CARE HOME ADULTS 18-65
Willow House 101 Countess Road Amesbury Salisbury Wiltshire SP4 7AT Lead Inspector
Roy Gregory Unannounced Inspection 4th January 2006 02:30 Willow House DS0000044553.V275235.R01.S.doc Version 5.1 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.V275235.R01.S.doc Version 5.1 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.V275235.R01.S.doc Version 5.1 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.V275235.R01.S.doc Version 5.1 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 23rd August 2005 Date of last inspection Brief Description of the Service: Willow House is a semi-detached, extended family home providing single bedroom accommodation for eight people over three floors, including one room with en-suite facilities. The other rooms have bathrooms and toilets nearby and some have wash hand basins. Communal space comprises a large sitting room and modern conservatory, which is used in part as the dining room. This in turn gives onto a pleasant garden that overlooks open countryside. The home is situated unobtrusively alongside similar residential properties on the northern edge of Amesbury, and is easily accessed by public or private transport. The registered manager is also the co-owner (with her husband) of the business. Willow House DS0000044553.V275235.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 2:30 p.m. and 8:00 p.m. on Wednesday 4th January 2006. The inspector met with all of the residents at various times, including as a guest at the evening meal. The registered manager, Sharon Arnott, was available for most of the time and made documentation available. Additionally there were conversations with care staff. The inspector looked at two care plans in detail, and at all documentation relating to medications used in the home. Other records consulted included those that monitored fire safety. All communal areas were visited and two individual rooms were seen with the consent of their occupants. The inspector also took the opportunity to talk with a visiting learning disability nurse. A pre-inspection questionnaire was provided by Mrs Arnott, whilst “comment cards” were received from seven residents, four relatives of residents, and a care manager. What the service does well:
Over the previous year some residents of the home have been faced with various health challenges. The responses of the home have been focussed on maintaining individualised support whilst maximising residents’ access to health agencies and professionals. The visiting learning disability nurse had high praise for the consistency and value of this approach. Support plans showed creativity on the part of staff and management, with frequent recorded reviews and evidence of resident inputs. In one instance, a resident had been supported to write to their consultant setting out their unwillingness to abide by a part of their care plan. Many care plans contained signatures of outside professionals, as well as residents themselves, showing the home takes advice from others and secures inter-agency agreements to ways of working, for example to manage risks posed by epilepsy. Arrangements for medication practice were considered commendable. The home was well maintained, residents saying they were pleased with their personal and communal space. They could achieve privacy or togetherness as they chose. Standards of cleanliness were high, and Mrs Arnott had good systems in place for monitoring to ensure tasks were accomplished when due. Residents expressed themselves freely and positive interactions were seen between staff and residents. After the early evening meal the majority went out, to two different clubs. Those remaining at home appeared relaxed and engaged in following different interests. All comment cards from residents were positive, as were those received from supporters. Three of the latter made additional comments: “We are tremendously grateful for both the physical and emotional support X has received from the staff at Willow House…they have supported all of us during a very difficult year”. “I have always been most
Willow House DS0000044553.V275235.R01.S.doc Version 5.1 Page 6 satisfied with the care given…I am always kept well informed”. “I am very satisfied with the splendid care given…I have nothing but praise.” What has improved since the last inspection? 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. Willow House DS0000044553.V275235.R01.S.doc Version 5.1 Page 7 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.V275235.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (None of these standards was assessed at this inspection) EVIDENCE: (Standards 1-4 were assessed as met at the previous inspection of 23rd August 2005, since when there have been no new admissions and none were in prospect at this time.) Willow House DS0000044553.V275235.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Planning for support to individual needs is an inclusive process, subject to regular review and responsive to change and to residents’ self-determination. Identification and management of risk underpin reasons for intervention and support. EVIDENCE: Care records kept at least once per day for each resident, in individual books, were objective. These provided evidence of the implementation of care plans and assisted their review. In turn, dated amendments and additions to plans showed that review was active and regular. Personal profiles were signed by residents and their key workers. This good practice could be usefully extended to the assessment of skills, an important and useful document prominent in each support plan. It could be seen how skills assessments were used to identify areas of risk or vulnerability. In one plan, for example, difficulties in the areas of travelling, shopping and understanding money were identified, giving rise to good quality risk assessments, which in turn informed specific care plans. Some confusion was engendered by more than one component of a support plan having the same title, or no title, a discrepancy that can be easily remedied. Another
