Inspection on 06/02/06 for Willoughby Grange

This inspection was carried out on 6th February 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

Willoughby Grange 04/04/07

Willoughby Grange 31/05/06

Willoughby Grange 23/08/05

Willoughby Grange 03/03/05

Willoughby Grange 18/11/04

Willoughby Grange 16/02/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Willoughby Grange Willoughby Road Boston Lincs PE21 9EG Lead Inspector Mick Walklin Unannounced Inspection 6th February 2006 10:30 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 Willoughby Grange DS0000002575.V282559.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. Willoughby Grange DS0000002575.V282559.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Willoughby Grange Address Willoughby Road Boston Lincs PE21 9EG 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) 01205 357836 01205 356756 willoughbygrange@fshc.co.uk Laudcare Ltd (a wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Carla Jayne Wilson Care Home 44 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (10), Old age, not falling within any other of places category (33) Willoughby Grange DS0000002575.V282559.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users with dementia only to be admitted to those rooms designated on the ground floor for the category DE(E) The home is registered to provide personal care with nursing for service users of both sexes whose primary needs fall within the following categories: Old age not falling within any other category (OP) (33) Dementia (over the age of 65 years) (DE(E) ) (10) Dementia (DE) (1) The maximum number of service users to be accommodated is 44. The category Dementia (DE) applies to the person named in the Notice of Proposal to Register dated 4th February 2005 only. 23rd August 2005 3. Date of last inspection Brief Description of the Service: Willoughby Grange Nursing Home is situated within half a mile of the town centre of Boston. It is a purpose built two-storey home, with the first floor accessed by a lift. The home has a self-contained wing, which provides 11 places for residents with dementia. Car parking facilities are situated to the front of the building, and a courtyard with garden furniture is situated to the side of the home. The home is owned by Four Seasons Health Care and is registered to provide accommodation for 44 service users. There are 6 double rooms and the remainder are single rooms. Four of the rooms have en-suite facilities. The home has its own mini bus and is also situated close to a bus route and the centre of Boston. Willoughby Grange DS0000002575.V282559.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was over a period of 7 hours. The main method of inspection used was called case tracking which involved tracking the care three residents receive, through the checking of their records, discussion with them and the care staff and observation of care practices and interactions. A tour of the premises was conducted with the manager. Documentation relating to the management of the home was also inspected. What the service does well: What has improved since the last inspection? What they could do better: The Statement of Purpose, which gives information about the home, should be updated to reflect management changes. Assessments and care plans should be fully completed so that staff are aware of care needs. All records relating to medication should be correct to ensure safe practice. The activity programme could be more varied to provide better stimulation for residents. Residents should be consulted about whether they want locks fitted to their bedroom Willoughby Grange DS0000002575.V282559.R02.S.doc Version 5.1 Page 6 doors. Staff should be thoroughly vetted before commencing employment to ensure that residents are safe. Steps should be taken to ensure that all areas of the home are safe. Arrangements for in-house training are good, but the training programme should be improved to ensure that staff are updated. 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. Willoughby Grange DS0000002575.V282559.R02.S.doc Version 5.1 Page 7 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 Willoughby Grange DS0000002575.V282559.R02.S.doc Version 5.1 Page 8 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, 3 & 5. The procedure for introducing new residents to the home is satisfactory, but pre-admission and admission assessments must be more detailed to ensure that residents needs can be met. EVIDENCE: The home has a Statement of Purpose, which outlines the services provided, but this has not been updated following changes in the management arrangements. The manager said that she would usually be responsible for the pre-admission assessment, and copies of these were seen on resident’s files. However, one resident who had been admitted last month only had a partially completed assessment, with key information missing. The manager explained that this information should have been completed on admission. Informal visits are encouraged prior to admission, but many admissions are directly from hospital, so this is not always possible, so relatives would be encouraged to visit. All admissions are on a trail basis. Willoughby Grange DS0000002575.V282559.R02.S.doc Version 5.1 Page 9 