Inspection on 29/01/08 for Willow Court

This inspection was carried out on 29th January 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Willow Court 29/09/08

Willow Court 11/09/06

Willow Court 07/02/06

Willow Court 08/08/05

Willow Court 08/11/04

Willow Court 25/05/04

Similar services:

Ashlea Mews Residential Home

Eastwood

West Lodge

Arran House

Avenue Community Nursing Home

Cosin Lodge

Farmborough Court

Cragston Court

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

CARE HOMES FOR OLDER PEOPLE Willow Court Osborne Gardens North Shields Tyne & Wear NE29 8AT Lead Inspector Andrea Goodall Key Unannounced Inspection 29th & 30th January, & 1st February 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Willow Court DS0000028826.V346601.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 Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Willow Court Address Osborne Gardens North Shields Tyne & Wear NE29 8AT 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) 0191 296 5411 0191 2964568 Willow.Court@fshc.co.uk Cotswold Spa Retirement Hotels Limited (wholly owned subsidiary of Four Seasons Healthcare Ltd) Thomas Michael McGuinness Care Home 48 Category(ies) of Dementia - over 65 years of age (45), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (3) Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One named resident is under the age of 65 years. Should this resident leave the home the Commission for Social Care Inspection must be notified. One service user is category DE. No further admissions to take place in this category without prior agreement of CSCI. 11th September 2006 Date of last inspection Brief Description of the Service: Washington Lodge is a purpose-built care home. The home provides both nursing and personal care for people with dementia care needs and a small number of people with mental health needs. Care in the home is provided by Registered Mental Nurses supported by care staff. The home is owned and managed by Four Seasons Healthcare Ltd, which is a large national provider of care services. Since the last inspection the manager has been registered by the CSCI. Willow Court is a modern two-storey building that provides 48 bedrooms, all of which have en-suite facilities. There are lounges, dining rooms and bathrooms on both floors. The home has its own kitchen and laundry room. Access into the home is level and a passenger lift provides access to the first floor. At the rear of the home there is an enclosed garden. The home is situated in a residential area of North Shields close to local shops and good public transport links. The weekly fees for residential care range from £410.58 to £487.60 (depending if self-funded). The weekly fees for nursing care range from £517.29 to £599.20 (depending on NHS bandings or if self-funded). Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Before the visit: We looked at: • information we have received since the last visit on 4th December 2006 • how the service dealt with any complaints & concerns since the last visit • any changes to how the home is run • the provider’s view of how well they care for people • sent 20 surveys to relatives to get their views of the service - we received 7 responses from relatives The Visit: An unannounced visit was made on 29th January 2008. A visit was also made with an Expert by Experience on 30th January 2008. An Expert by Experience is someone who uses social care services. They are part of the inspection team and can help inspectors to get a picture of what it is like to use care services. Mrs Molly Herridge, an Expert by Experience, talked with residents and staff, joined them for a lunchtime meal, and looked at parts of the home. Her comments are in this report in bold text. During the visit we: • talked with people who use the service, relatives, staff, the manager & visitors • joined residents for meals and looked at how staff support the people who live here • looked at information about the people who use the service & how well their needs are met • looked at other records which must be kept • checked that staff had the knowledge, skills & training to meet the needs of the people they care for • looked around parts of the building to make sure it was clean, safe & comfortable • checked what improvements had been made since the last visit We told the manager what we found at a feedback visit on 1st February 2008. Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? There is a better range of activities for people since the new activities coordinator started to work here. The home now has ‘lunch clubs’ for those people who are able to help themselves, and this helps to keep up their independent living skills. There have been some improvements to the décor in some bedrooms. The Expert by Experience said, “Bedrooms that had just been refurbished were very attractive.” There are plans to improve the rear garden with wooden decking, and to provide easy access for residents to use the garden in the next couple of months. There are also plans to provide new large screen televisions for residents to be able to see more easily. Relatives said, “There have been some changes to staff which are better. All the staff now seem caring.” The home now produces a monthly newsletter, which helps relatives keep informed about events in the home. Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 7 Most relatives surveyed feel that the manager has made some good changes to the service. One visitor said, “The manager is stricter that the last one and seems to have better control of the service and the staff.” What they could do better: 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 Court DS0000028826.V346601.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 Court DS0000028826.V346601.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 and 3. (Standard 6 is not applicable to this service) People who use the service experience good quality outcomes in this area. A full assessment of peoples’ needs means that the home can be sure that the service is right for them. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The home provides an information pack (Service Users Guide) for potential residents or their representatives prior to their admission. The information pack contains corporate information about the provider, and a brief brochure about Willow Court. The manager indicated that the information pack is also made available in vacant bedrooms for new residents. In surveys most relatives felt that they got enough information from the home and other agencies to make a decision about whether to use this care home. One relative said, “I looked at seven other nursing homes, but opted for this one because it’s nice and bright.” Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 10 There is currently one resident living here who is registered blind. At this time the information pack is not available in audio format (such as cassette or DVD) for people with a visual impairment, which could be considered discriminatory. Before people to move to the home their needs are assessed to ensure that Willow Court can meet those needs. The home uses a pre-admission assessment form, social work reports, and a comprehensive dependency rating assessment to assess each person’s needs. A sample of assessments was very detailed and provide clear, narrative descriptions of each person’s physical and mental health needs. There is also a social care assessments that relatives are invited to complete. These include a background history of the person’s preferences, social interests and religious/spiritual needs. Of the sample some were incomplete due the absence of relatives’ involvement, making it difficult for the home to know those people’s social care needs. Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. Overall, residents have sufficient support to ensure that their personal and health care needs are met. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: After a resident has moved to the home a care plan is designed around their assessed needs so that staff know how to provide the right support. Most of the sample of care plans examined clearly outlined each resident’s needs and how these should be supported. Care plans are written in a respectful way that that promotes the individuality and dignity of each resident. The sample showed that most care plans had been evaluated on a monthly basis and most had been updated to reflect any change in need. For example a new care plan had been designed when a resident’s mobility had deteriorated to show that they now needed a wheelchair at all times. However, in one care plan a significant change in a resident’s ability to dine independently had not Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 12 been updated so the care plan did not show that they now need full physical assistance at mealtimes. Overall, the care files contained clear assessments to monitor residents’ physical well-being, for example with mobility, falls, and nutrition. Health care record showed that residents are supported to have good access to health care services such as GPs, psychiatric services, and continence advisors. There were some very good instances of how the assessment and care planning processes led to improved support for residents. For example, clear assessment of one resident’s mobility needs led to a referral to physiotherapy services. In the surveys, relatives generally felt that they were kept well-informed of any illness or change in health of the residents. Risk assessments were generally in good order. The manager has arranged for a number of residents to use special beds (profiling beds) to support their moving and assisting needs and to prevent them from falling from bed. However the risk assessments about the use of this equipment refers to ‘bed rails’. In this way the risk assessments do not show the justification and consent by relatives for the actual equipment that is being used to limit the movement of those residents. There are clear moving and handling plans in place for people who need support with their mobility. The Expert by Experience said, “Many residents had to be lifted into their wheelchairs. Lifting equipment was used and the residents were treated very gently.” The qualified nursing staff are responsible for managing resident’s medication. This is delivered to the home by a pharmacy within individual blister packs or containers for each resident. Medication is securely stored, and only transported around the home in a locked medication trolley. Administration of medication was carried out correctly, and medication records were in good order. During the inspection visits there were many instances of good practice where staff supported residents in a sensitive and respectful way. For example, sitting with individual residents to provide sensitive support at mealtimes, and supporting people with their mobility at the resident’s own pace. Residents are supported with their personal grooming and appearance. A weekly hairdressing service is available at the home, which several residents use. The Expert by Experience said, “I was impressed by the way she (the hairdresser) spoke to the ladies and worked with them, making them so smart.” In surveys relatives had many positive comments about the way that staff support the people who live here. Their comments included, “They do their best to treat the residents with dignity”, and “the nurses and carers have a genuine affection for the residents and are concerned about them all”. One Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 13 relative said, “It’s when staffing levels are down then only the basics get done. Sometimes my relative is dressed in clothes belonging to other people.” Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. Overall, residents have sufficient opportunities to make choices about activities, daily routines and menus so that they lead a lifestyle that matches their social care needs. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: There have been very good improvements to the activities available to residents since the recent employment of a new activities co-ordinator who works at the home 5 days a week. In surveys one relative said, “The new activities lady, whose role is mission impossible, manages to involve (some residents) in various activities.” There is a chart on both floors that show the type of activities on offer each day, such as crafts and music, but usually daily activities are decided on the day to meet residents’ choices. Discussions were held with the activities coordinator about using the whiteboards on both floors to advertise the activities chosen for that day. There have also been social events such as 100th Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 15 birthday parties, Burns Night party, Chinese New Year event, and entertainment from singers. The Expert by Experience said, “The activities co-ordinator had borrowed reminiscence boxes from the Alzheimer’s Society and had found these stimulated a lot of interest.” Discussions showed that the activities staff was enthusiastic in her role and would like to develop reminiscence activities further. At this time there have been no trips out due to the weather. The home could have access to a shared minibus in better weather. One resident said, “I never get the chance to go shopping now”, and discussion were held about future opportunities for small groups of resident to go out locally. Records show good contact between the home and relatives either during visits or by telephone. There were some visiting relatives at the time of this visit who had positive comments to make about recent improvements to the service. In surveys relatives said, “Staff are very friendly and helpful” and “They make us feel welcome.” One relative said, “Some residents have few visitors but the staff give them the same care and attention as those whose families are around.” The daily lifestyle of residents is quite flexible and they can choose where they spend their time and some people choose where they dine. Some people were spending time on their own rooms for privacy during these visits. In discussions residents who were able to comment felt that meals were very good. One resident said, “The food is very nice, but I have to take a tissue because there are no serviettes.” (The manager explained that these are available but that staff need to remember to place these on tables.) At a lunchtime meal the tables were suitably set with tablecloths, condiments, glasses and teacups. The meal was served to individual preference. There are chalkboards in each dining room with the meal choices. It is very good practice that residents are asked at the time of the meal which of the two main choices they would like so that they can make an informed choice whilst seated at the table. This supports their decision-making and communication skills. It is also good practice that the manager has introduced a ‘luncheon club’ where a small number of resident can dine together in a lounge where they can help themselves, where capabilities allow, to parts of their meal and drinks. This promotes independence and helps residents to retain their skills. The Expert by Experience said, “I joined some ladies for lunch and the meal was delicious. The table is nicely set and the menu is on display.” Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 16 Some people need full assistance with their meals. Staff provided this is in a sensitive and unhurried way. But there were several people who needed this assistance so some staff had to attend to a number of residents at the same time. Two gentlemen were seated in their special posture armchairs, which had been taken into the dining room so that they could enjoy the social occasion. It was a concern that one person’s plate was placed on the armrest, in between support from a staff, and could have been knocked over. (The manager indicated that there are plans for catering staff to be more involved in serving meals. This would be good as it would release more time for care staff to support residents.) Tea and coffee is served in the morning and afternoon with homemade cake that is made freshly every morning. Some residents said they would like to have cold drinks at different times throughout the day, but there is currently no facility for those residents who are able to get their own cold drinks. Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience adequate quality outcomes in this area. People know how to make a complaint but staff are not trained in adult protection so residents’ rights are not safeguarded. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: Information about how to make a complaint is provided in the Service Users’ Guide. However the complaints procedure is not currently available in other accessible formats at this home, for example on cassette or DVD for people with reading or visual impairments. In surveys, five out of seven relatives felt that they had sufficient information about how to make a complaint, and five also felt that the home either ‘always’ or ‘usually’ responds to concerns. There have been 4 complaints and 2 anonymous concerns about the service at this home over the past year. These mainly related to concerns about low staffing levels, cleanliness, and personal hygiene of residents. These were investigated by the manager or Provider and two were found to be partly substantiated. The Provider has taken appropriate steps, including disciplinary action where necessary, to address those areas. Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 18 It was indicated that the home only keeps a record of written complaints and how these are managed, so there are currently no records of verbal complaints. The manager agreed such a record should be kept as it would show that the home takes all concerns seriously, show what actions the home has taken to resolve concerns, and could be used as part of the home’s quality assurance processes. There have also been three safeguarding adults investigations at the home over the past year. Two of these were about alleged verbal abuse by staff, which were not substantiated. The third was about a significant medication error by one member of staff. The medication error was substantiated, and the Provider took appropriate disciplinary action to dismiss that staff member. The manager and deputy manager have attended a Trainers’ course in Safeguarding Adults protocols. It is clear from previous actions that they and the Provider are very aware of their responsibilities under these protocols. At this time all nursing staff have also attended protection of vulnerable adults training. However few care staff have had this training. As a result a recent allegation by a resident was only recorded as part of that person’s behaviour, and was not reported to the manager or Provider for investigation. In this way care staff are not aware of their responsibilities to report any allegation of abuse. (A visiting social worker alerted the manager to this at a later date. It was then investigated by the manager with input from psychiatry services and was unsubstantiated.) The manager indicated that there are now proposals for all care staff to receive training in safeguarding adults. Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 19 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, 21, 22, 25 and 26. People who use the service experience adequate quality outcomes in this area. Overall the home is warm, comfortable and safe but the lack of environmental signposting for residents does not support their dementia care needs. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: Overall the building is in a good state of repair and well maintained. The home benefits from having a full time maintenance staff to attend to minor repairs and redecoration. Since the last inspection a number of bedrooms have been redecorated and provided with new carpet (or laminated flooring where requested). The manager also indicated that there are plans in place to fully redecorate the front entrance in the near future. Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 20 The manager has successfully obtained a grant to improve the accommodation for the people who live here. He has plans to provide decking to the rear garden for residents to sit out, provide patio doors for residents to have easy access to the garden, and provide 42” televisions in a lounge on each floor for cinema activities. A visiting relative commented, “There have been improvements to the décor and we can see that this is continuing.” At this time the bathrooms and shower rooms are very bare and clinical in appearance. The manager is aware that these rooms need to be redecorated to make them more comfortable and inviting for the people who live here to use. One bathroom on the ground floor was being used to store redundant furniture, so was not usable. The shower rooms have no shower curtains to protect the privacy of residents. There was a trolley with vinyl or latex gloves and continence pads being stored in a shower room, which does not promote residents’ dignity and could present a cross-infection risk. All of the people who live here have dementia care needs, which can affect their communication skills and orientation. However there are no environmental clues for residents to find their way around. For example, there is very little signposting to support residents within this large building, other than small brass numbers on bedroom doors and small brass plaques many of which did not have the residents’ name. The Expert by Experience said, “I found the layout quite confusing and names on bedrooms doors were very small.” All doors are the same colour (e.g. brown wood) so residents are not supported to distinguish between bedrooms, toilets, bathrooms, offices, cupboards, or sluice room. Discussions were held with the manager about the use of colour-contrasting and methods of signposting to support the orientation of people with dementia care needs. There is no induction loop system for the televisions to assist people with a hearing loss. Bedrooms are spacious single rooms and all have good sized private en-suite facilities. The Expert by Experience said, “Bedrooms that had just been refurbished were very attractive.” It is good practice that some rooms that are overlooked by neighbouring houses have been provided with blinds to support the privacy of the residents. There are a couple of other bedrooms that can be looked into from the car park and side of the home that would also benefit from these. The lighting in the hallways is rather dim and the manager has arranged for this to be upgraded. The lighting in bedrooms is also dim which could present a tripping hazard for the people who live here. Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 21 Housekeeping is carried out by domestic staff. There are usually two domestic staff on duty each day. Most areas were clean, although there was food on the chairs and floor of the dining rooms throughout the first visit. This may be due to one domestic staff calling in sick on this day. Over the visits there were several occasions when toilets required attention. The manager commented that it might be useful to have routine checks of these by the domestic staff. Odour control was satisfactory in most areas of the home, but on all visits there was a strong odour in one area of the ground floor near a communal toilet. The manager has arranged for the carpet in this area to be replaced which will help to address this. Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience adequate quality outcomes in this area. Sufficient staffing is provided for the number of residents but lack specific skills in caring for people with dementia. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: At the time of this inspection there were 38 people living at the home (31 people receiving nursing care and 7 people receiving personal care). The staff rota is planned for 2 qualified nurses (either RMN or RGN) and 5 care staff to cover both floors. (On the day of the first visit there was one care staff less due to sickness.) The staffing plan is based on the number of residents and the ratios of those receiving nursing or personal care. Staffing levels are not based on individual dependency needs. At this time there are 24 people who need two staff to attend to their physical, personal and behavioural needs. In surveys relatives felt that more staff would improve the service. One relative wrote, “At times the level of staff does not seem to be adequate. It means residents are not supervised at all times.” Another relative wrote, “When I visit there is only one staff in the sitting room and if she is called away Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 