Willow House DS0000044553.V275235.R01.S.doc Version 5.1 Page 10 improvement agreed by Mrs Arnott, is that the assessment of skills should be revisited and dated at annual review, so it is clear that the information and assessment contained is current. In one support plan, there was documentation of the resident’s disagreement about implementation of some aspects of their care plans. The resident had been assisted to write to their consultant, who was a signatory to the care plan, asserting their right to make decisions of their own despite the identified risk that had given rise to the terms of the care plan. Willow House DS0000044553.V275235.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11-17 The nature of care planning, and quality of working relationships between service users and staff, mean that residents have access to planned and spontaneous activities that fit their individual wishes and needs. These provide for personal development, sustaining relationships and access to the wider community. Meals are provided in a homely way. EVIDENCE: There was evidence of involving family members in life history work. One care plan had a diagram to assist the resident in identifying various social connections. Another resident had a care plan for ensuring regular contact with family and friends, with specified key worker responsibilities. Simple monitoring enabled ongoing evaluation of how this was working. Daily care notes for all residents demonstrated their participation in a wide range of individual and group activities and interests. On the evening of the inspection, two residents were out at a needlework club, with staff support, whilst three were out at a social club in Salisbury. One of the older residents had commenced use of a day centre facility at a local home for older people, which they were finding rewarding.
Willow House DS0000044553.V275235.R01.S.doc Version 5.1 Page 12 A care plan was seen that responded to a resident’s expressed concern not to have certain daily living tasks done for them, by stressing encouragement of the person to complete tasks independently, in accordance with their wishes. At the evening meal, one resident chose not to join the others at the dining table as he was not hungry at that time. One member of staff, plus Mrs Arnott, joined the residents’ meal, and there was easy conversation around the table. The food was well presented, with some degree of self service. Some residents were involved in preparation or clearing of the meal. Willow House DS0000044553.V275235.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 20 There is prompt attention to routine and exceptional health matters, backed by excellent established working relationships with a range of other social care and health professionals. Medicines practice is safe and individually tailored. EVIDENCE: The inspector met with a learning difficulties nurse from the local community team, who was visiting to assess and advise on the acute needs of a resident at the time. She described her recent development of a health action plan for another resident, using pictorial tools to maximise the individual’s involvement. With regard to yet another resident, she had worked with Mrs Arnott on pilot work on consent pathways. The nurse expressed confidence in Willow House staff and management to observe and respond appropriately to health indicators, including medication issues. An epilepsy management plan for a resident referred to documented events and to discussions with named doctors, who had signed up to the plan along with the resident concerned and their care manager. It also had the stamp of the local community team for people with learning disability. Related to this was a care plan for bath provision, again endorsed by a range of professionals. Records of medical appointments for one resident showed that from June 2005, there had been six GP contacts, two appointments with the dentist, two
Willow House DS0000044553.V275235.R01.S.doc Version 5.1 Page 14 with the audiologist, and ongoing podiatry attention. Monthly weight charts were maintained for all residents. There were good records of administration of medications, including records of medicines being taken in and out of the home. All medication-related information for individuals was kept next to their respective administration sheets. Residents had signed pictorial explanations about use of medicines. A programme of installing locking wall-mounted cabinets in residents’ rooms was underway, the intention being to make medication issues more personalised and to help residents feel more involved in the process, whether or not they are able to take on actual self-administration. Mrs Arnott also saw this change as reducing the risk of drugs errors. There was a homely medicines policy, with evidence of annual review with the GP of the individual protocols that result from it. There was evidence of a good working relationship with the supplying pharmacist, whilst there had also been a visit from the PCT pharmacist. There was ongoing liaison with the GP and learning disability nurse about the possibility of introducing a protocol for buccal administration of an emergency medication for a resident, Mrs Arnott having already obtained advice from the Commission concerning training and disposal issues. Willow House DS0000044553.V275235.