CARE HOME ADULTS 18-65
Willow House 101 Countess Road Amesbury Salisbury Wiltshire SP4 7AT Lead Inspector
Roy Gregory Unannounced Inspection 22nd May 2007 01:00 Willow House DS0000044553.V336199.R01.S.doc Version 5.2 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 House DS0000044553.V336199.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 Adults 18-65. 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 House DS0000044553.V336199.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Willow House Address 101 Countess Road Amesbury Salisbury Wiltshire SP4 7AT 01980 622220 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) Sharonarnott@tiscali.co.uk Sharon Anne Arnott Glen Arnott Sharon Anne Arnott Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (8), Physical disability (3), of places Physical disability over 65 years of age (3) Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. No more than 8 service users with a learning disability may be accommodated at any one time No more than 3 of the 8 service users with a learning disability may also have a physical disability 4th January 2006 Date of last inspection Brief Description of the Service: Willow House is a semi-detached house that has been extended over the years. It has single bedrooms, over three floors, for eight people with a learning disability. One room has an en-suite bathroom. The other rooms have bathrooms and toilets nearby and some have wash hand basins. There is a large sitting room and modern conservatory, which has a comfortable sitting area and a big dining table. At the back is a pleasant garden that overlooks open countryside. The home is on the northern edge of Amesbury, in a road of similar houses. It is not far from the A303 trunk road between London and the West Country. It is easy to catch a bus to Amesbury or Salisbury. The home has a car to help people get about, and some people like to walk into Amesbury town centre. The registered manager is also the co-owner (with her husband) of the business. Weekly fees are set in accordance with the Wiltshire County Council “fair pricing tool”. For people currently living there, fees vary between £400 and £900 per week. Fees do not include items such as transport, toiletries, newspapers and social outings. There is a service users’ guide provided to people living there, and their relatives, to help explain how support is provided, what services they can expect and what additional costs they will have to meet. Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection visit took place between 1:00 p.m. and 8:30 p.m. on Tuesday 22nd May 2007. Initially the inspector met with the registered manager, Sharon Arnott, and the co-provider, Glen Arnott. Later, as people returned to the home from activities in the community and at day resources, it was possible to spend time talking with individuals who live in the home. One person, who had moved to the home since the previous inspection, invited the inspector to see their room and to talk privately there. Another talked whilst attending to jobs in the garden. Other people were met in the main sitting room, whilst the inspector also joined the evening meal. Three members of staff were spoken to, including two who had joined the team since the previous inspection. All communal areas of the home were seen. Records that were read included a sample of care records and those about staff recruitment, supervision and training. The inspector also looked at how medication was used and how the home links up with health professionals and other community resources. Particular attention was paid to the records of assessment and subsequent review of two people admitted to Willow House since the previous inspection. The close relative of one of them was contacted by telephone. The inspector has also had contact prior to the inspection with various professionals at the Salisbury community team for people with learning disabilities. Sharon Arnott completed an Annual Quality Assurance Assessment for the Commission, which included many strands of information about the home. Also available at the inspection visit were the returns from the home’s own annual survey of people living there and their supporters. The judgements contained in this report have been made from evidence gathered during the inspection, which included the visit to the service and taking into account the experiences of people using the service. What the service does well:
For the two people who had moved into Willow House, there were good records of how their needs were assessed. They had visited the home and for one, the help of an advocate had been obtained to ensure the move was appropriate for them. The other person told the inspector that on moving in, they already felt it was right to live there. Their relative was “delighted” with the placement. They thought Willow House’s assessment and good quality of information contrasted with other aspects of the pre-admission period that were the responsibility of other agencies. A member of staff described care plans as “the cornerstone of what we do”. Care and support plans were comprehensive but easy to follow. They were
Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 6 signed by the people they related to, or representatives. Risk assessments were filed alongside the parts of care plans that they related to. Where there was a clinical element in a plan, it was counter-signed by relevant professionals such as psychologist or community nurse. This showed the home was sharing good practice with others and not working in isolation. The community nurse for people with a learning disability was currently seeking GP agreement to a protocol in connection with a person’s epilepsy needs. The occupational therapist was another familiar figure at the home. Professionals at the Salisbury community team for people with a learning disability have spoken to the inspector about their high regard for the approach and insight of Mrs Arnott and the staff at Willow House. People spoken to said they decided when to get up and go to bed. Some liked to have a lie-in at the weekend. People made use of different parts of the home and garden as they chose. People went to a variety of day resources, including three that were specifically for older people. Mrs Arnott had given a training talk to staff at one day resource, to enable them to continue to meet the needs of a person from Willow House. She had prepared a plan to respond to the increasing loss of day resources, which she saw as a challenge that