Inspection on 11/05/06 for Willett House Nursing Home

This inspection was carried out on 11th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Willett House Nursing Home 10/07/07

Willett House Nursing Home 17/10/06

Willett House Nursing Home 07/12/05

Willett House Nursing Home 05/07/05

Willett House Nursing Home 02/03/05

Willett House Nursing Home 19/10/04

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

CARE HOMES FOR OLDER PEOPLE Willett House Nursing Home Kemnal Road Chislehurst Kent BR7 6LT Lead Inspector Cheryl Carter Unannounced Inspection 11th May 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 Willett House Nursing Home DS0000010148.V295020.R02.S.doc Version 5.1 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. Willett House Nursing Home DS0000010148.V295020.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Willett House Nursing Home Address Kemnal Road Chislehurst Kent BR7 6LT 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) 020 8402 8224 020 8325 5171 Mission Care Mrs Moonwattie Janet Chuttoo Care Home 32 Category(ies) of Dementia (32) registration, with number of places Willett House Nursing Home DS0000010148.V295020.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing Notice issued 17 March 1997 Date of last inspection 7th December 2005 Brief Description of the Service: Willett House is a 32-bed purpose built home providing nursing care for people with dementia. The home is situated in a quiet residential area of Chislehurst close to shops and local bus routes. The home is a two-storey building that provides twenty-eight single bedrooms and two double bedrooms in four self contained units; each unit has eight service users. There are gardens at the side and rear of the building and car parking to the front. Willett House Nursing Home DS0000010148.V295020.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors Cheryl Carter and Rosemary Blenkinsopp carried out the inspection 0n 11th May 2006 between 10.00am and 4.00pm. The inspector met with the manager who was on duty on the day of the inspection. The inspectors had a tour of each unit, examined health and safety records, observed staff communicating with service users and relatives. The inspectors met with one relative who was visiting at the time of the inspection. Two members of staff one a long term staff and the other the most recent staff to start at Willett House met with the Inspector. Feedback was given at the end of the inspection. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Willett House Nursing Home DS0000010148.V295020.R02.S.doc Version 5.1 Page 6 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 Willett House Nursing Home DS0000010148.V295020.R02.S.doc Version 5.1 Page 7 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): 1, 2, 3, 4, 5, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users and their representatives have the information they need to make an informed choice as to whether to move into the home. Service users and their relatives have a copy of the terms and conditions attached to living in the home. Service Users needs are assessed prior to them moving into the home, but plans of care are not well documented which runs the risk the service users need are not being met. EVIDENCE: The Statement of Purpose was updated recently and a copy was sent to the Commission. Copies of contracts were not readily available on file. An assessment is carried out on the prospective service user prior to moving into the home, however the original assessment carried out is kept on a separate file. Service users have the opportunity to visit the home prior to moving in, Two residents were case tracked from two separate units. The home does not provide intermediate care. Willett House Nursing Home DS0000010148.V295020.R02.S.doc Version 5.1 Page 8 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, 11. Quality in this outcome area is adequate. The judgement was made using available evidence including a visit to this service. Care plans and risk assessments are not sufficiently detailed to fully reflect the needs of residents. EVIDENCE: Care plans and supporting documentation were inspected. The inspector met with the two residents, the key worker of one and the husband of the other. It was difficult to assess, in the period spent on the units, if the care plan reflected the care given. The Registered Manager must review and update care plans to reflect the changing needs of the service users. (Req.1) The medication on the fist floor units was inspected. Generally the medication administration charts were well completed with written details on nonadministered medications. There were no unexplained gaps. Resident’s photographs were in place and allergies recorded. Records relating to the drugs fridge temperatures were in place as well as a staff signatures list. Willett House Nursing Home DS0000010148.V295020.R02.S.doc Version 5.1 Page 9 The “ as required medications “ need to have full instructions relating when to give the medication, amount an duration. The use of pharmacy labels on medication charts should be avoided. Hand transcriptions of medication should have two staff signatures in place to confirm the information is correct. (Recommendation 1) There were no controlled medications in use the day of the inspection. The medication storage cupboards were open and one had a broken lock. The medications to be disposed of were located in a ground floor room, which was locked. There was a large quantity of medication in this room in an open area, the safety of this must be questioned as well as the wastage costs and frequency of collection. (Req. 2) In general care plans mainly reflected physical health needs with little information on other health care needs. Risk assessments covered only limited issues and included only the basic information including frequency of reviews. There were little signs of well being amongst residents many of whom were sleepy, slumped forward in chairs. Interaction between residents was limited, and staff interactions were task focused, there was little in the way of spontaneous interactions from staff. The two care plans contained some information in relation to their original placement including hospital discharge letters. The original assessment conducted by the home was not in the individual file. It was stated these are kept separately alongside contracts terms and conditions and other records. In the care plans, one had a photograph of the resident the other did not. The ongoing assessment information was generally well completed. The care plans focused on physical health needs with limited information on