CARE HOMES FOR OLDER PEOPLE
Willow Bank Care Home Bell Dean Road Allerton Bradford West Yorkshire BD15 7DN Lead Inspector
Kate Shackleton Key Unannounced Inspection 9:30 20th June 2007 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 Willow Bank Care Home DS0000038927.V330262.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. Willow Bank Care Home DS0000038927.V330262.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Willow Bank Care Home Address Bell Dean Road Allerton Bradford West Yorkshire BD15 7DN 01274 889275 F-P 01274 889275 darrenpwalkden@aol.com 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) Victorguard Care plc Ms Carol Delaney Care Home 59 Category(ies) of Old age, not falling within any other category registration, with number (59) of places Willow Bank Care Home DS0000038927.V330262.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th March 2006 Brief Description of the Service: Willow Bank Care Home, which is a purpose built establishment, is situated in a rural area of Bradford within a care village setting. It provides social and personal care for 59 older people. It is approximately two miles from the City centre. There are local shops and amenities close by. There is ample parking for visitors, and the home is protected around the periphery of the building by closed circuit television. Information about the service is provided in the homes brochure given to service users and or their representatives. The commission for Social care inspection reports are available in the home for people to read. At the time of this visit fees ranged from £350 to £403-71p. Willow Bank Care Home DS0000038927.V330262.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The accumulated evidence used in this report has included: • A review of the information held on the homes file since its last inspection. • Information submitted by the registered provider in their Annual Quality Assurance Assessment document • An unannounced visit to the home. The visit lasted about seven hours and included a tour of the premises, talking to service users, relatives, and management. Examining a small sample of records and observing staff working with service users. What the service does well:
Prior to admission the manager meets with the prospective resident and family members. This allows individuals the opportunity to have all of their questions answered. People are given the opportunity to visit before making a decision. On the day of admission an individual member of staff is allocated to give the resident special attention and help them settle in. All admissions are subject to a trial period. Particular attention is paid to residents’ health care needs. Everyone is registered with a GP and have access to all the NHS healthcare facilities in the local community. Arrangements are made for health care professionals to visit residents at when necessary. There is a good choice of meals and special diets are catered for. Snacks and drinks are available throughout the day and night. Staff are recruited in a way that seeks to make sure that only suitable people are employed ensuring the safety and protection of residents. The staff are provided with comprehensive training to improve their knowledge and skills. This seeks to ensure that residents receive a service from staff whose practice is up to date. Management take complaints seriously and act quickly to resolve issues to everyone’s satisfaction. Residents live in a clean attractive and well-maintained home. The environment is light, airy and spacious. It has a wide range of up to date Willow Bank Care Home DS0000038927.V330262.R01.S.doc Version 5.2 Page 6 specialist equipment and adaptations to meet the needs of people who use the service. The management of the home are keen to get residents views about the way care is delivered. They act on ideas put forward to improve life for people living at Willow Bank. What has improved since the last inspection? What they could do better:
The manger must undertake a full comprehensive needs assessment before admission. To be confident that the service can meet the persons needs consideration should be given to the personal, social, emotional, health and cultural needs of each individual. The assessment should concentrate on achieving positive outcomes for residents. Residents must have a care plan that has been agreed with them or their representative. It should be written in plain English, be easy to understand and consider all areas of the individual’s life including health, personal, emotional, cultural and social care needs. The plan must include the support that staff has to provide to meet the needs of residents whilst maintaining their ability to retain some independence. Areas should be identified where staff are willing to support residents to take some risks in order for them to live interesting and fulfilling lives. Staff needs to be provided with the skills and ability to support and encourage residents to be involved in the ongoing development of their plan and make the process interesting and worthwhile. Plans must be properly reviewed and where needs have changed, action taken and the plan amended accordingly. Good care planning means that service users receive a service that is specifically designed to meet their diverse care needs. The management of incontinence needs to be mindful of issues relating to promoting the privacy and dignity of residents.
