Inspection on 21/01/08 for Willow Bank Nursing Home

This inspection was carried out on 21st January 2008.

CSCI found this care home to be providing an Adequate service.

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

Willow Bank Nursing Home 14/01/09

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Willow Bank Nursing Home 5 Barwick Road Leeds Yorkshire LS15 8SE Lead Inspector Carol Haj-Najafi Key Unannounced Inspection 21st January 2008 9:30 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 Willow Bank Nursing Home DS0000071040.V358268.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 Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Willow Bank Nursing Home Address 5 Barwick Road Leeds Yorkshire LS15 8SE 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) 0113 2647924 0113 2648414 Maria Mallaband Ltd Mrs Linda Ann Oram Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 37 First inspection 2. Date of last inspection Brief Description of the Service: Willow Bank is a privately owned nursing home, originally built in the late 1950s and has been used as a care home since 1956. Set around the east side of Leeds and close to the motorway junction, the home has a well-maintained garden and two sun lounges. The home is situated within walking distance to the local shops, library, hairdressers, surgery, pharmacy and public house. The home offers long term, respite and transitional care, and has twenty-eight single and four double bedrooms all with en-suite facilities. The fee charged by the home ranges between £449 and £695 per week. This information was provided on 21 January 2008, during the inspection. Fees cover the costs of accommodation, care and laundry, with the exception of chiropody, hairdressing and personal newspapers. Information about the home including a Statement of Purpose and Service User Guide are available at the home. Up to date information about fees can be obtained directly from the home. Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The Commission for Social Care (CSCI) inspects care homes to make sure the home is operating for the benefit and well being of the people who live there. More information about the inspection process can be found on our website www.csci.org.uk This is a new service because changes were made to the organisation. The service was registered in October 2007 and this is the first key inspection. Before the unannounced visit we reviewed the information we had about the home. The manager completed an annual quality assurance assessment (AQAA) and we used this to help us decide what we should do during our inspection. Surveys were sent out to people who live at the home, their relatives and health care professionals. Twenty surveys were returned. Comments from the surveys have been included in the report. One inspector did the first unannounced visit on the 21 January and was at the home from 9.30am to 6.30pm. A pharmacy inspector did another unannounced visit on 23 January and was at the home from 10.00am to 2.30pm. During the inspection, time was spent looking around the home and talking to people who live who live at the home, visitors and people who work there. Interactions between staff and the people who live at the home were observed. Care plans, risk assessments, daily records, staff recruitment and training records were looked at. The pharmacy inspection looked at arrangements within the home that support the safe handling of medicines. Medicine records, storage and administration were looked at. Feedback was given to the registered manager at the end of the visit. What the service does well: People’s needs are properly assessed before they move into the home so everyone can be sure that the person is moving into the right home and their needs can be met. Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 6 Good systems are in place to make sure people’s healthcare needs are met. Surveys from healthcare professionals said the home provides a “good level of care”, “good communication” and “ a good standard of care”. Relatives are happy with the quality of care and feel very welcome when they visit. Relative surveys said they are always kept up to date with important issues. Some good care practices were seen during the inspection. Staff showed warmth and were kind and courteous. Staff were seen to laugh and joke with people. One person who lives at the home said staff were nice and she loved one staff member being on duty because “she is very special”. People live in a nice, clean and comfortable environment. People are confident that they will be listened to and that appropriate action will be taken if they have a complaint. One relative said they talk to the manager or deputy if they have any concerns. What has improved since the last inspection? What they could do better: The home must make sure people get enough information about the terms and conditions of their stay before they move in. Care plans must accurately cover the important areas of people’s care needs and staff must know what these are. This will make sure people are getting the right care to meet their needs. Daily life for people living at the home is not varied. More social and recreational activities would provide a more stimulating and fulfilling lifestyle. One person said they don’t come downstairs because there is “never anyone to talk to”. People at the home must be treated with respect and dignity at all times. Some unacceptable practices were seen during the inspection. One staff member was overheard saying to another staff “leave her there cause she’s a feeder anyway”. At lunchtime, one staff member was feeding two people. The staff member did not inform the people what they were eating and initially there was very little conversation. Staff should receive regular refresher training to make sure their skills and their knowledge are up to date. Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 7 Staffing levels are not adjusted accordingly when the home is providing more intense levels of care, and this has affected the quality of the service. Staff said “when we are full staff get stressed”, another staff member said “it’s up and down, sometimes we have no quality time with people”, and another said, “when staffing levels are ok we have a lovely time with people, other times we don’t have time to do our job properly”. Some moving and handling practices are not individualised and people who live at the home are at risk of injury. There are poor systems for the accurate administration, recording and storage of medicines. This puts people at risk of not receiving their medication safely and as prescribed. This may have an affect on their health and wellbeing. As a result of this inspection 12 requirements and 5 recommendations were made. These can be found at the end of this report. 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 Nursing Home DS0000071040.V358268.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 Nursing Home DS0000071040.V358268.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): 2 & 3 (Standard 6 does not apply) People who use the service experience adequate quality outcomes in this area. People’s needs are properly assessed before they move into the home so everyone can be sure that the person is moving into the right home and their needs can be met. People might not always receive enough information about the home before they move in. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: In the AQAA, in the ‘what we do well section’, the manager said, “welcoming atmosphere; individual pre-assessment; support for resident and the families; terms and conditions are given to residents; prospective residents are offered to visit the home and stay for lunch prior to admission; good Statement of Purpose and service user guide”. Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 10 During the site visit, two sets of admission records were looked at. Each person had assessments that identified the type of support they required. The manager and deputy co-ordinate any admissions and complete the preadmission assessments. The manager said they always visit the person before they offer a placement at the home. Both surveys from people who live at the home said they had received a contract and they received enough information about the home before they moved in. The manager was unable to find the terms and conditions that had been given to a number of people, including one person who had recently moved into the home. She said people who move in or their relatives are given terms and conditions and asked to sign them but she could not explain why they were not available for several people. The home has thirty two permanent beds, three transitional beds and two respite beds. Several concerns were raised about the impact on staffing levels and the affect this has on people living at the home, when people with high dependency needs stay at the home on a short term basis. These concerns have been covered in more detail under the staffing section of the report. Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience adequate quality outcomes in this area. People’s healthcare needs are met. A good assessment process is in place to make sure people’s needs have been assessed but the overall care planning process does not make sure people’s individual needs are met. Staff generally have a good relationship with people who live at the home but there are occasions when care practices do not promote dignity and respect. Medication is not always administered or recorded accurately. Medication with limited use once opened is not always identified. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: In the AQAA the manager said, “Each care plan is person centred”, and identifies “individual strengths and personal preferences”. “Our monthly magazine is very popular and has birthday greetings with photographs”. Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 12 We looked at four people’s assessments and care plans. The assessment process works well. Each person had detailed assessments which had been completed on a fairly regular basis. The assessments covered nutrition, risk of pressure sores and moving and handling. People’s weight and blood pressure had been regularly checked and recorded. Care plans also had good detail about how a person’s needs should be met but some of the information was out of date and incorrect. Some staff did not know what was written in some of the care plans. For example, one plan had been written in October 2005, and had been regularly reviewed, however, the care plan said the person walked with a ‘zimmer’ frame but staff confirmed that she had not walked with the frame for some time. Another plan said a person, who has a pressure sore, should have a high calorie diet but the cook and a carer were unaware of this. The plan also said they should be repositioned every 2-3 hours but again the carer was unaware of this. Another plan said a person wears a hearing aid but they were not wearing one on the day of the inspection, and an experienced carer was not aware the person should wear a hearing aid. Most of the inspection was spent either talking to people or observing interaction between staff and people who live at the home. Some good practices were observed, and staff showed warmth and were kind and courteous. Staff were seen to laugh and joke with people. One person who lives at the home said staff were nice and she loved one staff member being on duty because “she is very special”. Poor practice was also seen on the day. When staff were helping people get ready for lunch they were looking for wheelchairs to take people through to the dining room; staff said people who cannot walk through to the dining room stay in wheelchairs at mealtimes. Staff could not find enough wheelchairs to transport people through to the dining room, and one staff member was overheard saying to another staff “leave her there cause she’s a feeder anyway”. At lunchtime, one staff member was feeding two people at the same time. The staff member did not inform the people what they were eating and initially there was very little conversation. After a while another staff member started supporting one of the people, she then got up and did another task, and the original staff member continued feeding both people. These practices are not personalised and show a lack of respect. At lunch six people were in the dining room, four people were in wheelchairs, one person was sat on a dining chair, and one person was in their own ‘easy style’ chair. The practice of people staying in wheelchairs should be looked at to make sure it is not a time saving exercise for staff. Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 13 The person in the easy style chair struggled to reach her plate and only ate a very small amount of her main meal; staff did not offer any assistance with the meal. A staff member then gave full assistance with dessert and fed the person. The levels of support were extreme because for the first course the person had no support and for the second course the person had total support. One survey from a person who lives at the home said they usually receive the care they need; one survey said they always did. Three healthcare surveys were returned. They were all satisfied with the care that is provided at Willow Bank. Under the ‘what do you feel the care service does well?’ They wrote “good level of care”, “good communication” and “provide a good standard of care”. Two surveys said the care service always seeks advice and acts upon to improve healthcare needs; one said usually. Two said healthcare needs are always met; one said usually. Staff said good systems are in place to make sure healthcare needs are met. Care staff said they always report any concerns to the nurse on duty, and they contact the GP if they have concerns. One person who lives at the home said the staff look after them if they are unwell. Findings from the pharmacy inspection. There is a good, detailed policy in the home covering all aspects of medicines management. There is also a copy of the latest guidance from the Royal Pharmaceutical Society which staff have been asked to read. This means staff have access to up to date information on legal requirements and guidance. The current and previous months Medication Administration Record (MAR) charts were looked at. There is no record of staff authorised to administer medicines kept with the charts. This makes it difficult to identify who was involved in administration if a problem or error was to occur. There were very few gaps on the MAR charts but the accuracy of the record keeping was inconsistent. For example one person prescribed 100ml of antibiotic syrup for 7 days had only 5 days of administration recorded when course complete was written. There is inconsistency in the recording of the quantity of medication supplied and the date received. This means it is difficult to have a complete record of medication entering the home and to check if medication is being administered correctly. The quantity of medication that is used from one monthly cycle to another should be recorded on the new MAR. This makes sure there is a method of tracking how much medication has been administered and to know how much stock there is. There were details missing from handwritten entries. To make sure there is an accurate record the quantity supplied, the date of entry, the signature of the person making the entry and a witness signature where possible should be included. Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 14 The code ‘O’ was used on a number of occasions to record no administration. However there was no definition on the chart to explain why the person had not received their medication. The MAR charts did not have any codes printed on them for staff to record the reason why medication was not administered. It is important that a clear reason is given so there is accurate information on how a person is taking their medication. The prescriber, who may wish to review the medication, may also use this information. The MAR charts for one person who self administers their medication had a tick against each entry. It was explained that this was a record of the person being watched to see if they had taken their medication. MAR charts are to record administration by staff. Any other activity should be recorded separately or written clearly on the MAR to show it was not administration that had taken place. A record is made of the disposal of all medication so that medication leaving the home is accounted for. An audit of current stock and records showed that some medication had been signed for but not given. For example one person was prescribed 28 tablets at one a day. The MAR had 20 records of administration but 16 tablets were left. It is important that medication is given as prescribed so that a person’s medical condition is not affected. The room for storing medication is very warm and has no ventilation. Room temperatures are checked and recorded. The records show that temperatures are regularly higher than the maximum of 25 degrees recommended by most manufacturers. This puts people at risk of receiving medication that may be unsafe to use. Medication that has to be made specially is not checked to see if there is a limited time it can be used for. For example a bottle of medication was found with an expiry date of 22/01/08. This had only been opened on 21/01/08 but there was nothing written on the bottle or MAR chart to highlight the expiry date. The controlled drugs cabinet is small. This would cause problems if large items such as a bottle of liquid were supplied. The legal storage requirements may not be met. The controlled drugs register is suitable for use. The recording of the disposal of controlled drugs does not include the quantity destroyed. This is required to make sure there is accurate information about these medicines. The care plans for three people were looked at. The care plans need to be updated to provide detailed information on the person’s medication and medical condition. Such details are important as it means staff have up to date information on the care requirements for that person. For example one person who had recently arrived at the home had medication to be administered once a week. There was no record in the care plan or on the MAR chart to identify what day of the week it should be given. Another person self administers their medication. A risk assessment had been done but was missing details of the medication. This means there is not an accurate Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 15 record of what medication the person is taking. This makes it difficult to do a review of self administration. The ordering of prescriptions is the responsibility of the nursing staff. However the prescriptions are not returned to the home before going to the pharmacy. Prescriptions should be checked before sending them to the pharmacy. This is to make sure that any changes from the previous month are on the new prescriptions, to check for missing items and to inform the pharmacy of items that were not requested. The checking of prescriptions is an important part of the management of residents’ medication. Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the service experience adequate quality outcomes in this area. Relatives are happy with the care and support the home provides. People receive a balanced diet and they are happy with quality of the meals. People who live at the home do not have a stimulating or varied lifestyle and there are few opportunities to engage with others. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: One relative said they were very happy with the care. He said he was always made to feel welcome and said he was very impressed with the way staff handled a recent incident. He thought staff were very efficient and had given reassurance. Four relative surveys were returned. They were very positive about the care that is provided at Willow Bank: • The surveys said the care home always gives the support they expect Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 17 • • • The surveys said they are always kept up to date with important issues The surveys said the care service always meets the different needs of the people, for example, disability, age and faith Two surveys said the home always meets the needs of their relative; two said usually The following additional comments were made in the surveys: • They care • Care and consideration 99 of the time- very minor issues now and again • They do their best under the circumstances In the AQAA the manager said they could “improve activities and encourage more residents to attend the residents meetings”. Two staff surveys said they could improve activities. One survey from a person who lives at the home said there are sometimes activities; one said never. We spoke to six staff, including the manager, and three people who live at the home. All staff and two of the people who live at the home said the level of daily activity should improve. One person said there is no stimulation, another person said people are generally bored. Staff said people enjoy it when entertainers visit the home; one was coming the week after the inspection. The manager said they had identified that there are not enough daily activities and had tried to recruit an activity organiser. An activity organiser had started in June 2007 but had only stayed for about two weeks. This is clearly a longstanding problem that must be addressed because the outcome for people living at the home is not satisfactory. One person was celebrating their birthday on the day of the inspection, relatives visited and staff were seen singing and wishing the person happy birthday. The manager said they celebrate everybody’s birthday. At lunchtime only six people had their meal in the dining room, all other people ate in their rooms. Staff said some people choose to stay in their room; others stay in their room for health reasons. One person said they don’t come downstairs because there is “never anyone to talk to”. The lack of social interaction can leave people feeling isolated. Lunch was generally disorganised; it could have been more of a social occasion for people if it had been better organised. Tables had not been prepared for lunch and as people came through to the dining room a place was set. There were no condiments on the table. People did not eat the meal together because people were being brought through at different times and getting their meals at different times. Two people waited over ten minutes for their meal. Staff could not find enough tabards for people. The manager said meal times were not Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 18 usually disorganised but the inspection, a new admission and the absence of the kitchen assistant had led to disruption on that particular day. People said they liked the meals. Staff said the meals were generally satisfactory. Menus were nutritious and varied. One person suggested having a better choice of sandwiches. One person said the meals were sometimes cold, another person said the meals were hot. Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. The people who live at the home are safeguarded. People are confident that they will be listened to and that appropriate action will be taken when necessary. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: In the AQAA in the ‘what we do well’ section, the manager said, they have a “very comprehensive,robust, transparent complaints procedure”. “Act on critism to aim for positive outcome, and learn by them” . “Ensure the residents feel safe and supported and understand the complaints procedure”. “Open door policy and robust adult protection policy”. All eleven staff surveys said they know what to do if a person living at the home or their relative has concerns about the home. Both surveys from people who live at the home and the relative surveys said they know how to make a complaint. One relative said they talk to the manager or deputy if they have any concerns. In November 2007, we received copies of three complaints that had been made about the home. The complaints had similar issues and were about the attitude of the staff, medication, general care, healthcare, and moving and Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 20 handling. The manager said they went through a difficult time in November when they had an outbreak of ‘Novovirus’. One person said they thought the complaints were made when the home had people staying at the home on a short term basis with high dependency needs and staff felt under pressure. In response to the complaints, the home has carried out investigations and produced an action plan to address the problems. Staff meetings have been held to discuss care practices and staff attitudes, staff have attended moving and handling training and medication training is being arranged. Staff and management have attended adult protection training and were familiar with the adult protection procedures. Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 21 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, 25 & 26 People who use the service experience good quality outcomes in this area. People live in a nice, clean and comfortable environment. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: A tour of the building was carried out. A selection of bedrooms, communal areas and bathrooms were visited. The home was clean and tidy and there were no odours. There was information displayed around the home informing people what was happening. Bedrooms were personalised and some people had brought items when they moved in, which included pictures, ornaments and photographs. Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 22 The home was nicely decorated and seemed well maintained. Hot water was tested in several bedrooms and bathrooms. Temperatures were generally ok but one bath exceeded 45c which is above the recommended temperature. The manager and a staff member said the bathroom in question was not used but they agreed to make sure the temperature of the water is reduced. Throughout the home there were supplies of wipes, hand wash, aprons and thermometers for testing the temperature of bath water. In the AQAA the manager said, “ Although Willowbank is fully furnished, service users own furniture is encouraged and accomodated in their own bedrooms. All prospective service users and their families are encouraged to look around without appointment, so that they can see a working home in its entirety”. Both surveys from people who live at the home said the home was always clean and fresh. Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience adequate quality outcomes in this area. Staff are confident they can meet people’s needs when staffing levels are appropriate. When the home is providing more intense levels of care, staffing levels are not adjusted accordingly and this has reduced the quality of the service for people living at the home. Gaps in staff training could lead to gaps in staff’s skills and knowledge and this could result in people’s needs not being met. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: Staff surveys were positive about the care they provide and the support they receive. Some concerns were raised about staffing levels. • Every survey said they are given the training that is relevant to their role • Every survey said they are given up to date information about the needs of the people at the home. Three people made additional comments about receiving information at handovers when they start their shift. Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 24 • • • • Seven surveys said they have the right support and experience to meet the different needs of people living at the home, including disability, age and faith; four said usually. One survey said, “We provide proper care to everyone. The people we take care of are well looked after”. Another survey said, “we provide a high standard of care in a homely, friendly environment”. Five surveys said there are always enough staff on shift; six surveys said there are usually enough. One survey said staffing levels can be a problem, “if we have respite care that expect 1-1 care but because we have nursing care of our own, someone has to be left while later”. Surveys from people who live at the home said there are usually staff available when you need them. Two relative surveys said on occasions there should be more staff. A healthcare survey said they thought staffing levels might be a bit low at times. Staff and management were asked about staffing levels. The manager said the home never operates below the minimum staffing levels and often the home has vacant beds, hence less people stay at the home. Although the manager acknowledged that when they provide a service to people with high dependency needs staff can sometimes be busy. Staff said there are occasions when staffing levels are too low and this is when they provide short term care to people with high dependency needs. One staff member said, “when we are full staff get stressed”, another staff member said “it’s up and down, sometimes we have no quality time with people”, and another said, “when staffing levels are ok we have a lovely time with people, other times we don’t have time to do our job properly”. In the AQAA the manager said, “We have our own NVQ Assessor for NVQ2 and NVQ3, Most of the carers, have gained their NVQ2, working towards or are starting NVQ3. The home gives good induction and probationary periods, regular staff meetings. Flexible rota to fit the needs of the home”. Most staff said they were satisfied with the training they receive. One person said training was not kept up to date. Training records were not up to date so it was not possible to verify what training staff had attended. There is no information that identifies staff training needs. According to the training records, three staff who were on duty had not attended fire training. One person had not done any training in the last twelve months. One person who had worked at the home for several months confirmed they had completed an induction programme but their induction workbook was not Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 25 available. They had only completed their induction programme and attended moving and handling training. Three staff had recently started working at the home. We looked at their recruitment process. Two files had all the relevant information to confirm these recruitment processes were well managed, which included application forms, references and CRB (criminal records bureau) checks. One file had all of the information but there was a discrepancy in employment dates. Information in the application form did not correspond with what a referee had written. The manager agreed to follow this up. Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 26 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 & 38 People who use the service experience adequate quality outcomes in this area. The overall management of the home is satisfactory. In the main, the health and safety of people are protected. Although people who live at the home are at risk of injury because moving and handling practices are not individualised. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The manager has been the registered manager of Willow Bank for four years and is suitably qualified. The manager said she “encourages people to come and see her and operates an open door policy”. Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 27 All staff surveys said the manager regularly/often meets with them to give support and discuss how they are working. One survey said, “The manager is always available” and “she is very approachable”. Another survey said, “She is always asking us how we are working and any problems”. In the AQAA the manager said, they have “good support from the area manager”. The AQAA said quality assurance questionnaires are sent to people who live at the home, their families and other professionals. The results from August 2007 were displayed near the entrance. We looked at personal allowance records. All financial transactions were recorded and receipts were obtained for any purchases made. Two people’s monies were counted and the amount corresponded with the amount on the balance sheet. The AQAA also said relevant policies and procedures were in place and reviewed between July and October 2007. It also said equipment has been serviced or tested as recommended by the manufacturer or regulatory body. Portable electrical equipment and hoisting equipment were tested in September 2007, gas appliances were serviced in April 2007 and fire equipment was tested in August 2007. Dates of testing fire and hoisting equipment were verified at the inspection. Staff were observed transferring people from chairs to wheelchairs. They used transfer belts to help when transferring. One person was being transferred using this technique but they did not put their feet on the floor during the transfer, therefore they did not weight bear. This method must only be used with people who can weight bear. The person’s care plan stated this method of transfer was the right method but this was based on the person weight bearing. Incorrect moving and handling techniques put the health and safety of people at risk. Two of the complaints that were received in November 2007 raised concerns that staff were lifting people rather than using proper equipment. As a result of the concerns staff attended moving and handling training in December 2007. At the inspection staff were talking to each other about using mobile hoists. One staff member said there was not enough room for the hoist in some areas of the lounge. Another staff member agreed. The home had an environmental health visit just before the CSCI inspection. The environmental health report confirmed standards had improved and a 3* rating was awarded. Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 28 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 2 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 29 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 OP2 Regulation 5 Timescale for action People must receive personalised 31/03/08 terms and conditions to make sure they have enough information to help them decide whether they are getting the service they chose at the price they expected. People must have a care plan 31/03/08 that identifies how their needs should be met. This will make sure their health and welfare needs are identified properly and met. Staff must follow care plan 31/08/08 guidance to make sure people’s needs are met and they are safe. All medication must be accurately administered and recorded on the MAR chart. This will make sure that people receive their medications correctly and the treatment of their medical condition is not affected. Medication must be stored safely. A system for the safe handling of medication with DS0000071040.V358268.R01.S.doc Requirement 2 OP7 12 (1) (a) (b) 15 3 OP7 12 (1) (a) (b) 18 13 (2) 4 OP9 29/02/08 5 OP9 13 (2) 29/02/08 Willow Bank Nursing Home Version 5.2 Page 30 6 OP10 12 (4) (a) limited use once opened must be in place. This makes sure that medicines are safe to administer. Staff practices must promote 29/02/08 personalised and individualised care. This will make sure the rights of the people who live at the home are respected and people are treated with respect and dignity. People who live at the home must have opportunities to engage in activities that give them with a stimulating and fulfilling lifestyle. People who live at the home must be able to engage with other people at the home to make sure their social needs are met. The temperature of the hot water in the first floor bathroom must be reduced to make sure people who live at the home are not at risk of scalding. Staffing levels must be adjusted accordingly so they are adequate to meet the assessed needs of the people who living at the home at all times. Staff must receive appropriate training to make sure the health, welfare and safety of people living and working at the home are protected. Moving and handling assessments and practices must be individualised to make sure needs are met and people are not at risk of injury. 31/03/08 7 OP12 16 (2) (n) 8 OP12 16 (2) (m) 29/02/08 9 OP25 13 (4) (a) 29/02/08 10 OP27 18 (1) (a) 29/02/08 11 OP30 18 (1) (a) 29/02/08 12 OP38 13 (5) 29/02/08 Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 31 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 A system should be in place to record all medication received in to the home and medication carried over from the previous month. This helps to confirm that medication is being given as prescribed and when checking stock levels. For accurate information on MAR charts all handwritten entries must have detailed information and a witness signature where possible. The home should check and sign all repeat prescriptions before they are sent to the pharmacist. This will reduce the risk of errors. Reference employment dates should be cross referenced as part of the recruitment process to make sure people who live at the home are protected by robust recruitment procedures. A training programme should be produced so individual training needs are identified and met. 2 3 4 OP9 OP9 OP29 5 OP30 Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Willow Bank Nursing Home DS0000071040.V358268.R01.S.doc Version 5.2 Page 33 - 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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