23 there is no-one to watch.” The manager stated that if carers are called away, domestic staff are now asked to supervise lounges. Relatives had many positive comments about the attitude of staff. Staff were described as “caring”, “devoted”, “friendly”, and “helpful”. It was evident that there are good relations between staff and residents, and residents seemed relaxed and comfortable when they had the opportunity to chat to staff. Some residents described staff as “very nice” and “very kind”. There have been about 8 changes to the staff team over the past year. This is a staff turnover of about 25 staff, which is common for a staff team of this size in this type of care service. Some of the changes are as a result of disciplinary actions, and some relatives felt that this has been beneficial to the service. One relative said, “There have been some changes to staff which are better. All the staff now seem caring.” The Provider is an equal opportunities employer and promotes good equality and diversity procedures when recruiting new staff. There are a few staff from Poland and Asia working at the home. Relatives commented that some staff are “difficult to understand because of their language”, and commented that it must make it more difficult for residents with dementia care needs to understand them. The Expert by Experience said, “I was a bit concerned about the number of foreign staff working in the home and although their English is excellent I wondered how their accents would affect communication with the residents.” The manager stated that all foreign staff are subject to a language assessment before being employed. It was evident from personnel record that most recent staff appointments have been employed (on a probationary period) with only a POVAFirst check whilst awaiting the CRB (police clearance) check. The manager stated that this was common practice due to the length of time that CRB checks take to be returned, and that all new staff are supervised until the return of that check. However this practice is only be acceptable in ‘exceptional circumstances’ and with the involvement of CSCI (as outlined in the Department of Health ‘POVA Guidance’.) At this time 6 out of the 17 care staff have achieved either NVQ level 2 or 3, which are national care qualifications. This means that the home is slightly short of the 50 minimum standard for staff training in NVQ. The manager indicated that the Provider is now carrying out it’s own NVQ training so that in future more staff will have the opportunity to train towards this qualification. Although the home specifically provides care for older people with dementia care needs, it is not known if any staff have had certificated training in this Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 24 area of care. There are no training records of this and the manager is unaware of any staff having received this during his employment at the home. In this way the home is unable to demonstrate that its care staff are fully equipped to support people with dementia care needs. The manager indicated that there are proposals to provide some in-house training in this area of care in the future. Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People who use the service experience adequate quality outcomes in this area. Overall the management of the home is improving, but training and practices do not promote the health & safety of residents. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The manager has been in post at this home for over a year. He has been registered as the manager by CSCI. He is a qualified nurse (for learning disabilities) and plans to commence training towards the Registered Managers’ Award in the near future. He has many years’ experience of working in social and health care settings for vulnerable adults. Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 26 He is supported and supervised in the management of the home by a Regional Manager of Four Seasons Healthcare Limited. The staffing structure of the home includes a deputy manager and 6 nurses (who are qualified either in mental health or general nursing). The nursing staff are responsible for supervising the care of residents. In this way there are clear lines of accountability within the organisation and the home. Most relatives surveyed feel that the manager has made some good changes to the service. One visitor said, “The manager is stricter that the last one and seems to have better control of the service and the staff.” The home has arranged occasional Relatives’ Meetings for their suggestions and comments about the service, but unfortunately there has been a low attendance. The home now produces a monthly newsletter, which helps relatives keep informed about events in the home. The Provider’s comprehensive quality assurance processes include a number of audits of the home. Each of the homes in the company is required to complete an extensive audit of a number of areas, for example care plans, control of infection and medicines. These are analysed centrally and an action plan developed to help the home make any necessary improvements. The quality assurance process also includes the required monthly visits by a representative of the Provider. The Regional Manager carries these out, however the last recorded visit report kept by the home is dated August 2007. If requested, the home will support residents to keep their personal monies in a pooled bank account. As this is a non-interest accruing account, it was stated that a limit of around £300 is recommended by the home. When a resident’s monies are too low or too high the administrator contacts the relatives. There are clear computerised statements, which are managed by the home’s administrator, of any deposits or withdrawals. Any transactions carried out by staff on behalf of a resident are receipted and signed by at least two members of staff. The system is regularly audited by the Provider. In this way monies held on behalf of residents are securely managed. There are a number of gaps to staff training records in health and safety. For example very few staff have had training in Infection Control. Some care staff prepare snacks for residents