Willow Bank Care Home DS0000038927.V330262.R01.S.doc Version 5.2 Page 7 In order for residents to enjoy a stimulating lifestyle with a variety of options to choose from staff need to find out from each resident the types of social and cultural interests and recreational activities that interests them. This should be recorded in the care plan. The activities provided should reflect individuals’ views. 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. Willow Bank Care Home DS0000038927.V330262.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 Willow Bank Care Home DS0000038927.V330262.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): 3. Standard 6 does not apply to this service. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Some of the needs of prospective residents are assessed prior to their admission to the home so that the manager can make a judgement as to whether or not the service can meet the persons’ needs. The lack of a detailed assessment has the potential to allow admissions whereby all of the persons needs cannot be met. EVIDENCE: Files examined confirmed that assessments are completed prior to admission. The manager will do the assessment wherever the prospective resident or their family chooses. This can be either at the persons own home, in hospital or at Willow Bank. Relatives and prospective residents are offered the opportunity to
Willow Bank Care Home DS0000038927.V330262.R01.S.doc Version 5.2 Page 10 visit the home for a look around and are admitted subject to a trial period. It is sometimes the case that relatives/representatives visit and make the decision on behalf of the person requiring care. On the day of admission an individual member of staff is allocated to help the person settle in. The three pre admission assessments examined lacked sufficient detail and were incomplete in some areas. Residents spoken to were not always able to recall some of the details surrounding their admission to the home but felt that satisfactory arrangements had been made. Relatives spoken to confirm that the manager had visited to discuss the prospective residents care needs and offered them the opportunity to visit. One relative was impressed with how quickly the manager had responded to their request for help and arranged admission. Willow Bank Care Home DS0000038927.V330262.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 and 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ health care needs are met. There is the potential for residents to have some important needs not met which could have a negative impact on their wellbeing. EVIDENCE: Because the initial assessment lacks sufficient detail, care plans fail to address the diverse needs of service users. The care plans looked at referred only to the physical and health needs of people using the service. The social, emotional, religious and cultural needs are not considered. Incomplete plans run the risk of residents having a range of unmet needs. Residents or an advocate have not signed and dated the plans suggesting that they have not
Willow Bank Care Home DS0000038927.V330262.R01.S.doc Version 5.2 Page 12 been involved. A member of staff explained that senior carers do the care plans. Residents spoken to knew nothing about their care plans. Plans do not consistently detail the action, which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the service user are met. There was no evidence that discussions had taken place with residents about their personal preferences or wishes regarding how staff should deliver the service. A named carer and a key-worker system operate and there are plans to expand the key worker role. Healthcare needs were recorded in the plans looked at. Residents are registered with a GP and can access other healthcare professionals as needed. One resident confirmed that she is taken to the surgery. The health care needs of people unable to leave the service are managed by visits from local health care professionals. Recordings in care notes confirmed this. Willow bank has been awarded Bradford Councils Quality Premium 3 rating. This is the highest rating. Aspects of healthcare audited in this quality rating include pressure area care, falls and hospital admissions. Health care needs are monitored and appropriate action and intervention taken. A nutritional risk assessment is completed for all residents and specialist advice is sought if needed. There was no evidence in care plans to show that any discussions had taken place with residents about supporting them to administer their own medicines. One resident self medicates and is provided with secure arrangements for the safe storage of her medicines. Medicines are dispensed from a monitored dosage system supplied by a local pharmacist. The provider of the system provides staff with training. There is a medication policy to guide staffs practice and only senior careers are allowed to give out medicines. Two pots of unfinished liquid medication were found on a table in the lounge. They had been left there following the breakfast medicine round. Discussed with the manager the potential dangers of this practice. In this instance the likelihood of anyone else being harmed if they had taken the medicine was unlikely. Service users and relatives spoken to said that staff delivers a service that respects resident’s