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 Some care plans still do not provide enough information for staff to fully meet residents support needs. Arrangements with local health care providers ensure that resident’s health needs are met, but medication administration and stocktaking arrangements need to be more detailed. EVIDENCE: A new 24-hour reporting system has been introduced, to improved communication and handovers. Care plans outline the need, the goal, care required and evaluation. The previous inspection highlighted that one care plan inspected did not accurately reflect the residents current needs, and was in need of review and updating. On this occasion, two of the three care plans inspected accurately reflected the needs of residents, but the care plan for one resident, who was suffering from a long standing pressure sore, was incomplete and lacking detail. The Waterlow pressure area assessment had only partially been completed and was not dated, and a pressure area body map and initial wound assessment were blank. Evaluation of the care plan simply stated “no changes”, and daily records gave no indication of the condition of the wound, with entries such as “care as plan”. Although the Willoughby Grange DS0000002575.V282559.R02.S.doc Version 5.1 Page 10 resident was being nursed in bed, no turning chart had been completed for two days, despite the care plan stating “re-position every 2-4 hourly”. All residents are registered with one of five local GP practices in Boston. The home has a good relationship with these practices, and residents said that they receive prompt attention if they are unwell. Chiropodists and opticians visit on a routine basis, and the manager said that those residents requiring dental services are registered. The home is currently considering changing to a pre-packed administration system. Medication is stored securely in a clinical room, and is administered by qualified nurses and senior carers who have undertaken training. Some controlled medication had been entered incorrectly into the register, giving a wrong total, and one resident’s medication had not been signed for that morning, with no explanation as to whether it had been omitted. A list of homely remedies used has been agreed with GP’s to ensure safe administration practice. Willoughby Grange DS0000002575.V282559.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. Although there is a monthly activity plan, it is not varied enough to fully meet the needs of residents to provide a stimulating environment. There is good contact with relatives, and standards of catering in the home are good, ensuring that resident’s choice and dietary needs are catered for. EVIDENCE: A monthly activity plan is displayed in the dining area. The home employs an activity co-ordinator for 30 hours per week, who was being assisted by a person on work experience. Some residents were participating in table games at the time of the inspection. Staff said that it was very difficult to engage some residents in activities. One resident said “There’s things going on, but I do get bored here sometimes”, and another said that she would like to get out more, “even if it was only into town”. There is good contact with relatives, with many visitors during the inspection. Relatives commented that they were made to feel welcome by staff, and there was no restriction on visiting. Regular relatives and residents meetings use to be held, but the manager explained that these had discontinued due to lack of interest. However, she had recently reinstated the meetings, with a good response from relatives. Willoughby Grange DS0000002575.V282559.R02.S.doc Version 5.1 Page 12 Residents said that they are well consulted by staff, and staff were observed to be offering choices in a variety of settings. They said that the standard of food is “excellent – can’t fault it” and “great – just like home cooking”. There is a choice of two main meals, with a variety of choice for breakfast and tea. Menus are displayed on blackboards in communal areas. A head chef, assistant chef and kitchen assistant are employed, and those kitchen staff interviewed demonstrated a good knowledge of resident’s dietary needs. The kitchen is well organised, with good cleaning and monitoring records. The head chef explained that little pre-prepared food is used, and they have a philosophy of home cooking and baking. Willoughby Grange DS0000002575.V282559.R02.S.doc Version 5.1 Page 13 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 & 18. There are satisfactory procedures for dealing with complaints and adult protection issues, ensuring that residents can raise concerns and are protected. EVIDENCE: The complaints procedure is contained in the ‘home portfolio’, and staff interviewed were clear about their responsibilities should they receive a complaint. Two complaints have been received by the Commission, and both were referred to the provider for investigation. The manager also said that a complaint was received last week, relating to staffing shortages in the dementia unit at weekends, and an inadequate call bell system. This complaint has been referred to the Regional Manager for investigation, but the manager was aware of problems with the system, and the company is looking into a replacement