Inspection on 19/01/07 for Willow Brook House

This inspection was carried out on 19th January 2007.

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 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 Brook House 16/12/09

Willow Brook House 02/09/09

Willow Brook House 12/09/08

Willow Brook House 27/06/07

Willow Brook House 04/10/06

Willow Brook House 01/02/06

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

CARE HOMES FOR OLDER PEOPLE Willow Brook House 77 South Road Corby Northants NN17 2XD Lead Inspector Mrs Kathy Jones Key Unannounced Inspection 19th January 2007 9:00 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 Brook House DS0000065185.V325238.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 Brook House DS0000065185.V325238.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Willow Brook House Address 77 South Road Corby Northants NN17 2XD 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) 01536 260940 01536 260941 kingfisher.house@ashbourne.co.uk www.schealthcare.co.uk Ashbourne (Eton) Limited Vacant Care Home 48 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (25), of places Physical disability over 65 years of age (25) Willow Brook House DS0000065185.V325238.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. No person falling within the OP category can be admitted where there are 25 people of the OP category already in the home. No person falling within the PD(E) category can be admitted where there are 25 people of the PD(E) category already in the home. No person falling within the DE(E) category can be admitted where there are 23 people of the DE(E) category already in the home. The total number of Service Users in the home must not exceed 48. Date of last inspection 4th October 2006 Brief Description of the Service: Willow Brook House is a care home providing personal care and accommodation to forty eight older people over the age of sixty five years. Up to twenty five people may have a physical disability and up to twenty three people may have dementia. The registered provider is Ashbourne (Eton) Ltd, which is owned by Southern Cross Healthcare. Willow Brook House is a purpose built facility located in the Old Village area of Corby Northampton, with local community shops nearby. There are two floors; residents with dementia are located on the lower floor and residents with a physical disability on the upper floor. All bedrooms are for single occupancy and have en-suite facilities. There are 23 bedrooms on the lower floor and 25 bedrooms on the top floor. Communal dining rooms, lounges and bathrooms are located on both floors. The following fees were provided by the acting manager as being current at the time of the inspection: Fees range between £3331.31and £348.55 dependent on assessed needs for those funded by local authorities. Fees for self-funded residents range between £500 and £550 dependent on the room. The fees include personal care, accommodation, meals and laundry. Chiropody and hairdressing services can be arranged and are charged separately. Other costs would include personal expenditure such as newspapers, clothing and toiletries. Willow Brook House DS0000065185.V325238.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Standards identified as ‘key’ standards and highlighted through the report were inspected. The key standards are those considered by the Commission to have a particular impact on outcomes for residents. Inspection of the standards was achieved through review of the information held by the Commission for Social Care Inspection as part of the pre-inspection planning and an unannounced inspection visit to the service. The pre-inspection planning was carried out over the period of half a day and involved reviewing the service history, which details all contact with the home including notifications of events reported by the home, telephone calls, letters, and details of complaints and concerns received. The report from the last inspection carried out on 04 October 2006 was also reviewed and the findings taken into account when planning this inspection. The information gathered assisted with planning the particular areas to be inspected during the visit. Information gathered through a pre-inspection questionnaire and questionnaires received from residents, relatives and health professionals were incorporated into the inspection report of 04 October 2006 and therefore have not been included within this report. The unannounced inspection visit covered the morning and afternoon of a weekday. The inspection was carried out by ‘case tracking’ which involves selecting residents’ and tracking their care and experiences through review of their records, discussion with them, the care staff and observation of care practices. The inspector also spoke with other residents’ who were not part of the case tracking process. A sample of staff files were reviewed to check the adequacy of the recruitment procedures. Communal areas and a sample of residents’ bedrooms were viewed and observations were made of residents’ general well being, daily routines and interactions between staff and residents. Feedback on the inspection findings was given to the acting manager at the time of the inspection. What the service does well: There is a thorough assessment process for prospective residents with a detailed dementia care