social aspects, psychological needs and mental health issues. Risk assessments were in place for skin integrity – the waterlow score. These were noted to be the same for many months and when high risk had been identified there was little noted on interventions or an increased frequency of review. Manual handling assessments were in place and body mass indicator information. Specific risk assessments for nutrition and use of cot sides, which was referred to in one care plan, were not in the files. Within Magnolia unit there were several files easily accessible on the windowsill, which contained bowel, bath and behaviour charts these were completed. Information of this type should be retained on the resident’s file. Charts of this type are not in line with current care planning. All information must be retained in a confidential manner. Willett House Nursing Home DS0000010148.V295020.R02.S.doc Version 5.1 Page 10 Of the two residents, one was unable to communicate; she was sitting in the lounge head forward and little other forms of communication evident. Her husband met with the inspector. The other resident was able to answer questions and hold a reasonable level of conversation; He was orientated in time, place and person, his key worker met with the inspector and she demonstrated a good knowledge of the resident. The inspector recommends that there should be a review of the activities and staffing levels to encourage more interaction and better stimulation of the service users. Willett House Nursing Home DS0000010148.V295020.R02.S.doc Version 5.1 Page 11 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): 12, 13, 14, 15 Quality in this outcome area is adequate. The judgement was made using available evidence including a visit to this service. Service Users appear to have choices in their day but these are limited. Activities in the home are limited and there is a general gloomy atmosphere at the home. EVIDENCE: The lunch was observed on one unit. Residents were provided with plated meals and there was no choice offered either by way of amount or meal. Systems are in place where residents choose their meal the night before. Drinks were not readily available in units or in some of the bedrooms, which were occupied. It was a hot day and residents can easily become dehydrated The kitchen was inspected after lunch. Food storage was appropriate with supporting records in place. Stock rotation is undertaken and all foods checked were in date and labelled. The fresh fruit and vegetable are delivered weekly on a Saturday. Variety of fresh fruit is limited. Fresh fruits namely bananas, potatoes and onions were seen. Bananas are used in banana custard although fresh fruit is not routinely provided in a form residents can enjoy. This should be investigated .Two choices are offered at meals, however with items such as “ Turkey dippers “ on the menu the appropriateness of such meals must be reviewed. The inspector suggests the use of pictorial aids for food choices may be useful. (Recommendation 2) Willett House Nursing Home DS0000010148.V295020.R02.S.doc Version 5.1 Page 12 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): 16, 17, 18 Quality in this outcome area is poor. The judgement was made using available evidence including a visit to this service. The home has a complaints procedure. The inspector found evidence that not all complaints are being recorded. EVIDENCE: The complaints records were examined. The inspector found that at least one serious incident involving a service user that was not recorded. The manager said that she was about to write it up. This was also an incident that should have been notified under Regulation 37 and this was not done. The incident occurred back in December but was not notified to CSCI. The registered provider needs to review its complaints procedure and have systems in place where complaints are recorded listened to and acted on swiftly. There were several references during the inspection, from different sources regarding the shortages of staff and the quality of the agency staff that were used. (Req. 3) Willett House Nursing Home DS0000010148.V295020.R02.S.doc Version 5.1 Page 13 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, 20, 21, 22, 23, 24, 25, 26 Quality in this outcome area is adequate. The judgement was made using available evidence including a visit to this service. Some parts of the home are well maintained but others are not. Service users have the specialist equipment they need and there are sufficient suitable toilets and washing facilities for the service users. Some bedrooms were quite clinical, no obvious signs of personal possessions, other bedrooms were personalised to meet the service users needs. EVIDENCE: The ground floor lounge had been recently refurbished including wooden flooring. This was pleasant, although the rug on the wooden flooring may pose a hazard and must be risk assessed. The glass coffee table may also be unsuitable for residents and again risk assessments are needed. There were areas within the home, which were in need of redecoration and refurbishment. Walls and skirting boards were marked and chipped and carpets stained. There was an unpleasant odour in the hallway and the carpet was badly stained. The inspector was told that refurbishment of that area of the Willett House Nursing Home DS0000010148.V295020.R02.S.doc Version 5.1 Page 14 home is planned, however the manager had no idea when this work will begin. This has been the same excuse in two previous inspections. The registered provider must have in place the plans for the refurbishment of the home with dates for the commencement and finishing of the work. The registered providers are required to provide a written planned programme of work schedule for the refurbishment of the home with timescales. (Req. 4) The registered person must ensure that the home is free from offensive odours. (Req.5) Some bedrooms were personalised: they had photographs, ornaments and personal items, others were bare. The manager is proposing to go ahead with linoleum type flooring in the majority of bedrooms. This gives a very clinical feel and staff must make very effort to personalise areas and promote a homely feel. This was not the case in some bedrooms. (Rec.3). The fridges in each of the units were in need of cleaning and defrosting. It was also noted that portable fans and heaters were in several areas, these must be risk assessed. The area adjacent to the lounge was very hazardous with furniture causing obstructions; again this could pose a risk to residents. The registered person must ensure that all parts of the home to which service users have