Inspection on 02/09/09 for Willow Brook House

This inspection was carried out on 2nd September 2009.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Willow Brook House 16/12/09

Willow Brook House 12/09/08

Willow Brook House 27/06/07

Willow Brook House 19/01/07

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 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Willow Brook House 77 South Road Corby Northants NN17 2XD Lead Inspector Kathy Jones Key Unannounced Inspection 2nd September 2009 09:00 DS0000065185.V377527.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Willow Brook House DS0000065185.V377527.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Willow Brook House DS0000065185.V377527.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 willowbrookhouse@ashbourne.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Vacant Post 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.V377527.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 12th September 2008 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 detailed in the ‘scale of fees’ provided as being current at the time of inspection: Private General Residential Customer: £627.00 Private Dementia Customer: £627.00 LA/HA funded General Residential Customer: £355.21 LA/HA funded Dementia Customer: £381.63 Local Authority/Health Care funded customers are accepted on the expected to pay rates above. In addition a request is made for a £20 third party top up, which is set at the discretion of the manager. Willow Brook House DS0000065185.V377527.R01.S.doc Version 5.2 Page 5 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. Information about the service including the most recent inspection report is available in the foyer. Willow Brook House DS0000065185.V377527.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. 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 people using the service. Inspection of the standards was achieved through review of existing evidence, pre-inspection planning, inspection visits to the service, collating information received in surveys received from relatives, people who use the service and staff and drawing together all of the evidence gathered. We received completed surveys from three people who use the service, two staff and a health professional. This information was taken into account as part of the inspection planning and helped to form our judgements. The pre-inspection planning was carried out over the period of half a day and involved reviewing the service history, which details all contact and correspondence with the home and previous inspection reports. The last full inspection (this is called a key inspection) took place in September 2008. Information from this inspection was taken into account as part of the planning. This inspection involved three visits to Willowbrook House. The first inspection visit on the 2nd September 2009 was unannounced and was carried out by one inspector and a senior member of the head office team. During this inspection visit, we found previous requirements about care planning, monitoring of people’s health and the management of medication had not been met and we copied and seized evidence of non compliance with regulations for consideration of enforcement action. Further requirements have been made in statutory requirement notices which are also detailed at the end of this report. Compliance with these notices will be checked through another inspection. A second inspection visit was made on 7th September 2009 to continue inspection of the key standards. This visit was announced and carried out by one inspector. Further evidence of non compliance with regulations was collected. A brief visit was also made on 22nd September 2009 to collect another piece of evidence. The inspection was carried out by using a method of inspection called case tracking. This involves selecting samples of peoples’ records and tracking their care and experiences. Observations of the homes routines and care provided Willow Brook House DS0000065185.V377527.R01.S.doc Version 5.2 Page 7 were made and views on the care provided were sought from people who use the service, visitors and staff. The management of residents’ medication was checked through reviewing prescribed medication for a sample of people and a sample of staff files were reviewed to check the adequacy of the recruitment procedures in protecting people who use the service. Communal areas and a sample of bedrooms were viewed and observations were made of people’s general well being, daily routines and interactions between staff and people who use the service. Verbal feedback was given to the Acting Manager during the inspection visit on 2nd September 2009 and verbal feedback on the main issues of concern was given to the Responsible Individual during a telephone call on 3rd September 2009. The Responsible Individual, Acting Manager and a Project Manager were all present during the inspection visit on 7th September and verbal feedback on the findings was given throughout. What the service does well: People who use the service and relatives spoken with were appreciative of staff and were grateful of the care and help they gave them. Staff spoken with all told us that they wanted what was best for the people using the service. Visiting arrangements are flexible and staff had developed good relationships with peoples’ friends and families. We have identified the need for management and staff to have more training and a better understanding of safeguarding vulnerable adults’ procedures. It is important though, to note that there have been some instances where appropriate referrals have been made and action taken to safeguard people who use the service. What