assessment tool for those people with dementia, which helps to ascertain if their needs can be met. Some residents’ and relatives were very happy with the care provided to them and were particularly pleased with aspects of the care such as staff assisting residents’ with nail varnish and lipstick. Willow Brook House DS0000065185.V325238.R01.S.doc Version 5.2 Page 6 There is a flexible visiting policy and residents were observed to welcome visitors at varying times of the day. Residents, a relative and a social worker spoken with were happy with the staff providing care. A resident described them as being “very good” and a relative said they are “marvellous”. Staff appear to have worked hard to minimise the impact of staff shortages on residents by being flexible with their duties. What has improved since the last inspection? What they could do better: To help residents make an informed choice about moving into the home a statement of purpose and service user guide need to be developed providing information about the service provided. Care plans do not provide staff with sufficient information and guidance for meeting all of residents’ needs, particularly in relation to challenging behaviours. While the preferences of residents who wish to get up late appear to be respected, the arrangements for medication and meals to fit in with their preferred routines are not adapted accordingly. For example, in one case, the gap between tea and breakfast was as much as nineteen hours, with no evidence of anything in between. The manager had already identified the need to alter the arrangements for meals. There was no proper menu in place, with meals being decided on an ad hoc basis, meals were mainly convenience foods and residents were not consistently receiving the assistance they needed. Residents expressed disappointment about the loss of the activity organiser who had made a positive impression on them over a short time in post. Residents said they were now bored and would clearly benefit from some interim arrangements for activities until someone else is recruited. Complaints procedures need to be improved to ensure that all concerns raised including verbal concerns/complaints by residents and their relatives can be captured and acted on. Dealing with concerns expressed verbally at an early stage may also help to prevent the necessity of raising more serious concerns and reduce the risk to residents. Willow Brook House DS0000065185.V325238.R01.S.doc Version 5.2 Page 7 Arrangements for addressing maintenance issues promptly need to be reviewed, as it is unacceptable that some residents have been without hot water in their en-suites since well before the inspection in October 2006. Arrangements for smokers need to be reviewed. Although Willow Brook House is working towards being a no smoking home, there are currently a few residents who use a designated smoking room, however there is no ventilation and the cigarette smoke drifts down the corridor. Staffing levels continue to be a cause for concern, with continuing shortfalls in the number of staff required to meet residents’ needs, particularly at weekends. Shortfalls in kitchen staff have also impacted on care staff and ultimately residents, as care staff have been called on to cook meals. Staff training records identified some shortfalls in basic training to meet the needs of residents. The findings of this inspection and failure to comply with statutory requirements raise concerns about the management oversight of the service and effectiveness of the quality assurance processes. 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 Brook House DS0000065185.V325238.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 Brook House DS0000065185.V325238.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): 1, 3, std 6 was not inspected as intermediate care is not provided. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The admission process establishes the homes ability to meet the needs of people admitted to the home, prior to admission. However the lack of information prevents prospective residents from making an informed choice about admission to the home. EVIDENCE: At the time of the inspection there was no statement of purpose or service user guide available. These documents are considered to be important sources of information for prospective residents and their representatives in helping them to choose a home. Without full information about the service and the type of care provided, prospective residents are unable to make an informed choice about moving into the home. The information contained on the companies website relating to the categories of admission was found to be incorrect. It referred to the provision of nursing care, which Willow Brook House does not currently provide. Willow Brook House DS0000065185.V325238.R01.S.doc Version 5.2 Page 10 A sample check of residents care records identified that an assessment is carried out prior to admission to establish a prospective residents’ care needs. For prospective residents’ with a diagnosed dementia, an additional dementia care assessment is carried out to establish their specific care needs and provide staff with an understanding of them as individuals. Care records reviewed for one resident indicated that their assessed needs were outside the range of needs that Willow Brook House is registered to admit. This particular resident had lived at Willow Brook House for in excess of three years at the time of the inspection and following a re-assessment and recent reviews a decision had been made that the residents’ needs could no longer be met and a new placement was being sought. Admission of people outside the category of registration is not only a breach of the conditions of registration but also increases the risk of residents’ needs not being met. However records for a more recently admitted resident, confirmed that a more thorough assessment had been carried out, and that their assessed needs were within the category of registration. Willow Brook House DS0000065185.V325238.