system. Staff demonstrated an adequate knowledge about the adult protection procedure. All staff complete an adult protection workbook during their induction, but do not receive update training. The Lincolnshire Adult Protection Committee guidelines are kept in the manager’s office, and it is recommended that a copy be available for staff reference in the upstairs office. Willoughby Grange DS0000002575.V282559.R02.S.doc Version 5.1 Page 14 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, 22, 24 & 26. The home provides a comfortable and pleasant environment for residents, and improvements are ongoing. However, residents should be consulted about fitting locks on their bedroom doors, to ensure their privacy. EVIDENCE: The home is generally well maintained and comfortable. Since the last inspection, new blinds have been fitted to the conservatory, and new curtains and chairs have been ordered, with some chairs having already been delivered. Some carpets, particularly in bedrooms are stained, and these have been identified, and the manager said that these will be replaced. The shower floors in the dementia unit are also scheduled for replacement. The Environmental Health Officer has visited recently, and has recommended that an extractor fan be fitted in the area of the lounge where residents smoke. The Fire Officer has recommended that bedroom doors be replaced, as they do not meet the criteria for fire doors. The previous inspection highlighted that most bedrooms are not fitted with locks, and residents personal possessions Willoughby Grange DS0000002575.V282559.R02.S.doc Version 5.1 Page 15 are not protected, and the manager said that this will be reviewed when the doors are replaced. Residents interviewed said that their rooms are comfortable, and that they are happy with the standard of accommodation. None wanted locks fitted to their bedroom doors, but residents must be consulted about this, and appropriate locks fitted if requested. The home provides nursing care, but there are no hospital style beds. Staff said that this did not cause problems, but it was noted that a number of divan beds are being renewed, and it is recommended that the use of hospital style beds for nursing residents be considered. There are a team of three cleaners and a housekeeper. All three cleaners were off on the day of the inspection, but standards of cleanliness were satisfactory, although the housekeeper was clearly very busy. The previous inspection highlighted an unpleasant odour, in the dementia unit, and this was not present during this inspection. However, one of the upstairs toilets in the main building smelt very damp. The dementia unit has limited communal space, and it is recommended that ways of increasing communal space be explored. Staff said that laundry facilities are satisfactory, and there are safe procedures for the transporting of foul laundry. Willoughby Grange DS0000002575.V282559.R02.S.doc Version 5.1 Page 16 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. There are adequate staff to ensure that the needs of residents are met. Arrangements for in-house training are good, but the training programme should be improved to ensure that staff are updated. Recruitment documentation did not provide evidence of a robust procedure, which could put residents at risk. EVIDENCE: Staffing levels of six staff in the morning, and five in the afternoon, plus a qualified nurse were maintained throughout January. There are three night staff, and 24-hour qualified nursing cover. Staff said that these levels are satisfactory to meet the needs of residents. Residents complemented the care that staff provide, saying they are “nice, friendly and caring”. However they commented that staff seem very busy, “especially at mealtimes”, and it was also noted that call bells were ringing for a considerable time when tea was being served. The manager said that there are now always two staff allocated to the dementia unit during the day. Only one member of staff has completed NVQ 2 or above. Four other staff are due to commence shortly, and the company will now be providing the training. However, it is recommended that more staff be enrolled to commence NVQ level 2 to ensure that the standard of 50 qualified be met. Some mandatory training, such as health and safety, moving and handling and fire training are delivered in house, but records were not available for inspection. However, staff confirmed that they receive periodic updates. There is no training plan for Willoughby Grange DS0000002575.V282559.R02.S.doc Version 5.1 Page 17 the year, outlining what training is due to be delivered, and identifying when updates are due. Some training packs are available on disc from the training department, such as POVA, dementia care, infection control and understanding aggression. Three staff have recently received training from the Alzheimers Society on dementia care. The files of two newly recruited staff were inspected. Both contained references, proof of identity and evidence of a formal interview process, but there was no evidence of a Criminal Records Bureau disclosure having been obtained for one member of staff. The manager agreed to check this with the CRB office. One member of staff outlined her recruitment process, and described her first weeks