has improved since the last inspection? What they could do better: A more detailed assessment of peoples’ needs prior to inspection would help to ensure that the right information is used to plan peoples care. Based on the information in these detailed assessments care plans need to be in place for everyone using the service to guide staff in the actions they need to take to meet peoples care needs safely and fully. Willow Brook House DS0000065185.V377527.R01.S.doc Version 5.2 Page 8 Management and staff need to have a better understanding about the importance of people receiving prescribed medication and their responsibilities to ensure they consistently do. There needs to be more staff awareness of the need to consult with health professionals such as General Practitioners regarding matters affecting peoples’ health such as the absence of prescribed medication. Better and simpler record keeping systems, which staff understand and use consistently, would help management and staff maintain a better overview of peoples health. This should identify things more easily such as an increase in falls, which would enable referrals to be made to appropriate health professionals such as a falls advisor. Managers need to be familiar with safeguarding vulnerable adults’ procedures and their responsibilities to ensure they are consistently followed and all allegations are followed up. More care and attention to the premises is needed to make sure that all areas have a good standard of décor, cleanliness and that all equipment is maintained and in working order. Staff all need to have training to help ensure that they know what is expected of them and that they are supported by having all the necessary skills and knowledge to meet peoples’ needs. The findings of this inspection, the continued breaches of regulations and risks to people using the service have identified serious concerns about the management and oversight of Willowbrook House. This highlights the need to establish why these concerns were not identified by the organisations monitoring systems. Improved management and monitoring systems need to be put in place to reduce the risk and improve outcomes for people who use the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Willow Brook House DS0000065185.V377527.R01.S.doc Version 5.3 Page 9 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.V377527.R01.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3, Standard 6 was not assessed as intermediate care is not provided. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment and admission processes do not provide any reassurances that peoples’ needs will be met. EVIDENCE: Information is available to people considering using the service and their families in the form of a statement of purpose and service user guide. Copies of these documents and a copy of the most recent inspection report are available in the foyer. The statement of purpose and service user guide give information about the services and what people can expect to be provided. Current fees are also detailed. People are encouraged to visit to look at the facilities and their suitability to help them make a decision about moving in to Willowbrook Willow Brook House DS0000065185.V377527.R01.S.doc Version 5.3 Page 11 House. Surveys received from three people who use the service confirmed that they received enough information to help them decide that Willowbrook House was the right place for them. The statement of purpose identifies that prior to agreeing admission for a potential resident, a review of their current needs will be carried out. Southern Cross Healthcare has a comprehensive assessment document which assists staff in identifying people’s current needs. We looked at the assessment that had been carried out for someone who had been admitted just over four weeks prior to the inspection. We found that the assessment had not been fully completed and did not give a complete picture of the persons needs. Information gathered through the assessment is important in establishing prior to admission if they are able to meet the person’s needs, and then following admission, as a basis for planning and delivering the required care. Willow Brook House DS0000065185.V377527.R01.S.doc Version 5.3 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples’ health and well being is put a risk because of failures in the assessment and planning of their care and management of their medication. EVIDENCE: Three surveys were received from people who use the service. Two responded that they usually get the care and support that they need and the other that they always do. People and their relatives spoken with during the inspection were happy with the care that they received and a relative was full of praise for the support from staff. A relative commented that their mother enjoys a bath but would prefer to have one twice a week, rather than just the once indicating the need to plan people’s care more carefully around their needs and preferences. Willow Brook House DS0000065185.V377527.R01.S.doc Version 5.3 Page 13 We looked at a sample of care plans and associated care records to see how peoples care is planned and supported. We had made requirements at our last inspection about care planning and arrangements for monitoring people’s health and well being and wanted to be satisfied that improvements had been made. We found that the only care plan in place for someone admitted more than four weeks prior to the inspection, was a plan covering their night time routine. There were no care plans to instruct and guide staff in any other care and support that they needed to provide. From the minimal information on the pre-admission assessment and