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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of planning and organisation to meet residents’ specific needs results in their health and personal care needs not being met or fully met. EVIDENCE: At the time of the last key inspection in October 2006, there were mixed views about the quality of care provided. This appears to be still the case. Residents and relatives spoken with during the inspection confirmed that they were happy with the care provided. However comments found in a record of a residents’ review and the complaints record identify that some relatives have raised concerns about the quality of care provided since the last inspection. A care manager from social services who was visiting Willow Brook House to carry out a review one month after a resident’s admission was very pleased with how the resident had settled in. The care manager had noticed a big improvement in her condition and described her as “a different woman”. Willow Brook House DS0000065185.V325238.R01.S.doc Version 5.2 Page 12 Residents’ care files contain a comprehensive set of assessment and care planning documents. These documents are designed to guide staff in identifying and meeting the assessed needs of residents’. Review of the documents, highlighted that those relating to personal care needs, contained relevant information, which included consideration of what residents are able to do for themselves. This is considered important in helping residents to maintain as much independence as possible. They also contained individual preferences, for example one resident liked to wear nail varnish, which she was wearing at the time of the inspection having been assisted by a staff member. However a care plan for a resident identified as having challenging behaviour did not provide staff with full information about the behaviours or guidance as to how to manage the behaviours. Similar issues were raised in the report of the last inspection. Nutritional risk assessments had been carried out to identify those residents at risk of weight loss. However review of one resident’s care plan identified that it did not take proper account of the resident’s routines. For example the resident’s normal routine is to have breakfast about 11am, as she likes to get up late. Lunch is served at 12-30 and tea at 5pm. Although the care plan stated, “give snacks and finger foods in between meals”, discussion with staff identified that no arrangements were in place for this, putting the resident at risk of further weight loss. Times for administration of medication also highlighted that due account had not been taken of the gaps between medications for residents’ whose routines do not fit in with the medication rounds. Review of the management of residents’ medication confirmed that there is an audit trail, with records kept of medication received and administered to residents. A sample check of the records and the medication, found that it tallied with the remaining tablets. The manager advised that she carries out a monthly audit of the medication system. Observation of the administration of medication raised concerns about the security of the medication, with the medication trolley being left unlocked and for a brief period this was outside the field of vision of staff. A staff member was also observed to handle a resident’s tablets without any protective gloves creating a risk of infection. Records for the administration of a medication, which states it should not be given if the pulse rate falls below a certain level, identified that care staff were recording the pulse rate. Advice was given at the last inspection that checking of the pulse is a nursing task, and that if the task is to be delegated to care staff there must be evidence that staff have received training and the accountable nurse has assessed individual competence. A staff member said that she had received some training but that there was no record of this. Staff were observed to treat and speak to residents in a respectful manner and a staff member was observed to be sensitive to protecting the dignity of a Willow Brook House DS0000065185.V325238.R01.S.doc Version 5.2 Page 13 resident with dementia. A resident complained that her legs were cold and it was noted that several ladies were not wearing tights or stockings. Staff advised that the undignified practice of sharing a communal supply had been stopped two weeks ago, however alternative arrangements were not yet in place for residents’ leaving them without tights or stockings. Willow Brook House DS0000065185.V325238.