Inspection on 17/10/06 for Willett House Nursing Home

This inspection was carried out on 17th October 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.

Other inspections for this house

Willett House Nursing Home 10/07/07

Willett House Nursing Home 11/05/06

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 heryl Carter Unannounced Inspection 17th October 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.V323737.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. Willett House Nursing Home DS0000010148.V323737.R01.S.doc Version 5.2 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.V323737.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing Notice issued 17 March 1997 Date of last inspection 11th May 2006 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.V323737.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over four hours on a weekday over a period of approximately five hours. The focus was to follow up progress from the previous inspection. At the time of the inspection the Manager was on duty with two other qualified staff and care staff. One qualified staff was a bank staff, and there were two agency care staff. The inspector met with the two agency care staff. Both confirmed that they had been orientated to the home on their first day, their identity had been checked and general health and safety matters are being addressed. 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.V323737.R01.S.doc Version 5.2 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.V323737.R01.S.doc Version 5.2 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): 2, 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Not all files seen had contracts and Statements of Terms and Conditions. No files had a letter to service users indicating that the home can meet their needs. EVIDENCE: The files of four service users were examined. The preadmission assessments were examined and these had sufficient detail to ensure that the home would be able to meet the care needs and for staff to create a care plan. Of the files seen not all had Contracts and Statement of Terms and Conditions. (Recommendation 1) The registered manager must ensure that all residents are appropriately assessed prior to admission and the home must confirm in writing its ability to meet the service user needs. (Req.1) Willett House Nursing Home DS0000010148.V323737.R01.S.doc Version 5.2 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&9 The quality in this outcome area is poor. Care plans are not sufficiently robust to ensure that all care is given according to need. The disposal and ordering of medication needs to be reviewed. EVIDENCE: The inspector selected two care plans of residents with whom she had met. One of the residents was on one to one care. She had a diagnosis of Lewy body Dementia. In the assessment section of the care plan under the heading “communication” – no problems were indicated. It was clear from the inspectors own observations that the resident was confused, confabulating and spoke in Italian, all of which would lead to problems with communication. Also on this document it was indicated that the resident was confused, the document then asked for a mini mental state to be completed – this was not done. On another assessment of mood the resident scored 5, which is indicative of depression however, there was no further intervention relating to this nor was it included in the care plan. One issue that was stated was that Willett House Nursing Home DS0000010148.V323737.R01.S.doc Version 5.2 Page 9 she was prone to urine infections, although there was no evidence of extra fluids being provided for her. Her care plan included physical health problems and behaviours displayed by the resident. Some of the behaviours observed, described and documented included scratching, spitting and hair pulling. The daily events mainly reflected physical heath issues whilst there was a separate chart for her behaviour. Her weight chart indicated a two-kilo weight loss over a period of one month again there was no intervention relating to this. The inspector did observe, that the interventions of staff, in relation to this residents behaviour, were negative and not generally in the way of day to day conversation, nor was this evidenced at any point except when her son arrived The second care plan the information was similar again this gentleman required extra fluids to be given because of renal failure and reoccurring Urinery tract infections. The daily events referenced he was eating and drinking. However on his fluid chart, on one date he had received only 260 mls input, for 24 hours, and another 490 mls. Fluid charts which were in use, were inadequately completed with out totals, dates and any reference to fluids being offered. This resident’s waterlow score was 17 in September 06 and in October 06, was 23. This is a significant increase and reflects increased risk to skin damage and the development of pressure sores. Again no intervention or increased frequency of reviews was noted to address this issue. The Registered Manager must ensure that risks identified have a plan of care to meet the needs of the service user. (Req.2) Health appointments were recorded those relating to the GP in a separate book, others in the daily events and the diary. In the medication room those medications awaiting disposal were located. The