discussion with staff it was evident that the person required assistance with movement and handling. It would therefore be important that a movement and handling assessment be completed, and a care plan developed to identify how the person should be safely assisted. Review of a sample of other people’s individual care files identified that information was fragmented, making it difficult to obtain a clear picture of people’s care needs. Discussion with staff and review of the records, also identified that staff record information in different places which then makes it difficult to track changes to people’s health and care needs. Examples we found included records for someone with dementia who required monitoring in relation to an identified risk of constipation. We also found that monitoring in relation to people who had experienced falls was fragmented and that none of the records on their own could be relied on to give an overall picture as to the frequency of the falls. Following the inspection we have given the Acting Manager contact details for the falls advisory service. On the afternoon of our first inspection visit (2nd September 2009), we looked at a sample of people’s prescribed medication to see how this was being managed. We found that there were four people without their prescribed medication. This medication was delivered by the pharmacist late on the afternoon of 2nd September 2009; however people had been without their medication in some cases since at least 30th August 2009. We were particularly concerned that there had been no contact with a doctor about the risks of people not taking their prescribed medication or to try and arrange an emergency prescription. There are two storage areas for medication, one on each floor. The room where medication is stored on the ground floor was dirty and cluttered with a variety of items such as items left over from a fete, making it difficult to organise and check medicines safely. The room felt very hot and there was no system for checking that medicines were being stored at the correct temperature. Willow Brook House DS0000065185.V377527.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality of life for people varies according to their ability to express their preferences. EVIDENCE: The needs and interest of people using the service are quite varied, as is their ability to express their view about their daily lives and preferred activities. One person who uses the service told us that they prefer to spend time in their room and did not wish to take part in the activities, but that a staff member had made an effort to arrange for her to go to a local event that was of particular interest to her. During the inspection we observed staff engaging and interacting positively with people. On the day of inspection a small number of people who use the service were observed enjoying a bingo session. Surveys received from three people who use the service contained mixed views about the activities. One said that there are always activities they can take part in, one usually and the other Willow Brook House DS0000065185.V377527.R01.S.doc Version 5.3 Page 15 sometimes. A relative commented that one of the things that could be done better is to “have a permanent activities person and not someone who is taken away to care when they are short staffed.” The Acting Manager informed us that the level of activities should improve as the permanent activity organiser has returned from maternity leave. Staff were heard to engage people in conversation throughout the day, however observations indicated that some people, and particularly those with dementia would benefit by having available more opportunities for engagement in activities. The annual quality assurance self assessment tells us that it is planned over the next twelve months to increase training in activities for people with dementia. Visitors were observed to come and go throughout the day and confirmed that there is a flexible visiting policy. People were seen to enjoy visits from family and friends, who also spent time chatting with other people who use the service. Two people told us in surveys that they usually liked the meals. Another said that they always liked the meals and added “splendid cooking, meals etc”. The lunch time meal on the day of inspection was a choice between sausages in thick gravy or Cornish pasties. Staff on the dementia unit were dishing up meals from a list which contained a choice of faggots in gravy or Cornish pasties. People spoken with could not remember what was on the menu for lunch and were not aware that the menu had changed. Staff told us that people are asked to make their choices for meals the previous day and where they have difficulty expressing their preferences for meals, and then staff choose for them, based on what they usually eat. While staff were taking account of people’s wishes in relation to where they wanted to eat, arrangements for choosing what they wanted to eat, and when, could be improved, particularly for people with dementia. On our second inspection visit we were shown a new system called ‘choices’ which is a care planning system designed to help people make choices through verbal and non verbal cues. A timescale for implementation has not yet been set. We spoke with staff about arrangements for monitoring people’s nutritional intake. We had observed staff taking a meal to someone in their room who had been in bed. Staff said that the person was always more alert during the night rather than the day and although they ate a good breakfast did not always eat much at lunch or tea time. Staff did not know if consideration had been given to offering a meal at night if this was the persons preferred time for eating. Advice was given to the Acting Manager to review how this person’s nutritional needs were being met. Willow Brook House DS0000065185.V377527.