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, 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are flexible visiting arrangements however the routines of the home and arrangements for meals do not support residents’ needs or preferences and in some cases put them at risk. EVIDENCE: It was identified at the inspection in October 2006, that whether residents’ lifestyle matches their expectations and preferences appeared to be largely dependent on their level of dependency. Residents preferences and choices in relation to times for getting up and going to bed and times for breakfast continue to be very dependent on the availability of staff particularly those requiring two staff for assistance with movement and handling. One resident who prefers to get up late in the morning was found to have these preferences met, however this resulted in the resident having breakfast and lunch within a period of one and a half hours and a gap of nineteen hours between tea and breakfast. Staff on duty during the day did not know if this resident had been provided with any supper. Staff advised that not all residents have supper and for those that do it is usually a Willow Brook House DS0000065185.V325238.R01.S.doc Version 5.2 Page 15 hot drink and a biscuit, though if there are any leftovers from tea this is sometimes offered. Arrangements for meals were poor and although a menu was displayed by the front door, menu’s plans are not followed and staff decide what to cook on the day. The majority of meals were made up of convenience foods. The new manager advised that new menus had been drawn up and would be implemented by the end of the month and these would include some fresh ingredients. Food stocks were found to be plentiful at the time of the inspection however discussion with staff identified that this has not always been the case. It was identified that there have been several occasions where there have been no kitchen staff, and care staff have had to go and cook whatever they could find to ensure that residents weren’t left without food. Jugs of water or squash were available in residents’ rooms, which allows residents’ who are able to manage drinks independently to maintain a good fluid intake. A high number of the residents’ at Willow Brook House are of Scottish origin, which is reflective of the local community. One resident said they were generally happy with the food, but was unhappy that they had not been able to have their traditional Scottish breakfast of porridge. Discussion with the manager identified that the lack of porridge appeared to have occurred as a result of a misunderstanding and that arrangements would be made to ensure it was available to all residents who wanted it. Another resident said that they had been offered porridge for breakfast. Observations of the lunch time meal identified that there were insufficient staff to ensure that residents’ had all the assistance that they needed. It was also identified that equipment such as plate guards, that some residents were assessed as needing to maintain some independence, was not available. Residents spoken with were very disappointed that the activity organiser who was new in post at the time of the last inspection had left the day before this inspection. Residents and a relative had said that the activities provided had been very good, however two residents said it would now be boring. There is a flexible visiting policy and residents were observed to welcome visitors at varying times of the day. Willow Brook House DS0000065185.V325238.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, 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Written complaints are responded to appropriately. However the lack of procedures for recording and monitoring concerns and verbal complaints reduces the opportunity for resolving problems and can put residents at risk of continuing poor care. EVIDENCE: Since the inspection carried out in October 2006, the Commission for Social Care Inspection (CSCI) received three complaints about the service. The complaints were forwarded to Southern Cross Healthcare for investigation through their complaints procedure and responses to two of the complaints have been received. The third complaint had only just been forwarded to the company just a few days prior to the inspection. Complaints including those received directly by the service included concerns about standards of care, long gaps between meals and medication administration and staffing levels. One of the complaints received stated that residents and staff were frightened to make complaints, this could not be evidenced during the inspection and the new acting manager stated in a response to the complaint that she actively encourages communication about any concerns. It was identified at the last inspection that there was a problem with the management of verbal complaints/concerns. Advice was given at the time, that the lack of procedures for recording and monitoring concerns and verbal Willow Brook House DS0000065185.V325238.R01.S.doc Version 5.2 Page 17 complaints reduced the opportunity for resolving problems before they become serious issues and make it difficult to identify and act on any reoccurring issues. Discussion with staff, again identified that relatives continue to complain that there are not enough staff to meet residents’ needs, particularly