inspector counted 139 cartons of ensure /enlive build up drinks awaiting disposal. Some had expired, others the inspector was advised, were not needed. The inspector counted 237 ensure /enlive, which had been newly received, these were located on the shelf. They were arranged in no particular order and those with a shorter shelf life were sometimes located at the back, which may mean they would expire before use. This needs to be reviewed. There were three containers of disposed medications and records relating to them. Collection of these is every three months. The medication trolley was tidy and no overstocking evident. The medication charts were generally reasonably well completed with allergies recorded and photographs of residents in place. In some instances those medications that had not been given as prescribed, had reasons stated on the reverse of the chart. Some pharmacy labels had been used on the medication Willett House Nursing Home DS0000010148.V323737.R01.S.doc Version 5.2 Page 10 chart these should be avoided. Medications which had been received in the home, were not always fully completed and without staff signatures and dates. Those medication which were to be administered as required, need to have full instructions recorded, including specific reasons for the medication to be administered, maximum dose, and where applicable duration. (Req. 3) The homely remedies list was signed by the GP. The inspector was advised that some residents have their medication crushed into food or liquid. In these cases, and where a resident is unable to give consent, then the covert administration policy needs to be applied. In the event that covert administration of medication is undertaken a full multi disciplinary discussion must take place, this must be recorded and kept under regular review. The home is reminded that the Mental Capacity Act 2005 will have implications in respect of this. (Recommendation 2) Willett House Nursing Home DS0000010148.V323737.R01.S.doc Version 5.2 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 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There is a designated activity worker. Service users enjoy contact with families and staff supports them to do so. Service users benefit from a balance diet and have the opportunity to choose. EVIDENCE: The home has a designated activity worker that engages a number of the service users on a daily basis. Some residents looked unkempt with untidy hair and with clothes that are ill fitting and mismatched. Limited signs of well-being were noted with many residents displaying a drowsy appearance or sleeping. There was a general lack of attention to detail particularly in respect of dressing, shaving and general appearances. The inspector herself observed this after lunch with the resident who was case tracked. She was in a very stained top; no one tried to change this. When the inspector pointed this out quietly, the two staff went over and started to do this with her visitor there. This was 15.30 some three hours after lunch. Willett House Nursing Home DS0000010148.V323737.R01.S.doc Version 5.2 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home has a complaints procedure but not all complaints are being recorded. EVIDENCE: The home has a complaints procedure, however from the minutes of the visitors meeting there were a number of complaints about staff shortages, low staff morale and other issues. These need to be transferred into the complaints book that shows what action has been taken and the outcome. The registered manager must ensure that all complaints regardless of how trivial must be dealt with under the complaints procedure, and outcomes recorded in the complaints book. (Req.4) Willett House Nursing Home DS0000010148.V323737.R01.S.doc Version 5.2 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, 24, 26 Quality in this outcome area is good. The redecoration of the corridors has been completed and the ground floor is in good decorative order. The home is clean and free from odours. EVIDENCE: In the ground floor lounge area there is a Coke machine. This does not fit in with a homely environment. The Manager advised the inspectors that this is due to be repositioned into the staff area once work has been completed. In one of the first floor lounge area the TV was on with music playing. This makes it very difficult to communicate with residents who already have mental impairment. Willett House Nursing Home DS0000010148.V323737.R01.S.doc Version 5.2 Page 14 Willett House Nursing Home DS0000010148.V323737.R01.S.doc Version 5.2 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. There are insufficient staff at all times that are suitably deployed to ensure that the needs of service users are met. EVIDENCE: At the time of the inspection the Manager was on duty with two other qualified staff and care staff. One qualified staff was a bank staff, and there were two agency care staff. At the time of the inspection the home had one resident, who was on one to one care, and required an extra care staff. This was generally being provided through the use of agency staff. The inspector met with the two agency care staff. Both confirmed that they had been orientated to the home on their first day, their identity had been checked and general health and safety matters had been explained. On the day of the inspection, the extra staff member was