but have had no training in basic food hygiene. The manager stated that there are plans for staff to receive training in these areas in the future. All care staff receive moving & assisting training, and one qualified nurse is a moving & assisting assessor who can provide updated training to staff. However, during all the visits staff were pushing some residents in their wheelchairs without footplates. This meant that frail residents had to try to Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 27 keep their feet up to avoid injury to them. One staff told a resident “keep your feet up”. This is poor moving & handling practice. Records of hot water temperature of washbasins used by residents were up to date, but records of hot water checks to baths and showers could not be found at this visit. Hot water checks of baths are particularly important to prevent risk of scalding. All other records of services and maintenance of the building, utility supplies, and equipment were up to date. Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X 2 2 X X 2 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 13(4) and 17, Schedule 3, 3(q) Requirement Risk assessments regarding the use of equipment to prevent residents from falling from bed must reflect the actual equipment used. This is to ensure that the home has demonstrated the justification for equipment that limits a resident’s movement, and that it is the best of all possible alternatives. Residents with visual impairments or other reading difficulties must be provided with the complaints procedure in a format that meets their communication needs (e.g. on cassette or DVD) This is to ensure that everyone has equal access to information about how to make a complaint. All bathrooms and shower rooms and toilets used by residents must be in good decorative order, as planned; shower screens must be provided; and protective equipment and continence pads must not be on DS0000028826.V346601.R01.S.doc Timescale for action 01/04/08 2. OP16 22(5) 01/05/08 3. OP21 23(2)(d) & 12(4)(a) 01/10/08 Willow Court Version 5.2 Page 30 public display. This is to protect the privacy and dignity of the people who live here. The home must seek advice about the best environmental design and decoration within a home for people with dementia care needs. This is to ensure that the home considers the best ways it can support the orientation of the people who live here. The lighting to all bedrooms must achieve a minimum of 150 lux (e.g. the equivalent to a 100 watt light bulb). 4. OP22 23(2)(a) 01/08/08 5. OP25 23(2)(p) 01/04/08 6. OP29 19(5) This is to ensure that the rooms are bright enough for the people who live here. All new staff must have a 01/04/08 Criminal Records Bureau check before starting work. The commencement of new staff with only a POVAFirst check must be in ‘exceptional circumstances’ and must be first agreed with the CSCI. This is to ensure that only suitable people provide care for the people who live here. Arrangements must be made for all care staff to receive suitable training in dementia care. This is to ensure that staff are equipped to provide the right type of care for the people who live here. Regulation 26 visit reports must be kept by the home as part of the providers duty to carry out Regulation 26 visits. DS0000028826.V346601.R01.S.doc 7. OP30 18(1)(c)i 01/08/08 8. OP33 26 01/04/08 Willow Court Version 5.2 Page 31 9. OP38 13(4)(b) & 18(1)(c)i This is to ensure that the Provider and the manager are fully aware of the home’s operations. Staff must be provided with appropriate training in all mandatory health and safety areas, including Infection Control. Those care staff who also prepare foods for residents must have training in basic food hygiene. This is to ensure that staff are familiar with current health and safety practices. All wheelchairs used by residents must be fitted with footplates. This is to ensure residents’ safety, and to prevent possible injury to their feet, when being transported in their wheelchair. 01/07/08 10. OP38 13(5) 01/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations Consideration could be given to providing the Service Users’ Guide information pack in an audio format (e.g. cassette or DVD) to support the needs of people with a visual impairment or reading difficulties. Consideration should be given to staff completing the social care assessments for residents (in the absence of relatives) so that residents’ needs in this area of care can be met. Staff should ensure that care plans are updated to reflect the change in support required when there is a change in residents’ needs. Consideration could be given to supporting individual or small groups of residents to go out locally, where DS0000028826.V346601.R01.S.doc Version 5.2 Page 32 2 OP3 3 4 OP7 OP12 Willow Court 5 6 OP15 OP15 7 8 9 10 11 12 OP16 OP18 OP22 OP24 OP28 OP38 capabilities allow, as part of the activities programme. Proposals to include catering staff in the serving of meals in the dining rooms should continue to allow care staff more time to physically support residents with their meals. Consideration should be given to providing facilities for residents to help themselves (or staff) to cold drinks through the day, e.g. a water dispenser and/or jugs of juice in dining rooms. A record of any verbal concerns or complaints should be kept including any action taken and the outcome. Proposals to provide in-house training in Safeguarding Adults procedures should be put into place so that all staff know how to respond to allegations of suspected abuse. There should be an induction loop system in lounges to support people who have hearing impairments. Window blinds (or similar alternatives) should also be provided to those bedrooms that are overlooked by the car park. NVQ training should continue to ensure that at least 50 of the care staff team achieve this qualification. Records of the temperature of baths should be kept with other water temperature checks so that these are readily accessible by the manager or other staff. Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Willow Court DS0000028826.V346601.R01.S.doc Version 5.2 Page 34 - 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!