at weekends but there is still no record of this. Staff spoken to were aware of their responsibilities in reporting any concerns that put residents at risk, however there was no evidence of staff receiving any training in safeguarding vulnerable people form abuse. Willow Brook House DS0000065185.V325238.R01.S.doc Version 5.2 Page 18 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, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The clean and comfortable surroundings provided for residents, are compromised by failure to maintain basic services, such as hot water in some en-suites and provide adequate ventilation in the smoking room. EVIDENCE: Communal areas of the home and a sample of residents’ bedrooms were seen during the inspection. All areas were clean and comfortably furnished. At the time of the inspection a bath on the first floor was out of use as delivery of some parts was awaited and the other bath on that floor could not be used as the plug was missing. Staff said that there is a shower room but some of the residents’ don’t like the shower. The acting manager was unaware of this but advised that a plug would be purchased the following day from a local store. Willow Brook House DS0000065185.V325238.R01.S.doc Version 5.2 Page 19 At the time of the last inspection discussion with staff identified that there had been ongoing problems with hot water outlets in the home for some years and at the time of the inspection there was no hot water from approximately nine outlets. It could not be established exactly how long they had been without the hot water but it was of concern that this had not been addressed. In spite of a requirement this problem had still not been resolved and records showed that there was no hot water in twelve en-suite bathrooms. The new acting manager was unaware of the problems with the hot water but following enquiries identified that a quote for the necessary work had been obtained in November. There was no evidence of the work being commissioned. Some residents continue to be without basic services such as hot water and are reliant on staff carrying bowls of hot water to their rooms which also poses a health and safety risk. The dishwasher which had been out of action for approximately seven weeks at the time of the last inspection, had been replaced. There were indications that electrical wiring checks were overdue at the last inspection, the manager said that the certificate to confirm the checks had been carried out, was held at head office. As it was impossible to evidence that these necessary safety checks have been undertaken to safeguard residents’, advice has been given to keep a copy of relevant records at Willow Brook House. A no smoking policy had been implemented following a small fire in the home, however this had been reviewed as a result of complaints about residents, having to go outside for a cigarette in all weathers. Prospective new residents are informed that Willow Brook House is working towards being completely no smoking. However there are a small number of residents’ who had been smokers on admission to the home and these are now allowed to smoke in a designated room. The room used is not ventilated and therefore thick with smoke, which was also permeating the corridors, creating an unpleasant environment for smokers and none smokers. This also poses a risk to anyone with respiratory problems. Willow Brook House DS0000065185.V325238.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The improvements in the recruitment procedures provide better protection for residents however staffing levels and staff training need to be improved to adequately meet residents needs. EVIDENCE: Residents, a relative and a social worker spoken with were happy with the staff providing care. A resident described them as being “very good” and a relative said they are “marvellous”. There is a core group of staff who have worked at Willow Brook House for a few years. It was evident that on occasions the lack of consistent management has been quite difficult for them, and they have worked hard under challenging circumstances, to minimise the impact of staff shortages on residents. Shortfalls in staffing levels were identified at the last inspection and this continues to be an area of concern, which is impacting on the well being of residents. On the day of the inspection there was a carer short on the first floor, which was apparently due to a ‘mix up’ on the rota. This resulted in staff not being able to give residents’ all the assistance they needed, for example a resident was observed to be struggling to independently manage their meal where staff said normally they would have assistance. Willow Brook House DS0000065185.V325238.R01.S.doc Version 5.2 Page 21 Discussion with staff during the inspection identified that there has been no improvement in staffing levels since the last inspection, which are often inadequate particularly at weekends and holiday times. New years day was identified as being particularly poorly staffed with only four carers in the building and no kitchen staff. Staff managed to arrange for someone to come in to do the cooking, however this still left them very short staffed. The manager was unable to locate the staff rotas at the end of the day of inspection when these issues were discussed however advised that usual