privacy and dignity. Residents looked clean and well cared for. Comments heard included “The care is superb” and staff are “so kind, very very good.” Residents can lock their bedroom doors and staff were seen knocking before entering bedrooms. Staff were observed talking with residents in a kind and helpful manner. A couple of practices observed on the day compromised residents privacy and dignity. Protective pads were seen on some chairs. The manager explained that they are there to protect the furniture in case a resident has an “accident” This was taken to mean incontinence. The placing of these pads has the potential to highlight that people living in the home have issues relating to incontinence and could identify individuals who are incontinent. It is therefore considered poor practice in the management of continence. It demonstrates a
Willow Bank Care Home DS0000038927.V330262.R01.S.doc Version 5.2 Page 13 lack of respect for the privacy and dignity of residents and disregards the need to provide a discreet service. It was noted that when the manager and staff sat on chairs they folded the pad back. A member of staff was overheard calling from a distance to a member of care staff to assist a resident who is “wet through” Willow Bank Care Home DS0000038927.V330262.R01.S.doc Version 5.2 Page 14 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 and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. With the exception of activities residents and their relatives are content with the standard of care delivered. EVIDENCE: Residents have a choice of various activities during the week. However the activities do not necessarily reflect the individual interest of residents. Care plans fail to address this aspect of peoples lives. Some activities are not particularly meaningful or age appropriate e.g. colouring books and “cutting and sticking” There was a mixed response from residents ranging from “I like knitting” to “absolutely bored just sitting here looking at each other” and “I don’t like making things”. One resident said she joined in the activities but felt that they were child like. During the last twelve months new equipment such as floor games, song sheets and music have been purchased for group activities. The activity organiser has attended a training course to improve her
Willow Bank Care Home DS0000038927.V330262.R01.S.doc Version 5.2 Page 15 knowledge. A religious service is held in the home monthly and arrangements can be made for clergy to visit. The service welcomes visitors and provides a visitors lounge, which has tea and coffee making facilities. Visitors spoken to confirmed that they are made to feel welcome. The service promotes contact with the community and invites members of the local community to events in the home. The local primary school visits monthly to entertain residents. Residents spoken to confirmed that the routines of the home are flexible. They were able to give examples of how they are able to make choices and maintain some control. In general they commented favourably about the care delivered. Menus are changed seasonally and there is a choice of food at each mealtime. Special diets are catered for. Discussions with catering staff confirmed that they are informed of service users dietary needs. Meals are provided in an attractive dining room. Tables are properly set and specialist equipment is provided to help individuals to eat independently. Lunchtime was relaxed and residents were given enough time to complete their meal in a comfortable manner. Staff were seen providing sensitive support to residents who needed help with feeding. Service users said that the food is good and that they are provided with enough drinks and snacks between meal times. On special occasions themed meals are arranged. Willow Bank Care Home DS0000038927.V330262.R01.S.doc Version 5.2 Page 16 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 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and acted upon in the best interests of residents. EVIDENCE: The manager responds positively to complaints. There has been one complaint since the last inspection. It was dealt with appropriately and an advocate was used to ensure the best possible outcome for the resident. The complaints procedure is displayed in the home. Residents and relatives spoken to say they feel able to complain without any fear of recriminations. Staff receives training in safeguarding adults and in discussions with the manager it was evident that she understood her role in referring any suspicions or allegations of abuse to the local authority for investigation. The manager is trying to access improved training for staff. Willow Bank Care Home DS0000038927.V330262.R01.S.doc Version 5.2 Page 17 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 and 26 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a clean safe comfortable home. EVIDENCE: The home is purpose built and meets residents’ personal and collective needs in a comfortable manner. It is light airy and spacious. Aids and adaptations are provided and regularly serviced. The home employs a handyman who is responsible for routine maintenance and the monitoring of some health and safety aspects of the premises. Willow Bank Care Home DS0000038927.V330262.R01.S.doc Version 5.2 Page 18 Information provided by the manager