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Failure to consistently follow safeguarding vulnerable adults’ procedures places people who use the service at risk. EVIDENCE: Three people who use the service told us in completed surveys that they know how to make a formal complaint and have someone that they can speak to informally if they are not happy. Details of the complaint procedure are contained in the service user guide. A visitor spoken with during the inspection was satisfied that if they had any concerns, they would be listened to and acted on by staff. At the time of this inspection the Care Quality Commission and its predecessor organisation the Commission for Social Care Inspection had received no complaints about the service. The service has notified us about allegations that they have referred to Northamptonshire County Council through safeguarding vulnerable adults procedures. They have also kept us informed about actions that they have taken to safeguard people who use the service. The information we had received prior to this inspection indicated a clear understanding of safeguarding vulnerable adults’ procedures and the need to Willow Brook House DS0000065185.V377527.R01.S.doc Version 5.3 Page 17 report any allegations to Northamptonshire County Council (NCC). We were therefore concerned to receive information during the inspection about an alleged incident which had apparently not been reported to NCC as it had not been made in writing. We have made an alert to NCC safeguarding vulnerable adults’ team regarding this alleged incident and following the inspection the Acting Manager made a referral to NCC. We have re-iterated the need for the Acting Manager to report all allegations of alleged abuse regardless of whether they are received in writing or not. We have also made a safeguarding alert to NCC in relation to our findings that four people were without prescribed medication. Training statistics provided by the Acting Manager identify that some staff have not received training in safeguarding of vulnerable adults. This is an important part of helping to safeguard people who use the service. Following the inspection we have received confirmation that training will be provided for all staff. Willow Brook House DS0000065185.V377527.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are suitable for meeting peoples’ needs, although delays in the maintenance of equipment and premises compromise care delivery. EVIDENCE: We checked a sample of rooms during the inspection, which included shared areas such as lounges and dining rooms and some people’s bedrooms. Two people who completed our surveys told us that the home is usually fresh and clean and another that it always is. A relative commented that one of the things that could be improved was more thorough cleaning of the en-suite bathrooms. Willow Brook House DS0000065185.V377527.R01.S.doc Version 5.3 Page 19 The main areas were generally clean; however we observed areas such as the floor in the clinic room to be dirty. We also noted that following lunch on the dementia unit, tables were not wiped down and in the middle of the afternoon we found the tables sticky with food deposits and a partially eaten dessert on a sideboard. The décor throughout the home was in need of refreshing with paintwork in several areas being quite scuffed. The Acting Manager confirmed that there was a programme of re-decoration in place and that they had made a start on the corridor of the dementia unit where some murals painted on the walls had become scuffed and tired looking. The ‘nurses’ station’ had been removed from this floor, which the Acting Manager told us was to make it more homely. At the time of the inspection we noted that a desk and chairs were stored against the wall. Bedrooms are all single occupancy and have en-suite toilets and washbasins. We spoke with people who were happy with their rooms and pleased to be able to have some of their own personal belongings such as pictures and ornaments around them. We spoke with staff on the dementia unit about how people with dementia are able to identify their rooms. Staff said they had used to have pictures on people’s doors which were meaningful to them and helped them identify their rooms but had received some conflicting advice and removed them. Currently the bedroom doors are just numbered which would not necessarily be meaningful for someone with dementia. There is an enclosed garden area, which is accessible from the dementia unit on the lower ground floor. Staff told us that this area was used during the hot weather. The day of the inspection was warm with some rain showers. We did not see the garden area used during the inspection and had to move a piece of furniture to be able to open the door, which may have deterred people from accessing the area independently. Smoking is not permitted in the building. We observed people smoke just outside the front door which leads on to the car park. The weather was relatively warm on the day of inspection and people felt this was not a problem. We did receive a comment within a survey that smokers are sometimes using the reception area to smoke and the fumes then are being blown back into the home. This indicates the need to look at arrangements for people who have been admitted to Willowbrook with a history of smoking. Information submitted in the annual quality assurance self assessment confirms that there is a programme for regular servicing and checking of equipment. We did find that there were delays in the repair and replacement of equipment that had broken. For example there are two bathrooms and a shower room on the dementia unit. At the time of the inspection both baths Willow Brook House DS0000065185.V377527.R01.S.doc Version 5.3 Page 20 were waiting to be repaired. We were unable to establish exactly how long these had been out of action but staff thought it had been several weeks. Staff informed us that people had to use the shower rather than the bath. The Acting Manager was not aware of when the baths were likely to be repaired. The dishwasher in the main kitchen had also been broken for four weeks at the time of the inspection. Willow Brook House DS0000065185.V377527.