staffing levels are one senior and three care staff on each of the two floors. Discussion with staff identified that care staff have also often had to cook the meals as there has been no cook and when there has been a cook, due to the hours they work, care staff often have to wash up after tea reducing the number of carers providing care even further. The manager confirmed that if there are staff shortages, authorisation has always been given to use agency staff if cover cannot be found from the existing staff team. However it was identified that the process for obtaining authorisation can be quite time consuming and can cause a further reduction in the level of care to residents’ while staff make a series of telephone calls to try and obtain cover from existing staff and then obtain authorisation for the use of agency staff. The system is also reliant on three levels of management being immediately available to give authorisation. No details of the number of staff who hold a National Vocational Qualification were included in the questionnaire, however staff advised that it is very few. The National Vocational qualification in care provides staff with a basic understanding of care practices. At the last inspection it was difficult to verify what training staff had undertaken and this remains the case. A record held on the computer system indicates shortfalls in basic staff training and no evidence of induction training for new staff could be found. It was still not clear how many staff hold a National Vocational Qualification in care, which provides staff with a basic understanding of care practices. , The new manager acknowledged the need to identify what training had been undertaken and implement a training programme to ensure that staff are adequately trained to meet residents’ needs. It was identified at the last inspection that staff seemed very keen to attend training and further their knowledge. Staff were also quite receptive to advice give, for example it was noted at the last inspection that the tables for tea had been set shortly after lunch on the dementia unit which increased confusion. Staff had acknowledged this and the practice had been changed. Records for three relatively new staff members were reviewed to check the adequacy of the recruitment process. There was some difficulty locating the relevant records in some cases and some information had to be forwarded to the inspector following the inspection. However review of all of the information showed that references and criminal record bureau clearances are obtained prior to staff starting work, which helps to safeguard residents. Willow Brook House DS0000065185.V325238.R01.S.doc Version 5.2 Page 22 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The health and welfare of residents has not been properly protected by the management arrangements and quality assurance systems. EVIDENCE: Standard 31 relates specifically to the registered manager and their experience and qualifications. At the time of the inspection there was no registered manager in post and had not been one for some time, therefore this standard was not inspected as such. However it is considered from the perspective of the adequacy of the management arrangements as this is considered a key aspect of ensuring that residents receive appropriate care. Willow Brook House DS0000065185.V325238.R01.S.doc Version 5.2 Page 23 Willow Brook house has had a succession of temporary managers and the continuing shortfalls identified at this inspection highlight poor management oversight of this service. There is now a new manager, who had been in post for a few weeks prior to this inspection who is intending to submit an application for registration. A total of fourteen statutory requirements were made following the inspection in October 2006 and the dates for compliance had all expired at the time of this inspection. Eight of these requirements had not been met. These requirements relate to the planning of residents’ care, medication, regularity of meals and snacks, staffing levels and training and maintenance. All of these requirements are considered to have a direct impact on residents’ care and well being. The organisation has a range of quality assurance tools, however the full quality assurance programme would appear not to have been implemented due to various management changes. The new manager advised that she was starting to use some of the audit tools, which are part of the process such as a medication audit. Unannounced visits are normally carried out once a month by operations managers from Southern Cross to check and report on the conduct of the home and the care provided. The Commission for Social Care Inspection received a copy of the report of a visit carried out on 30th October 2006, which indicates that no concerns were identified. Records could not be found of any more recent visits, however the manager advised that a new operations manager had visited the day before the inspection. These visits are considered to be an important part of the quality assurance programme and enable the organisation to monitor the quality of care provided to residents’. Small amounts of money are held on behalf of residents’ to assist them with paying for things such as chiropody and hairdressing. The money is held securely and records of transactions kept. Since