmed that in response to a requirement staffing levels had been reviewed and increased. The acting manager advised that staffing levels had recently been reduced again due to their being less residents. At the time of the inspection there was a senior carer and three care assistants caring for twenty four residents between 8am and 8pm. Between 8pm and 8am only two care assistants are shown on the rota. The inspector was informed that all of the residents who require two staff for movement and handling choose to go to bed before 8pm and do not wish to get up before 8am. There was no evidence of how residents’ choices have been ascertained therefore staffing levels need to be reviewed to ensure their needs are met and they are receiving choice in their routines. The fact that the Willows is a large rambling building with The Willows Residential Home DS0000001713.V323907.R01.S.doc Version 5.2 Page 22 accommodation on two floors needs also to be taken into account when determining staffing levels. Three staff files were reviewed to check the adequacy of the recruitment process. Concerns about the process were raised during the inspection carried out in September 2006 and a requirement was made regarding the need to have criminal record bureau clearances in place prior to staff working in the home. Satisfactory information had been received for two of the three staff. However in respect of the third member of staff there was evidence that checks had been made against the protection of vulnerable adults register. The manager advised that she was working under supervision prior to the criminal record bureau clearance being received. There was no evidence of the supervision arrangements on the file and also no evidence of references being obtained prior to starting work. Failure to operate a rigorous recruitment process puts residents at risk. Records relating to staff training were poorly organised and it was difficult to evidence that staff have received appropriate and up to date training to carry out their roles. Staff training records indicated that the majority of staff have received very little in the way of training, staff felt that these may not be up to date and additional training had taken place however no other evidence could be found to support this. Copies of certificates to confirm four staff have received training in the management of medication had just been received and were shown to the inspector. As detailed in the health and personal care section of this report the inspector is also aware from discussions with the district nursing team prior to the last inspection that they had provided training for some staff on the administration of insulin, however there was no evidence to confirm this. The Willows Residential Home DS0000001713.V323907.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of consistent management and oversight of the home and lack of effective quality assurance systems does not safeguard the health, safety and welfare of residents. EVIDENCE: Standard 31 relates specifically to the registered manager and their experience and qualifications. At the time of the inspection the registered manager was on sick leave and had been for some time, 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 The Willows Residential Home DS0000001713.V323907.R01.S.doc Version 5.2 Page 24 that residents receive appropriate care. Temporary managers have managed the Willows in the registered managers absence. At the time of the last inspection on 26 September 2006 two temporary managers were sharing responsibility for the management of the home in addition to managing their own homes. Since then, there has been another temporary manager replaced by the current temporary manager who had been managing the home for a period of six weeks at the time of this inspection. While all of the temporary managers have expressed a commitment to addressing the shortfalls and there is evidence that some action has been taken, the lack of progress in raising the standards of care raises concerns about the communication and overall management and oversight of this home is a cause for concern. A total of thirteen statutory requirements including one immediate requirement were made following the inspection in September 2006 and the dates for compliance had all expired at the time of this inspection. Satisfactory information was received following the inspection to confirm the immediate requirement had been met. And an action plan confirmed that the other requirements would be met within the timescale. Nine of these requirements are considered not met or not fully met. Some action was taken following the last inspection action in respect of issues raised about specific residents medication and other medication issues however this inspection has again highlighted additional concerns. A recommendation was made to carry out an audit of staff training, as it had been difficult at the last inspection to ascertain what training staff had received. An action plan received confirms that this was done and additional training arranged however as detailed in the staffing section, no evidence of this could be found. The training record seen at the time of the inspection identifies shortfalls in staff training in relation to safe working practices, which includes movement, and handling, fire safety and first aid. The Willows Residential Home DS0000001713.V323907.R01.S.doc Version 5.2 Page 25 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 1 8 2 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 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X X 2 The Willows Residential Home DS0000001713.V323907.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12 (1) (a, b), 15 (b) Requirement Care plans must be regularly reviewed and be reflective of resident’s current needs including healthcare needs. (This requirement is outstanding from the last inspection – timescale for compliance 15/11/06) Where the accountable nurse delegates to individual care staff nursing tasks such as administration of insulin, there must be evidence to demonstrate that the accountable nurse, is, and remains satisfied of staff competence. Residents’ health care needs including nutritional needs must be monitored to ensure proper provision is made and special diets are adhered to. All residents’ must receive medication as prescribed. (This requirement is outstanding from the last inspection – timescale for compliance 19/10/06) Residents must receive any DS0000001713.V323907.R01.S.doc Timescale for action 28/02/07 2. OP8 12 (1) (a, b) 30/01/07 3. OP8 12 (1) (a, b) 30/01/07 4. OP9 12 (1) (a, b), 12 (1) (a, b), 13 (2) 12 (1) (a, 30/01/07 5. OP9 30/01/07 Version 5.2 Page 27 The Willows Residential Home b), 13 (2) necessary assistance with their medication and staff responsible for administration must be satisfied that medication has been taken. (This requirement is outstanding from the last inspection – timescale for compliance 09/10/06) Staff administering medication 15/02/07 must have been assessed as competent with training needs kept under review. (A similar requirement with a timescale for compliance of 09/10/06 was only partially met) Staff must receive training in the 15/02/07 organisations medication policies and procedures, which must take into account local practices and include management of diabetes. (A similar requirement with a timescale for compliance of 13/10/06 was only partially met) A complaint procedure, which ensures complaints are fully investigated with findings acted on, must be implemented. 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. (This requirement is outstanding from the last inspection – timescale for compliance 13/10/06) Staff must receive training and be assessed as competent in managing residents’ health conditions present in the home including diabetes, asthma and DS0000001713.V323907.R01.S.doc 6. OP9 12 (1) (a, b), 18 (1) (a) (c) (i) 7. OP9 13 (2), 18 (1 8. OP16 22 (1), 22 (2) 12 (1) (a, b), 18 (1) (a) 28/02/07 9. OP27 15/02/07 10. OP30 12 (1) (a, b), 18 (1) (i) 28/02/07 The Willows Residential Home Version 5.2 Page 28 pain. (This requirement is outstanding from the last inspection – timescale for compliance 30/11/06) 11. OP30 12 (1) (a, b), 18 (1) (i) 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. This must include training in safe working practices. Satisfactory information including references must be obtained prior to staff working in the home to protect residents’. Where a member of staff has been permitted to work in the home prior to receipt of a criminal record bureau clearance arrangements for safeguarding residents as detailed in the Miscellaneous Amendment regulations 2004 must be in place. Effective systems must be in place to improve maintain and maintain the quality of care. Movement and handling plans must be reflective of residents’ current needs and sufficiently detailed to guide staff in safe practice based on the individual needs. (A similar requirement is outstanding from the last inspection – timescale for compliance 13/10/06) 28/02/07 12. OP29 19 (1) (b) 30/01/07 13. OP29 19 30/01/07 14. OP33 24 (1) (a, b) 13 (5) 30/01/07 15. OP38 15/02/07 The Willows Residential Home DS0000001713.V323907.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP15 OP38 Good Practice Recommendations Arrangements for the provision of meals for residents on the first floor should be reviewed to ensure that they are served while still hot. The organisation of the furniture in the first floor lounge/dining room should be reviewed to ensure sufficient space for residents’ comfort and safe movement and handling. Medication administration times should be monitored to ensure that medication is administered at prescribed times with appropriate intervals between doses. 4. OP9 The Willows Residential Home DS0000001713.V323907.R01.S.doc Version 5.2 Page 30 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 Residential Home DS0000001713.V323907.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. 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