access are free from hazards. (Req. 6) On the top floor, two window restrictors were disconnected, allowing the window to open fully. These must be maintained to ensure all areas are safe for residents and extra staff vigilance is needed. Two residents were seen to be in their bedroom in bed with no fluids or stimulation i.e. radio, TV, the bedroom doors were closed. One resident confirmed that this was his choice; the other was unable to answer. Willett House Nursing Home DS0000010148.V295020.R02.S.doc Version 5.1 Page 15 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): 27, 28, 29, 30 Quality in this outcome area is adequate. The judgement was made using available evidence including a visit to this service. The numbers and skill mix of staff is not always sufficient to meet service users’ needs. Service users are not fully protected by the home’s recruitment policy and practices. EVIDENCE: Two staff were seen by the inspector, one a long-term staff and the other a new starter. The long-term staff was a qualified staff member. She demonstrated a good knowledge of her role and responsibilities within the home. She confirmed that she received training on mandatory and specific topics related to the residents group. Some training was the same session repeated and it was felt that although training was frequently provided the content was sometimes irrelevant. The manager should explore other avenues to provide training to enable the staff carry out their roles effectively. The inspector met with a second staff member and inspected her personnel files. The application form was limited in content and the use of English poor. The staff member herself was unable to answer some of the questions relating to training, supervision and appraisal, as she could not understand the content. This was raised with the Manager, particularly when staff are working with residents who have limited communication abilities. The feedback from a relative was very positive about this particular staff member who was described as patient, caring considerate and hard working. Willett House Nursing Home DS0000010148.V295020.R02.S.doc Version 5.1 Page 16 One personnel file had two references from friends not a professional reference nor was there evidence of clearance under CRB and POVA3 or any reference to induction. Generally the personnel files do not confirm safe recruitment practices and the quality of the training provided is debateable. There were several references during the inspection, from different sources regarding the shortages of staff and the quality of the agency staff that were used. The inspector noted that during the long period spent on Magnolia unit the vast majority of time only one staff member was present. The registered Persons must ensure that at all times suitably qualified, competent and experienced staff are working in the home in sufficient numbers appropriate to meet the health and welfare of all service users. (Req. 7) Willett House Nursing Home DS0000010148.V295020.R02.S.doc Version 5.1 Page 17 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): 31, 32, 33, 36, 37, 38 Quality in this outcome area is adequate. The judgement was made using available evidence including a visit to this service. The manager is committed to the service users. Staff supervision is inconsistent. The health safety records examined complied with standards. EVIDENCE: The manager of the home is committed to the service users. There are however some concerns expressed about the staffing issues particularly at weekends when the home is usually short of staff and the quality of agency staff poor. A random selection of health and safety records was examined. These records complied with regulations. There have been number of complaints made but not all of these were recorded. The inspector found records of disciplinary action taken following a complaint but this could not be cross referenced in the complaints book. The delay in the refurbishment of Willett House Nursing Home DS0000010148.V295020.R02.S.doc Version 5.1 Page 18 the home gives the home an institutional feel. Although the lounge has been refurbished the cola machine remains in the lounge. This does not help to make the room homely. (Rec.4) Willett House Nursing Home DS0000010148.V295020.R02.S.doc Version 5.1 Page 19 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 3 2 2 2 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 1 18 1 1 2 3 3 3 3 3 1 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 x x 2 3 2 Willett House Nursing Home DS0000010148.V295020.R02.S.doc Version 5.1 Page 20 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 15 Requirement The Registered Manager must review and update care plans to reflect the changing needs of the service users. The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. All complaint investigation reports must be comprehensive and show clearly how the findings of the investigation have lead to the conclusions. The Registered Persons are required to provide written evidence of a planned programme of refurbishment for the home with timescales The registered person must ensure that the home is free from offensive odours The registered person must ensure that all parts of the home to which service users have access are free from hazards. The registered Persons must ensure that at all times suitably DS0000010148.V295020.R02.S.doc Timescale for action 31/07/06 2 OP9 13.2 15/07/06 3 OP16 22(a) 31/07/06 4 OP19 23(2)d 15/07/06 5 6 OP26 OP25 16.2k 13(4) 15/07/06 15/07/06 7 OP27 18(1) (a) 15/07/06 Willett House Nursing Home Version 5.1 Page 21 qualified, competent and experienced staff are working in the home in sufficient numbers appropriate to meet the health and welfare of all service users. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations The use of pharmacy labels on medication charts should be avoided. Hand transcriptions of medication should have two staff signatures in place to confirm the information is correct. The inspector recommends the use of pictorial aids for food choices may be useful. If the proposed plan to have linoleum in all bedrooms should go ahead, staff must make very effort to personalise areas and promote a homely feel. The registered person should ensure that staff giving supervision receive the necessary training to make supervision effective. 2 3 4 OP15 OP24 OP36 Willett House Nursing Home DS0000010148.V295020.R02.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Willett House Nursing Home DS0000010148.V295020.R02.S.doc Version 5.1 Page 23 - 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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