and the sampling of some health and safety records showed that every effort is made to provide a safe environment. Staff receives fire training and fire equipment is routinely serviced. A record of hot water temperatures is kept to ensure the delivery of safe hot water and prevent the risk of scalding. A tour of the premises included all of the public areas, some bedrooms, bathrooms, toilets, laundry and the kitchen. The home is very clean and smelled fresh. Systems are in place to prevent the spread of infection. Willow Bank Care Home DS0000038927.V330262.R01.S.doc Version 5.2 Page 19 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 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The safety of residents is promoted through a robust recruitment process and a well-trained workforce. EVIDENCE: The rota shows that there is enough staff employed on each shift and especially at times of peak activity. Staff were observed responding quickly and appropriately to requests from residents and spent time talking to them. Residents spoken to say that staff are always available to provide assistance and that they never have to wait long for help. Residents said that they felt in safe hands. 75 of care staff have achieved National Vocational Qualification level 2 or above. Three staff have achieved the Registered Manager award. An external training provider delivers the staff training programme and the local college staff visits the service to deliver the NVQ training. Mandatory and specialist training is provided. Management places a high level of importance on training. Willow Bank Care Home DS0000038927.V330262.R01.S.doc Version 5.2 Page 20 Staff files examined showed that a proper recruitment process takes place, which endeavours to make sure that only suitable people are employed. Application forms are completed and an interview takes place. References are sought including a Criminal Records Bureau check. There is an induction programme that ensures new staff members are given the right information to be able to do their jobs well. Willow Bank Care Home DS0000038927.V330262.R01.S.doc Version 5.2 Page 21 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 35 and 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is managed in a manner that seeks to improve standards of care in order that residents receive a good service. EVIDENCE: The registered manager is experienced and qualified and there are clear lines of accountability within the home and with the owners of the business. The
Willow Bank Care Home DS0000038927.V330262.R01.S.doc Version 5.2 Page 22 owner of the home is on site on a very regular basis and monitors the standard of the service delivered. The service has policies and procedures to guide staffs practice. A quality assurance scheme asks for the views of residents. Questionnaires are circulated. Management make improvements where shortfalls in the service are identified. There is an annual business plan. Residents meetings are held and one resident confirmed that menus had improved as a result of discussions held in these meetings. The home operates with the philosophy that “If it is not good enough for our mum and dad it is not good enough” This statement is displayed in the reception area. The management resists holding money for safe keeping on behalf of residents and suggests to relatives/representatives that other arrangements are made. The safety and well being of residents and staff is promoted through proper recruitment processes, staff training and risk assessments. The home works to a clear health and safety policy and regular safety checks are carried out. Staff training programmes includes Health and Safety training. Willow Bank Care Home DS0000038927.V330262.R01.S.doc Version 5.2 Page 23 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 2 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 4 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Willow Bank Care Home DS0000038927.V330262.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 Prior to admission a full assessment of all of the persons’ needs must be made. The assessment must include the personal, health, social and cultural needs. The assessment should focus on achieving positive outcomes for people. A service user plan of care generated from a comprehensive assessment must be developed with each resident and or their representative. The plan must set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs are met. The plan should be agreed and signed by the service user whenever capable and/or their representative. The arrangements for managing incontinence should respect residents’ privacy and dignity at all times. Timescale for action 31/07/07 2 OP7 12 (1)(2)(3) 30/09/07 15 3 OP10 12 (4)(a) 30/06/07 Willow Bank Care Home DS0000038927.V330262.R01.S.doc Version 5.2 Page 25 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 OP12 Good Practice Recommendations Staff should seek the views of the residents when planning activities both in the home and wider community. Activities should reflect resident’s preferences and interests. Care plans should record this information. Willow Bank Care Home DS0000038927.V330262.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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
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