not on duty because of an inability to get someone. This had happened on previous occasions, and in such circumstances the staff on the unit cared for the resident. The inspector spent time on this unit. The staff was fully occupied with this resident maintaining her safety and that of other residents. Willett House Nursing Home DS0000010148.V323737.R01.S.doc Version 5.2 Page 16 At one point after lunch there was only one staff member in the unit who was trying to look after those residents in the lounge, those in their bedrooms and the residents who required one to one care. Some while later another staff arrived to assist; however this only provided the unit with two staff, when three are needed. It was noted during this period of staff shortages, that the resident who required one to one care, was in a wheelchair with lap strap in place. On no account should this type of restraint be used to compensate for staff shortages. There was no reference in the residents care plan or risk assessment relating the need to use a lap strap. The inspector met briefly with members of the permanent staff. The inspector detected a reticence and reluctance to impart information This was also noted with a relative. Low staff morale was described as being present amongst the staff team. Staff shortages and low staff morale was also noted in the minutes of the relatives meeting 2/9/06. The Manager attributed this to the staff vacancies and the dependency of some of the residents. The registered manager must ensure that there is sufficient number of staff on duty at all times to adequately address the health, safety and needs of all residents. (Req.5) Willett House Nursing Home DS0000010148.V323737.R01.S.doc Version 5.2 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, 37 & 38 The quality in this outcome area is adequate. The home is managed in a reasonable manner but there is room for improvement as noted elsewhere in the report. The manager is well supported by the Registered Provider however all staff and visitors to the unit do not experience the open approachable atmosphere. Quality assurance needs to be carried out. Most records are in order except where mentioned elsewhere in the report. All equipment is serviced and maintained to ensure safety and welfare of the service users and the home complies with the relevant legislation. EVIDENCE: Willett House Nursing Home DS0000010148.V323737.R01.S.doc Version 5.2 Page 18 The manager of the home holds the necessary qualifications to manage the home. Concerns regarding the staffing issues and the openness of the environment continue to be expressed. The home needs to carry out a quality assurance that includes all areas of the home and to identify the areas of concerns and to ensure that the service users and their families are satisfied with the service that they are receiving. This can be used as a tool to underpin the annual development plan. Service users and other stakeholders must be able to express their views so that these can be included in the process. (Req. 6) Records in general were adequate but care plans still needs to be developed. Equipment is serviced at regular intervals. The accident book should be regularly audited. Staff receives mandatory fire training but it is not clear from the records the frequency of fire training or what matters are discussed. Willett House Nursing Home DS0000010148.V323737.R01.S.doc Version 5.2 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X 3 3 X X X 3 X 3 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X X 3 3 Willett House Nursing Home DS0000010148.V323737.R01.S.doc Version 5.2 Page 20 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 OP3 Regulation 14 Requirement The Registered Manager must ensure that all residents are appropriately assessed prior to admission and must confirm in writing the home’s ability to meet the service user’s needs. The Registered Manager must ensure that risks identified have a plan of care to meet the needs of the service user. The registered person shall make arrangements for the recording, handling, and administration of medication. The registered manager must ensure that all complaints regardless of how trivial must be dealt with under the complaints procedure, and outcomes recorded in the complaints book. 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. An effective quality assurance DS0000010148.V323737.R01.S.doc Timescale for action 15/01/07 2. OP7 15 (1) 15/01/07 3. OP9 13.2 15/01/07 4. OP16 22.2 & 3 15/01/07 5. OP27 18(1) (a) 15/01/07 6 OP33 24 15/01/07 Page 21 Willett House Nursing Home Version 5.2 system must be implemented 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 OP2 OP9 Good Practice Recommendations The registered manager should ensure that all files have a signed contract and Statement of Terms and Conditions. The registered manager is advised that where residents have their medication crushed into food or liquid and service users are unable to give cosent, then the covert administration policy needs to be applied. In the event that covert administration of medication is undertaken a full multi disciplinary discussion must take place, this must be recorded and kept under regular review. Willett House Nursing Home DS0000010148.V323737.R01.S.doc Version 5.2 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. 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