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff do not have the necessary training to ensure peoples’ needs can be safely met. EVIDENCE: We received appreciative comments about the staff team from people who use the service in three surveys and from people spoken with during the inspection. Examples included “carers do their job well” and “I am so grateful to the staff for all their help daily”. Two of our surveys were completed by staff. They were asked if there were enough staff to meet the individual needs of all the people who use the service. Both responded “never”. Staff spoken with during the inspection agreed with colleagues who had completed the surveys that they were often short of staff. Staff advised that they were short of enough staff to meet peoples’ needs on the dementia floor on the day of inspection due to staff sickness which they say is often a problem. Staff said that the shortage resulted in care being delayed for people who use the service. We were unable to identify regular shortages of staff from a sample check of the staff. Given the comments from Willow Brook House DS0000065185.V377527.R01.S.doc Version 5.3 Page 22 staff we discussed with the Acting Manager the need to keep staffing levels under close review to ensure that there is sufficient staff to meet peoples’ needs. The manager acknowledged that staff sickness had been a problem but that this was being monitored and that staffing levels were being increased as of week commencing 7th September 2009 due to a recent increase in the numbers of people using the service. We looked at records relating to the recruitment of two recently recruited staff members and found that all the required information including references and criminal record bureau checks had been obtained prior to them starting work. A staff member who completed a survey stated that one of the things that could be done better was to give the right information at interview. They indicated that this together with not having a proper induction contributed to staff going off sick or leaving. We spoke with staff and the Acting Manager about the induction process. New staff are given an induction book to work through, but there is no clear system for ensuring that people understand basic procedures such as fire procedures before working on shift. We also found that there are no checks made to ensure that staff have had movement and handling training prior to assisting people who have movement and handling needs. If staff are not aware of safe movement and handling procedures, this puts them and people who use the service at risk of injury. Concerns about staff training were identified at the last inspection and the Acting Manager who was new in post at the time was in the process of arranging training to address the shortfalls. Review of the staff training matrix and discussion with staff identifies continuing shortfalls, with some staff not having had basic training including movement and handling training. The concerns about staff training were discussed with the Responsible Individual, Project Manager and Acting Manager on our second inspection visit. Discussion identified that two members of staff were trained to train staff in movement and handling, therefore arrangements were made during the inspection to train those staff who have not received the training. Willow Brook House DS0000065185.V377527.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and oversight of Willowbrook House has not adequately protected people who use the service. EVIDENCE: At the time of this inspection there was no registered manager in post. Willow Brook house has had a succession of managers. The current Acting Manager was in post for just a few weeks prior to the September 2008 inspection. We made it clear in that report that it was the expectation of the Commission for Social Care Inspection (predecessor to the Care Quality Commission) that an application for registration of a manager should be submitted without delay. Willow Brook House DS0000065185.V377527.R01.S.doc Version 5.3 Page 24 There were delays in submitting an application and it was necessary for us to prompt this. An application was being processed at the time of this inspection. A question in surveys sent to a sample of staff asks if the manager gives them enough support and meets with them to discuss how they are working. One staff member responded that they did regularly, while another stated they never did. Comments from staff during the inspection indicated that they did not feel supported by the manager. Concerns were raised by staff about management style, lack of support and approach to staff. Staff were also concerned about the fact that concerns and grievances were not dealt with in a timely manner. As part of the quality assurance system, the organisation has internal systems where various audits are carried out to measure compliance with regulations and identify shortfalls. The Operations Manager also carries out unannounced visits at least once a month to check on and report to the