the last inspection recording systems have been improved and it was easier to check the records against the receipts making it a safer and more transparent system. Various health and safety issues have already been raised in other parts of this report. For example: risks with staff carrying bowls of hot water to wash residents due to them having no hot water in en-suite bathrooms. Risks associated with cigarette smoke which impact on none smokers due to the lack of ventilation have also been highlighted in the environment section of this report. A sample check of staff training records identified that the majority of staff have received training in movement and handling, some in first aid and some had attended fire safety training. However records showed that some staff may not have received up to date training in some areas and the manager has identified the need to establish exactly what training each member of staff has received in relation to safe working practices. Willow Brook House DS0000065185.V325238.R01.S.doc Version 5.2 Page 24 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 1 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 1 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X 2 Willow Brook House DS0000065185.V325238.R01.S.doc Version 5.2 Page 25 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 OP1 Regulation 4 (1) (a, b, c) Requirement A statement of purpose must be developed which sets out all the required information about the facilities and services provided for residents. Care plans must be based on an assessment of residents needs and be fully reflective of their current health and welfare needs. (This requirement is outstanding from the last inspection – timescale for compliance 15/11/06) Care plans must provide staff with clear guidance as to the actions required of them to manage verbally and physically aggressive behaviours. (This requirement is outstanding from the last inspection – timescale for compliance 15/11/06) Timescale for action 13/04/07 2. OP7 12 (1) (a, b), 15 16/03/07 3. OP7 12 (1) (a, b), 15 16/03/07 Willow Brook House DS0000065185.V325238.R01.S.doc Version 5.2 Page 26 4. OP8 OP15 12 (1) (a, b), 16 (2) (i ) 5. OP9 13 (2) 6. 7. OP9 OP9 13 (2) 13 (2) 8. OP9 12 (1) (a, b), 13 (2) 9. OP27 OP12 OP15 18 (1) (a) 10. OP15 12 (1) (a, b), 16 (2) (i) Residents’ needs as detailed in an up to date care plan must be met. For example where residents are identified as requiring snacks in between meals there must be evidence that this occurs. (A similar worded requirement was made at the last inspection and has not been met - timescale for compliance 15/11/06) Residents’ must receive medication at intervals determined by the prescriber and advice sought where this poses difficulties due to a resident’s preferred routines. Medication must be stored securely at all times. Safe practices for the administration of medication must be adhered to reduce risks to residents’, including those of contamination. Where the prescriber’s instructions for administration of medication involve a nursing task, care staff must have the necessary training and delegated authority. (A similar worded requirement was made at the last inspection and has not been met - timescale for compliance 23/10/06) There must be sufficient staff on duty at all times to ensure that residents’ needs and preferences are fully met. (A similar requirement with a timescale for compliance of 23/10/06 has not been met.) Residents’ must be provided with meals and snacks at regular intervals. (This requirement is outstanding from the last inspection - timescale for compliance 23/10/06.) DS0000065185.V325238.R01.S.doc 16/03/07 19/02/07 19/02/07 19/02/07 26/02/07 19/02/07 26/02/07 Willow Brook House Version 5.2 Page 27 11. OP16 OP18 22 (1) 12. OP19 23 (2) (b), 23 (2) (j) 13. OP19 OP38 23 (2) (p) 13. OP28 OP30 18 (1) I (i) 14. OP33 24 (1) (a, b) Procedures for dealing with complaints must take account of the needs of residents and include procedures, for recording, responding to and monitoring verbal complaints to provide proper safeguards. Prompt action must be taken to address maintenance issues such as ensuring residents have basic services such as hot water in their en-suite bathrooms.(This requirement is outstanding from the last inspection - timescale for compliance 15/11/06.) Ventilation must be provided in the designated smoke room to reduce the risks to all residents associated with cigarette smoke drifting into communal areas. Staff must be sufficiently trained to meet the specific identified needs of residents’ living at Willow Brook House. (This requirement is outstanding from the last inspection - timescale for compliance of 15/11/06) Effective systems must be in place to improve maintain and maintain the quality of care. 16/03/07 26/02/07 16/03/07 16/03/07 16/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP38 OP31 Good Practice Recommendations The steep grassed area that presents a high risk to residents from falling should be levelled or fenced off. Efforts should be made to maintain consistent management arrangements to safeguard residents. DS0000065185.V325238.R01.S.doc Version 5.2 Page 28 Willow Brook House Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Brook House DS0000065185.V325238.R01.S.doc Version 5.2 Page 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!