working at the home, when she shadowed other staff, and completed an induction programme, which she found useful. Willoughby Grange DS0000002575.V282559.R02.S.doc Version 5.1 Page 18 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, 33, 35, 36 & 38. The home would benefit from a more robust management structure. There are procedures in place to monitor the quality of care that residents receive. The environment is generally safe for residents, but some concerns were identified. EVIDENCE: The manager has recently attended a fit-person interview, and has been registered with the Commission. She was previously deputy manager at the home, and has nearly completed the Registered Managers Award. There is no Deputy Manager in post at present, and because of the size of the home, this is impacting on the overall management. There are systems in place to monitor the quality of care provided at the home. The manager completed a self-assessment audit in July last year. A financial audit was undertaken in October, and the Regional manager conducted a ‘First Impressions’ audit in November. The manager is now required to submit monthly monitoring returns to the company. Willoughby Grange DS0000002575.V282559.R02.S.doc Version 5.1 Page 19 The home is appointee for two residents, and relatives deal with the finances for other residents. Money sent in by relatives is held in a pooled bank account, and accounting procedures are satisfactory. One resident with higher balances does have their own bank account accruing interest. Staff supervision was not occurring regularly last year, but this has now been timetable every two months as from January. Health and safety records are of a high standard, with good servicing records and evidence of regular routine checks. However, the following health and safety issues were identified: • • • Denture cleaning tablets were left in resident’s rooms, but no risk assessment had been conducted. This is especially concerning in the dementia unit. A fire exit through a stairwell was blocked by stored wheelchairs, and this was attended to by staff when pointed out. There is no risk assessment for the prevention of legionella, although there was evidence that steps are being taken to prevent risks. Willoughby Grange DS0000002575.V282559.R02.S.doc Version 5.1 Page 20 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 2 x 2 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 x 3 x 2 x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 2 Willoughby Grange DS0000002575.V282559.R02.S.doc Version 5.1 Page 21 Yes 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 OP1 Regulation 4 Requirement The registered person must ensure that the Statement of Purpose is updated to reflect management changes in the home. The registered person must ensure that a thorough preadmission assessment is conducted prior to admission to the home. The registered person must ensure that all care plans are reviewed regularly with the involvement of the service user or their representative, and accurately reflect residents current care needs. (Original timescale of 31/12/05 not met). The registered person must ensure that medication stocktaking and administration records are accurate. The registered person must ensure that satisfactory activities DS0000002575.V282559.R02.S.doc Timescale for action 31/03/06 2. OP3 14 31/03/06 3. OP7 15 31/05/06 4. OP9 13(2) 31/03/06 5. OP12 16(2)(n) (m) 31/05/06 Willoughby Grange Version 5.1 Page 22 are provided for all residents and a record is maintained of participation and provision. (Original timescale of 30/11/05 not met). 6. OP24 12(4) & 23(2)(m) The registered person must take action to safeguard residents personal possessions. (Original timescale of 31/12/05 not met). The registered person must ensure that all staff have evidence of a Criminal Records Bureau disclosure or POVA First check before commencing employment. The registered person must ensure that resident’s finances are banked in accordance with this regulation. The registered person must attend to the health and safety issues identified. 31/05/06 7. OP29 19 06/02/06 8. OP35 20 31/05/06 9. OP38 13(4) 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP18 Good Practice Recommendations It is recommended that a copy of the Lincolnshire Adult Protection Committee guidelines are available for staff reference in the upstairs office. It is recommended that ways of increasing communal space in the dementia unit be explored. It is recommended that the use of hospital style beds for DS0000002575.V282559.R02.S.doc Version 5.1 Page 23 2. 3. OP20 OP22 Willoughby Grange nursing residents be considered. 4. OP28 It is recommended that more staff be enrolled to commence NVQ level 2 to ensure that the standard of 50 qualified be met. It is recommended that the home has an annual training plan identifying what training is due to be delivered, and when updates are due. It is recommended that a deputy manager be appointed to support the registered manager. 5. 6. OP30 OP31 Willoughby Grange DS0000002575.V282559.R02.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Willoughby Grange DS0000002575.V282559.R02.S.doc Version 5.1 Page 25 - 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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