organisation on standards of care. We looked at three recent reports which did not identify any major concerns. The contrast between our inspection findings and the findings of these visits raises concerns about the effectiveness of these visits in monitoring the service. An annual quality assurance self assessment was completed by the manager prior to the inspection. This assessment completed in June 2009 indicates that action has been taken since the last inspection to address shortfalls identified. For example it tells us that no staff carry out movement and handling of people until they have been trained and all people who use the service have detailed care plans. This contrasts with our findings, which as detailed through this report are that requirements we made relating to care planning, health and welfare, medication and staff training have not been met. Following the first inspection visit on 02/09/09, Southern Cross has put additional management support in to Willowbrook House to address some of the shortfalls identified. Some people leave small amounts of money for safekeeping to assist with paying for services such as hairdressing and chiropody. This is kept in a central bank account, which accrues interest and is added to each individual account. A sample check confirmed that records are kept of all transactions and receipts kept to verify these. Shortfalls in staff training in safe working practices such as movement and handling continue, though as detailed in the staffing section arrangements were being made on our second visit to provide training for those staff that needed it. Failure to ensure that staff have up to date training places staff and people who use the service at risk of injury. Willow Brook House DS0000065185.V377527.R01.S.doc Version 5.3 Page 25 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 3 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 X X X Willow Brook House DS0000065185.V377527.R01.S.doc Version 5.3 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 (1), 14 (2) Requirement You are required to put in place effective arrangements to ensure that the needs of service user’s in respect of their health and welfare are assessed and reviewed. Each assessment must: a) Reflect the service users individualised needs in respect of their health and welfare. b) Identify any risks that may have actual or potential adverse affects on the health and welfare of the service user. Be reviewed at least monthly; and as and when circumstances or needs change that may affect the service users health and welfare to identify any further actions that need to be taken. Make arrangements to ensure that a written plan is prepared for each service user setting out how their needs in respect of health and welfare are to be met. DS0000065185.V377527.R01.S.doc Timescale for action 25/11/09 2. OP7 15 25/11/09 Willow Brook House Version 5.3 Page 27 3. OP8 13 A previous requirement has not been met. Make arrangements to ensure that risks to people’s health and welfare are identified and put in place a plan of action to reduce or eliminate the risk so far as possible. A previous requirement has not been met. Where people are regularly refusing meals, arrangements must be put in place to monitor the adequacy of their dietary intake. Where people have altered sleeping patterns and are refusing meals, arrangements must be made to provide nutritious meals at a suitable time. This is to help ensure that their dietary needs are met. You are required to ensure that there is an effective system in place to obtain and retain adequate supplies of prescribed medicines for service users so that they can be given them as and when prescribed. A previous requirement has not been met. All allegations of abuse must be referred to Northamptonshire County Council through safeguarding vulnerable adults’ procedures. This is to help ensure that people are adequately safeguarded. The premises and equipment must be kept in a good state of repair. This is to ensure that people’s needs are safely met. You are required to put in place arrangements to ensure that all staff are trained in the work they are to perform. DS0000065185.V377527.R01.S.doc 25/11/09 4. OP8 12 25/11/09 5. OP8 12 25/11/09 6. OP9 12 11/11/09 7. OP16 13 11/11/09 8. OP19 23 25/11/09 9. OP28 OP30 18 25/11/09 Willow Brook House Version 5.3 Page 28 10. OP33 24 A previous requirement has not been met. Effective quality assurance 25/11/09 systems which identify any breaches of regulations and any poor outcomes for people must be in place. This is to ensure that people are safeguarded and their health and welfare needs are met. 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. 3. 4. 5. 6. Refer to Standard OP9 OP9 OP12 OP14 OP8 OP27 Good Practice Recommendations Storage areas for medication should be kept clean and free from clutter to enable medicines to be organised and managed safely. Arrangements should be made to monitor the temperature of areas where medication is stored to ensure that the correct temperature is maintained. Arrangements for the provision of activities should be reviewed to ensure these are based on the needs and interests of individuals. Improvements should be made in the way people with dementia are supported to make choices, such as what they would like to eat. Arrangements for people who smoke should be such that they do not impact on other people and compromise their health. Staffing levels and deployment of staff should be closely monitored to ensure that people’s needs are met at all times. Willow Brook House DS0000065185.V377527.R01.S.doc Version 5.3 Page 29 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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