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Formal and informal complaints are accepted openly and addressed appropriately. Measures, including staff awareness, are in place to secure the protection of residents. EVIDENCE: One complaint, from a relative of a resident, had been received by the home since the previous inspection. After an initial documented telephone response, offering apology and an undertaking to investigate, Mrs Arnott had made a timely appropriate written response. It could be seen that the findings were shared with the staff group, with measures put in place to avoid recurrence of a similar cause for complaint, including an element in the resident’s care plan. It was evident from the nature of interactions between residents and staff, including Mrs Arnott, that preferences and dislikes are readily communicated, discussed and acted upon. Examples were seen of care plans for supporting residents with personal money management. Following recommendation at previous inspection, a tight procedure had been written up for safeguards around any withdrawal by the manager or deputy from an ATM on a resident’s behalf; no other staff may be involved in such a transaction. A member of staff confirmed that all are given personal copies of the “No Secrets” guidance to local inter-agency adult protection procedures; she and the inspector were unable to locate a home copy, Mrs Arnott was able to do so and placed it in a new, readily accessible location. Willow House DS0000044553.V275235.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 28 & 30 Willow House provides a homely and individualised environment, maintained and kept clean to a high standard. Residents are satisfied with their private and communal accommodation, both of which encourage and facilitate choices. EVIDENCE: Two residents were pleased to show their personal rooms to the inspector, and expressed satisfaction with them. Each had personalised their rooms, with varying assistance of their families, in different ways. Communal rooms allowed residents to spread out or to group as they chose. One said he liked choosing between his own room, the conservatory and the lounge as he chose. Staff displayed sensitivity to such choices. Standards of cleanliness in bedrooms and communal rooms, including bathrooms and toilets, were high. In the office/sleep-in room was a quarterly programme for spring-cleaning of all bedrooms, with four out of eight having already been completed for January 2006. Cleaning standards were audited regularly, alongside maintenance issues. Willow House DS0000044553.V275235.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 The home is adequately staffed to meet residents’ identified needs. EVIDENCE: No new staff had been recruited since previous inspection. Rotas showed that staffing varied between two and three depending on resident numbers at home and planned work. Willow House DS0000044553.V275235.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 40, 41, 42 &43 There are good provisions in place for overseeing delivery of a quality service. Documentation and record-keeping are purposeful. Consideration of health & safety provision on this occasion was limited to fire precautions, which were intact. EVIDENCE: The administrative tasks of the home, and documentation, were very well organised. There was a month-by-month calendar of scheduled administrative, monitoring and review tasks. Although there is an office, which doubles as a sleep-in room, this is used very little by staff, much working documentation, including the home’s policies and procedures, being kept at a workstation in the residents’ sitting room. But all confidential information was appropriately stored. Incident reports were objective, as were daily records of observations and care given. Staff seemed familiar with the policies and procedures and one was seen to make reference to them during the inspection. There were good records of monitoring of fire precautions, including training of residents and staff. The training materials used to promote residents’
Willow House DS0000044553.V275235.R01.S.doc Version 5.1 Page 19 understanding were seen. A vibrating receiver had been obtained to assist a resident to perceive the fire alarm, but it had been unsuccessful and in consequence there was an adaptation of the instructions to staff. Willow House DS0000044553.V275235.R01.S.doc Version 5.1 Page 20 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 X 2 X 3 X 4 X 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 4 26 X 27 X 28 4 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 3 34 X 35 X 36 X 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 3 12 3 13 3 14 4 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 4 4 X X X X 3 3 3 3 Willow House DS0000044553.V275235.R01.S.doc Version 5.1 Page 21 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 YA6 YA6 Good Practice Recommendations Ensure each component of a support plan has its own identifying title. Institute annual review of the “assessment of skills” for each resident. Willow House DS0000044553.V275235.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 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.V275235.R01.S.doc Version 5.1 Page 23 - 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!