would allow for increased use of community resources. Already a number of people benefited from funding for specific one-to-one time with staff every week, enabling the home to add staff to the “normal” rota. All people have a key worker, whose role includes ensuring support to individual activities that people choose. One person had been out with their key worker on the day of the inspection to watch aircraft, as a chosen activity. The next day they had chosen to go out shopping, and they also enjoyed going out for meals. On the person’s bedroom wall was a chart showing what they had planned for the week. Their key worker helped them write this every week. It included things like dusting their bedroom and changing bed linen, as well as things to do outside. If there was a cost involved, the chart showed how much money to take. The person went to church on Sundays. Two people enjoyed gardening as a hobby. They received support to use the home’s greenhouse and to plant flowerbeds. Arrangements had been made for them to acquire a council-provided raised allotment. Where any relationship difficulties had arisen within the home, these had been considered in depth and led to support plans to help people get along together. The monthly residents’ meeting had developed a motto, “Be Kind”, so they could consider regularly what this meant for people. It aimed to increase people’s appreciation of each other’s needs, and of mutual responsibility for relationships within the home and outside. Sharing an evening meal, the inspector found a homely atmosphere with natural conversation and allowance for privacy. Where people needed some assistance with eating, this was provided discretely and with dignity. People living in the home assisted if they wished with cooking, and everyone helped on a rota basis, for fairness, with clearing and washing up.
Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 7 The home was very clean throughout apart from one area where an odour problem was receiving ongoing attempts at resolution. There was a high standard of decoration. All choices of flooring, re-painting and so on were based on getting the ideas and wishes of people living in the home. The previous year’s maintenance plan had been achieved in full. The home has a stable staff team who know the people living there well. Two staff members had been appointed since the previous inspection. Both valued the support of staff meetings and individual supervision, which was monthly for full-time staff and two-monthly for part-time staff. Records of supervision sessions showed the needs of all people in the home were considered each time, with extra emphasis on any to whom the member of staff was key worker. Sharon Arnott saw it as a responsibility to encourage career progression and there was a culture of aspiration among the staff group generally. In 2006 the home gained the Investors in People award, which demonstrates commitment to training. Comments from the supporters of people in the home, from the most recent quality assurance audit by the home included the following: A lovely homely home where X is very happy. Caring and accommodating to residents’ and relatives’ needs, knowledgeable staff. Staff do a responsible and sometimes difficult job extremely well. What has improved since the last inspection?
Recommendations were made at the previous inspection for improvements to support plans. In response, the plans were laid out better. Each section of a plan showed clearly what the person’s aims were, as well as guidance to staff on how to support them to meet the aim. The useful “assessment of skills” was now being re-written at each person’s annual review and thus helping to inform aims to be decided. Medications practice had been made much safer, and more private, by installing lockable medicine cabinets in each person’s bedroom. This meant all administration took place alongside personal care giving and away from any distractions. Administration record sheets, with identifying photographs, were kept in the cabinets, and also a guide to the reasons for use of each medicine by the person, and other related information. This was an initiative of the home and demonstrates a progressive approach to making care more centred on the individual. In response to a safeguarding matter that had arisen at another home owned by Mrs & Mr Arnott, a diary had been introduced for use by the on-call manager. This was so they could record exactly how any call was made to them at the time it happened. Two people had asked for somewhere they could meet quietly, without relying on each other’s rooms. In response, the office/sleep-in room on the first floor
Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 8 was converted to a small sitting room and equipped with a television and facilities to make hot drinks. The room continues to double as a sleep-in room, by use of a sofa bed, but this is not out of step with the home’s culture of partnership between people living there and the staff who support them. 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 House DS0000044553.V336199.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 4. Quality in this outcome area is excellent. People’s needs are assessed so that they are only offered a place if their needs can be met. They are given good information, and the chance to visit and stay overnight, to help them decide if the home is right for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two people had begun living at Willow House since the last inspection. For one of these, an advocate was involved in the decision-making process about admission, as the person had no family support. Mrs Arnott said the process was quicker than is usually preferred, as there was pressure on the person to terminate their previous placement. However, Mrs Arnott had insisted on access to all records from that placement, initially denied, before confirming Willow House would be able to meet their needs. There was also a long correspondence with a legal representative, to clarify some important matters. In line with the home’s admissions policy, the person had visited the home so they had an understanding of where they might move to. Such visits were also seen as important for the people already living at the home. A “needs and skills” assessment by Mrs Arnott acted as a comprehensive assessment tool, which assisted in drawing up initial care plans. Its use would be improved by showing how and where assessments were carried out, and where other information was obtained.
Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 11 For the other person admitted, the assessment and admission process took place over the preferred six weeks’ period. A relative of the person told the inspector the process appeared “chaotic” on the part of agencies involved, with the exception of Willow House, where there was good information and planning. The person now living there recalled visits to the home, including having meals, plenty of opportunity to meet the people already living there and seeing the room available. On moving in, they already felt it was right to live there. Their relative was “delighted” with the placement, having identified a number of ways in which their relative had already benefited from the move. The community care assessment, prepared by the care manager, identified the person’s dissatisfaction with their previous placement, and the things they wanted their new home to have. Willow House offered a good fit with these. A service users’ guide is made available to prospective residents and their representatives. This explains in simple terms how support is provided, what services people can expect and what additional costs they will have to meet. When someone is admitted, they are given a personalised version of the guide to show the room occupied and the person’s key worker, together with details about the contract for their stay. A copy is given to their representative. The service users’ guide is also displayed in the home’s front hall, with the statement of purpose and a copy of the most recent inspection report. Some minor amendments to the statement of purpose were agreed during the inspection visit. Sharon Arnott also advised that the admissions policy is to be enlarged to include procedures for people leaving the home. Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is good. Care is planned and reviewed regularly with service user and supporter input and agreement. Service users are encouraged to make their own decisions. Risks are identified, and assessed in such a way as to encourage safe participation in a range of activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person had a support plan. Recommendations for improvements made at the previous inspection had been followed. The plans were well laid out. Each section of a plan showed clearly what the person’s aims were, as well as guidance to staff on how to support them to meet the aim. Key workers reviewed them every month, and made changes if necessary. In addition there were full annual reviews involving care managers and family members or other advocates. An “assessment of skills” for each person was reviewed and rewritten as part of the yearly review. This was used to help people decide what activities were most helpful to maintain and develop abilities in daily living and leisure.
Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 13 For five people at the home there were funding arrangements to provide a number of hours of specific one-to-one support by key workers. This was a way of increasing individual choices, by providing for extra safety and exploring things individuals might find difficult to identify for themselves. All people had a key worker, who would arrange one-to-one support time, but these funded arrangements were additional to the daily staffing rota. It was also evident from notifications of incidents that sometimes additional one-toone staffing was provided to enable an individual’s continued involvement in a group activity. For all people there were a number of individual risk assessments. Copies of these were inserted next to the parts of support plans that they referred to. The emphasis was on the benefits of undertaking various activities and ensuring the support would be in place to reduce risks to a safe level. Risk assessments were reviewed every three months, unless a sooner review was identified as desirable. Plans were signed by the people they were for, or their representatives. Where there was a clinical element, care managers, community nurse, the GP or psychiatrist, as appropriate, had signed them. This showed the home did not work in isolation, but shared issues with other professionals to form an agreed course of action. Daily care records kept by staff showed care and support were given in line with what was planned. They also gave evidence of key work activity. A member of staff described care plans as “the cornerstone of what we do”. Plans were in hand to obtain a wireless laptop computer, as a means of bringing direct involvement in support planning closer to the people living in the home. Plans included communication guidance developed from outside professional and family ideas, and the home’s experience of what communication methods were effective. For a person with very limited verbal abilities, the inspector was struck by the progress made in the level of communication between them and others in the home since the previous inspection. Another person used two communication boards, which were seen to be used regularly by them and staff. There was a care plan to guide use of these. People spoken to said they decided when to get up and go to bed. Some liked to have a lie-in at the weekend. People made use of different parts of the home and garden as they chose. There were examples in the care records of how people were supported to make decisions about their lives, and of how they were offered choices. It was expected that the new computer would enable some people to learn to use the internet with support, and to send and receive e-mails. Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 14 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. Quality in this outcome area is excellent. Varied activities give people access to the community and opportunities to pursue preferred interests. Relationships with family and friends are encouraged. People participate in everyday tasks and their rights are respected. A healthy diet is offered, and mealtimes are conducted as people want. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Personal preferences and interests were recorded and planned for in activity plans within individual support plans. People went to a variety of day resources, including three that were specifically for older people. The availability of such resources had been much reduced and the future of some was in doubt. However, Mrs Arnott saw this as a challenge. She had prepared a plan for replacing “traditional” day centre places with community-based resources and both group and one-to-one provision by the home’s staff. There was particular concern to meet the needs of one of the home’s younger people, who had previously been able to attend college and had a continuing need to
Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 15 mix with a similar age group. They had done some specific “person-centred” work with an external facilitator to help identify needs and wishes. Mrs Arnott had given a training talk to staff at one day resource, to enable them to continue to meet the needs of a person from Willow House. People in the home described various uses of key worker time that they found rewarding. One person had been out with their key worker on the day of the inspection to watch aircraft, as a chosen activity. The next day they had chosen to go out shopping, and they also enjoyed going out for meals. On the person’s bedroom wall was a chart showing what they had planned for the week. Their key worker helped them write this every week. It included things like dusting their bedroom and changing bed linen, as well as things to do outside. If there was a cost involved, the chart showed how much money to take. The person went to church on Sundays. The home had initially supported this wish but friends made at church had taken over providing the support. Another person used key worker time for shopping, going to the cinema and trips to the seaside. Another described help received to maintain their interest in visiting and reading about historical sites. The same person had expressed a wish to vote in the local elections and had been supported to do so. Two people enjoyed gardening as a hobby. They received support to use the home’s greenhouse and to plant flowerbeds. Arrangements had been made for them to acquire a council-provided raised allotment. One spoke of talking about gardening with a neighbour, over the garden fence. People had taken a variety of holidays in 2006. For the current year, three were going to Ibiza as part of a locally organised tour. The home was providing a member of staff to accompany them. There was also to be a holiday in Weymouth for all the people at Willow House, using two self-catering cabins. There was evidence of gathering views about this from residents and their advocates, including agreements reached about what people would have to pay. The home has a large car for taking people out, and staff may use their own cars. People pay a mileage rate for leisure trips. Where any relationship difficulties had arisen within the home, these had been considered in depth and led to support plans to help people get along together. The monthly residents’ meeting had developed a motto, “Be Kind”, so they could consider regularly what this meant for people. Friendships outside the home were recognised and people were helped to keep these up. Support plans included assistance to maintain family relationships. One member of staff involved people living in the home in a weekly informal menu-planning meeting. People were encouraged to join in shopping for food and many opted to do so. Food bought included plentiful fresh vegetables and fruit. Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 16 The main meal of the day is served for everyone in the evening, or lunchtime on Sundays. The dining table is just about large enough to seat all residents and staff, but people can and do choose to sit elsewhere, including in the garden in good weather. Sharing an evening meal, the inspector found a homely atmosphere with natural conversation and allowance for privacy. Where people needed some assistance with eating, this was provided discretely and with dignity. People living in the home assisted if they wished with cooking, and everyone helped on a rota basis, for fairness, with clearing and washing up. Some people had food-related support plans. Dietary needs and likes and dislikes were recorded and acted on. Care in accordance with a person’s assessment for risk of choking was observed. For people who had had a cooked meal while out during the day, cold alternatives of their choice were provided in place of the evening cooked meal. Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is excellent. The home provides personal support in line with people’s preferences and needs. There are good links and systems to ensure physical and emotional health needs are met. People are protected by the home’s medication procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans contained guidance to the ways people needed and preferred to receive personal care. People indicated they were comfortable with how they received such support. There was a system for recording all visits to health professionals and ensuring follow-up appointments were obtained and kept. A person’s relative said close liaison with health professionals, based on good knowledge of the needs of people living there, was an obvious strength of the home. On the day of the inspection there was a pre-arranged visit by a community nurse for people with learning disabilities. She had come to see one person there to progress a pictorial health plan being devised with the home, as part of a pilot scheme. Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 18 The same nurse had completed an epilepsy profile for another person. This had led to the home producing risk assessments in relation to the person’s epilepsy and bathing needs. The nurse was seeking GP agreement to a protocol. For another person with epilepsy, home staff had advocated strongly about changes to medication. A person’s relative was very pleased that the home was pursuing review of medication with a view to reduction of use. They saw this as an indication that the person’s health needs were being promoted in other ways. Medications practice had been made much safer, and more private, by installing lockable medicine cabinets in each person’s bedroom. This meant all administration took place alongside personal care giving and away from any distractions. Administration record sheets, with identifying photographs, were kept in the cabinets, and also a guide to the reasons for use of each medicine by the person, and other related information. One senior member of the care staff had the delegated responsibility for oversight of medication use and practice in the home. She re-assessed staff annually for competency to administer medicines. The supplying pharmacist had provided training workbooks for staff. The home received six-monthly audit visits from a PCT (Primary Care Trust) pharmacist, most recently two weeks before this inspection, when they had identified no shortfalls. Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is good. There are appropriate procedures to protect people from harm, and to receive and act on complaints. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In the home’s own annual survey of residents’ satisfaction in October 2006, it emerged that two people did not know how to make a complaint. Their key workers had been directed to address this with them. The home has pictorial guidance, and a flow-chart, to assist understanding of the procedure. These are displayed in the entrance hall. The service user guide, issued to all residents and their representatives, also shows the procedure for making complaints. None had been recorded since the previous inspection. People spoken to saw all staff, but especially Mrs Arnott and their own key workers, as very approachable. They considered any concern was listened to and would be taken seriously. When people had encountered difficulties within the home, or outside, they had brought them to staff attention and seen issues resolved. The “Be Kind” initiative from the residents’ meeting aimed to increase people’s appreciation of each other’s needs, and of mutual responsibility for relationships within the home and outside. The monthly quality monitoring undertaken by the manager includes provision to take account of any complaints that have been made in the previous month. It would be worth identifying that some matters raised by people in the home or their representatives and perhaps swiftly resolved, are in fact “low level” complaints. A simple log of such matters, signposting to the detailed recording
Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 20 in individual records, would provide oversight of any pattern that might emerge. It could also provide evidence to assist resolution of any formal complaint that might be received. There was a copy in the home of the Wiltshire and Swindon procedures for safeguarding adults, and all staff had been given a copy of the most recent brief “No Secrets” guidance to the procedures. An investigation under these procedures in 2006 at another home owned by Mrs Arnott was used as a learning tool for staff at both homes. Staff received a training session from a police officer from the vulnerable adults unit, and there had been a renewed emphasis on the importance of full record keeping. A diary had been introduced for use by the on-call manager, so they could record exactly how any call was made to them at the time it happened. Staff meetings included consideration of any incidents that had arisen, how they were addressed and how they might have been approached differently. Abuse awareness training was prominent in the induction of new staff, and was renewed annually for all staff. One member of staff had collected information about the new Mental Capacity Act, and five staff were to attend a training course about this. The home has an established record of obtaining advocacy support for people when needed. There was behaviour management guidance for individuals in care plans. For example, for one person there was evidence of a meeting that included their psychologist. This in turn led to a written strategy. This described negative behaviours that had been seen, and the approaches that had been found to reduce these, with emphasis on positive reinforcement of positive behaviours. All care plans had a plan for support to personal money management. Active support was seen in action. Good records were kept so people could be confident in the accuracy of systems used. These systems had been simplified over the past year to promote greater individual involvement. People always had their own money to spend when out. Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 21 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28 & 30. Quality in this outcome area is excellent. Willow House provides a homely and individualised environment, maintained and kept clean to a high standard. A range of shared spaces promotes choice and individual comfort. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Willow House was originally a family home. It has been extended over the years to the side and rear, and into the roof space. It retains a homely feel, with rooms of various shapes and sizes. A respondent to the home’s quality assurance questionnaire described the home as “Homely, but an adult atmosphere, which is refreshing in a care home”. Since the previous inspection there had been some redecoration. This included a bathroom and several bedrooms. One of the bedrooms was for a person moving in, who chose their colour scheme. The entire home presented well. Glen Arnott, co-owner, undertakes routine maintenance. He was pleased to have reached a point where making good has been completed since purchase of the home, so maintenance can proceed in a planned way. There was a
Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 22 forward plan for two years. The stairs and landings were due to be re-carpeted whilst people were away on holiday in July 2007. All choices of flooring, repainting and so on were based on getting the ideas and wishes of people living in the home. The previous year’s maintenance plan had been achieved in full. A lounge suite on one side of the conservatory provided an alternative sitting space to the main sitting room, away from the television. Both areas were well used. Two people had asked for somewhere they could meet quietly, without relying on each other’s rooms. In response, the office/sleep-in room on the first floor was converted to a small sitting room and equipped with a television and facilities to make hot drinks. It has been necessary to leave a locked filing cabinet there, and the room is still used by sleeping-in staff who use a sofabed, but it has resulted in an attractive additional room for people to use. Staff formerly made little use of the office and the room can still be used if necessary for a confidential meeting. Sharon Arnott has always set high standards of cleanliness in the home. There is a monitoring system to ensure daily, weekly and quarterly schedules are kept up. Sharon Arnott had obtained the current infection control guidance from the Department of Health. The home’s cleaning arrangements met the recommended outcomes. All areas were very clean. One toilet had been fitted with new flooring to fit with a person’s needs. This one room had an odour problem that had so far not been fully resolved despite advice having been sought from a number of sources. It was suggested the flooring manufacturer be asked for advice, and Mrs Arnott also had other avenues to try. There is a separate laundry room with modern equipment. For risk-assessed reasons, people living in the home do not use the laundry room unless accompanied by staff, but it is available any time. People are involved to varying degrees in managing their laundry, including ironing, and in cleaning their bedrooms and other parts of the home. Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 23 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36. Quality in this outcome area is excellent. People are supported by competent, trained staff, who experience regular supervision and are supported by an employer committed to staff development. Recruitment practices ensure people are protected from being cared for by unsuitable staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a stable staff team who know the people living there well. The staff rota is planned to provide three support staff each morning (to 6:00 p.m. at weekends) and two or three in the evenings, depending on planned activities. For example, if one or more people were going out in the evening, staff would be provided to support this. Funded one-to-one staffing for individuals is additional to the basic rota. Sharon Arnott said present staffing numbers enabled the rota to be covered without any need to take on agency support, and there was no recruitment under way. Sharon Arnott could put herself on a care shift if necessary, but this was a rare occurrence. Two members of staff had been recruited in the preceding year. For each there were a completed application form, two written references, a Criminal Records Bureau (CRB) check and a Protection of Vulnerable Adults (POVA) check, and
Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 24 proof of identity. Both of them presented as highly motivated in their work. They valued the support of staff meetings and individual supervision, which was monthly for full-time staff and two-monthly for part-time staff. Records of supervision sessions showed the needs of all people in the home were considered each time, with extra emphasis on any to whom the member of staff was key worker. The newly recruited members of staff each had a formal appraisal of their initial six months’ probationary period, which identified any difficulties and strategies to overcome these. It was also recorded that the views of people living in the home were taken account of in this appraisal. Training was planned for staff throughout the year. Individual staff training records, including certificates gained, showed that planned training took place. In 2006 the home gained the Investors in People award, which demonstrates commitment to training. Two of the care team were designated as senior carers. They carried out the supervision of support staff, and were themselves supervised by Sharon Arnott. They met fortnightly with Sharon Arnott in a senior team meeting. Minutes of these meetings showed that all residents’ needs and staff performance were considered. The meeting also helped determine staffing levels needed on the rota. The whole staff group had meetings approximately six-weekly. These included consideration of any incidents that had occurred, and progress made in meeting care plan goals. Usually a training element was included, sometimes facilitated by use of DVD material. The training plan showed that in different months, there were annual update training sessions on epilepsy, adult abuse awareness, the codes of conduct issued by the General Social Care Council, manual handling and infection control. One of the senior care staff had gained National Vocational Qualification (NVQ) in care to level 3. The other had achieved level 4 and was going on to the Registered Manager’s Award. Sharon Arnott saw it as a responsibility to encourage career progression and there was a culture of NVQ aspiration among the staff group generally. One support worker had gained level 3 and three others were working towards level 2 or 3. There were written agreements between the home and individual members of staff about funding arrangements for NVQ training. New staff received an induction based on current Skills for Care expectations. Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42. Quality in this outcome area is excellent. The registered manager provides leadership and direction so people benefit from a well run home. Quality assurance systems include obtaining the views of service users and their supporters to monitor and improve the service. There are systems in place to identify and promote the health and safety needs of residents and staff. Record-keeping is of a quality that protects people’s rights and best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Sharon Arnott is a registered mental health nurse and has achieved NVQ level 4 in management. It was clear that she maintained strong links with other registered services in the area, and with voluntary and statutory services. She could therefore talk with confidence about local and national issues likely to affect the lives of people living at Willow House. She was active on their behalf in seeking support to get good outcomes for them. For example, she had
Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 26 successfully applied for additional capital grant for environmental improvements, and used a local initiative that organised holidays for people with a learning disability. Sharon Arnott’s completion of the Commission’s required Annual Quality Assurance Assessment showed insight and a proactive approach to the management task. Members of staff knew exactly what was required of them and shared in management vision for the home. The manager of Willow House’s sister home shares on-call duties with Sharon Arnott, and is able to deputise in her absence, for example when Sharon Arnott is on leave. The two managers meet regularly to maintain their knowledge of events and needs that arise in each home. Sharon Arnott was also devising a contingency plan that could be put into action in the event of unexpected protracted absence. All records seen were well kept and showed that planned monitoring took place at planned times, with swift follow-up of any shortfalls identified. Therefore people living in the home, and members of staff, saw the service as well run and reliable. This was also reflected in the home’s annual quality monitoring exercise. There were returns of a pictorial questionnaire from most people, which showed a high level of satisfaction. Where people could not complete such an exercise themselves, returns showed who from outside the home had helped them to do so. A separate questionnaire was sent annually to people’s supporters, and was also kept available in the hallway for any visitor to complete if they wished. Occasional newsletters were another way the home kept in touch with people significant to the people living there. There were minutes of residents’ meetings held every month. Sharon Arnott was hoping one or more people might be willing to chair the meetings, with support as necessary. Minutes showed there was encouragement to all individuals to express views. The key worker system was also effective in bringing individual concerns or opinions to light and addressing them, informally or through reviews. People confirmed there had been an informal meeting to invite any comment that might be included in the Annual Quality Assurance Assessment that the manager was required to send to the Commission. Staff members confirmed they had been invited to read and comment on this document before it was sent in. With regard to provision for the health and safety of people living and working in the home, all staff were trained in moving and handling, fire safety, first aid, food hygiene and infection control. Glen Arnott carried out a schedule of weekly and monthly safety checks, including fire precautions and safe water temperatures. Electrical appliances were tested annually. At the inspector’s suggestion, an occupational therapist had provided all staff with wheelchair training relating to the separate needs of four people who make some use of wheelchairs. She had confirmed that staff were competent, and would be able to train new staff through induction. All staff received externally provided health and safety training, renewed three-yearly.
Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 27 A sample of risk assessments showed careful consideration of areas of possible risk. For example, there were measures to ensure safe access to the side of the property. There was evidence to show that any accident or incident led to consideration of whether a new or changed risk assessment or care plan was needed. The staff communication book ensured staff were kept up to date with such changes. Willow House DS0000044553.V336199.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 Adults 18-65 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 3 2 4 3 X 4 4 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 4 29 X 30 4 STAFFING Standard No Score 31 X 32 4 33 4 34 4 35 4 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 4 X 4 X 4 X 3 3 X Willow House DS0000044553.V336199.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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA2 YA22 Good Practice Recommendations Assessment information of prospective service users should show how, where and from whom information was obtained. Consider keeping a log of non-formal complaints and how they have been resolved. Willow House DS0000044553.V336199.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 House DS0000044553.V336199.R01.S.doc Version 5.2 Page 31 - 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!
