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Inspection on 23/10/07 for Willow House - City of York Council

Also see our care home review for Willow House - City of York Council for more information

This inspection was carried out on 23rd October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

All people are spoken with in some detail before they move to the home to find out what kind of help and support they will need. This helps the home to check that they can support people properly if they choose to move there. People spoken with said they were very happy living at Willow House. They said the staff are "kind and helpful". Care staff receive a range of training so that they know how to care for people properly and protect them from harm.

What has improved since the last inspection?

Care plans have now been introduced to show how staff at the home support people to live the life they choose. This is important to demonstrate how one person has different needs to another. Care staff now wear uniform tunics and name badges at work. This makes it easier for people new to the home, and visitors to work out different staff roles. All people are now assessed when they move to the home to see if they are at risk of either losing weight, or putting too much weight on. This helps the staff to identify which people need to be monitored more closely to make sure they do not develop problems that will affect their health or well being. These assessments could be improved still more. There has been planned refurbishment and redecoration, and some new carpets laid at the home. This improves the environment for the people living there.

What the care home could do better:

The care plans could be developed even more. This is so that people`s interests, preferences and personal goals can be identified. Then staff at the home can really recognise people as individuals and plan how they can help them to keep charge of their own lives. The way some medicines are stored could be improved. This will make sure that the drug is more likely to work well when given as a treatment. The staff could also check the drug fridge temperatures regularly to check that drugs kept there are stored at the recommended temperature and so are more likely to be effective. The home could continue to seek out opportunities to provide social events at the home. This will provide a more varied day-to-day life for people living there. Staff working at the home must make sure that they do not talk about individuals living there when other people may be able to hear. This will show that they are always aware, and demonstrating the importance of respecting people`s dignity and privacy. The home could look at those people who have a poor appetite and see if they can do anything else `in house` to make sure they have enough calories. The completed questionnaires about what it is like to live at the home could be analysed and displayed. This will show that the home listens to what people say. The manager needs to see if any of the ideas can be implemented to show that people can influence how the home runs. The manager could introduce regular residents` and relatives` meetings so that people can have a regular say in how the home runs. This too could show that people living at the home are central to how the home operates.The manager could organise some fire drills at the home to satisfy herself that staff are aware of their roles in the event of a fire there. The manager could also re-look at the fire risk assessment to make sure things are in place at the home to reduce the risk of a fire happening. The home could look at the security systems at the home to make sure that clinical equipment, stored there, is not accessible to people who shouldn`t have access to it. This will contribute towards keeping people safe.

CARE HOMES FOR OLDER PEOPLE Willow House - City of York Council Willow House Long Close Lane Walmgate York North Yorkshire YO10 4UP Lead Inspector Jean Dobbin Unannounced Inspection 23rd October 2007 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 House - City of York Council DS0000034914.V333726.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 House - City of York Council DS0000034914.V333726.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Willow House - City of York Council Address Willow House Long Close Lane Walmgate York North Yorkshire YO10 4UP 01904 630 437 01904 466232 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) www.york.gov.uk City of York Council Mrs Joyce Handy Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Willow House - City of York Council DS0000034914.V333726.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th November 2006 Brief Description of the Service: Willow House is a care home on two floors, which was purpose-built about 40 years ago and is run by City of York Council. The home provides personal care for 32 residents aged at least 65, who do not require nursing care. There is also 1 short stay bed. It is situated less than 15 minutes walk from the centre of York, inside the historic city walls, and with Walmgate Bar close by. There are small shops and a public house within a short walking distance. Bedrooms are located on both floors, with a vertical passenger lift to aid access. The lawned gardens with seating areas lead onto the bar walls and there are car parking facilities on site. Details provided in August 2007 state that the weekly fees are £432. Additional charges are made for hairdressing, chiropody services and individual items like toiletries. The service provides an information booklet about the home to prospective residents. The Statement of Purpose and service user guide, that gives information about the home is available, with a copy of the latest inspection report, for people to read. Willow House - City of York Council DS0000034914.V333726.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is what was used to write this report. • • • Information about the home kept by the Commission for Social Care Inspection. Information asked for before the inspection. This is called an Annual Quality Assurance Assessment. (AQAA) Information from surveys, which were sent to people who live at Willow House, their relatives, and other professional people who visit the home. 10 were sent to people at the home and 4 were returned. 4 were sent to people’s relatives and 1 was returned. 4 to Care Managers and 1 was completed and returned. A visit to the home by one inspector, which lasted about 6.5 hours. This visit included talking to residents and to staff and the manager about their work and training they had completed. It also included checking some of the records, policies and procedures that the home has to keep. • Information about what was found during the inspection was given to the registered manager and her line manager at the end of the visit. What the service does well: What has improved since the last inspection? Care plans have now been introduced to show how staff at the home support people to live the life they choose. This is important to demonstrate how one person has different needs to another. Willow House - City of York Council DS0000034914.V333726.R01.S.doc Version 5.2 Page 6 Care staff now wear uniform tunics and name badges at work. This makes it easier for people new to the home, and visitors to work out different staff roles. All people are now assessed when they move to the home to see if they are at risk of either losing weight, or putting too much weight on. This helps the staff to identify which people need to be monitored more closely to make sure they do not develop problems that will affect their health or well being. These assessments could be improved still more. There has been planned refurbishment and redecoration, and some new carpets laid at the home. This improves the environment for the people living there. What they could do better: The care plans could be developed even more. This is so that people’s interests, preferences and personal goals can be identified. Then staff at the home can really recognise people as individuals and plan how they can help them to keep charge of their own lives. The way some medicines are stored could be improved. This will make sure that the drug is more likely to work well when given as a treatment. The staff could also check the drug fridge temperatures regularly to check that drugs kept there are stored at the recommended temperature and so are more likely to be effective. The home could continue to seek out opportunities to provide social events at the home. This will provide a more varied day-to-day life for people living there. Staff working at the home must make sure that they do not talk about individuals living there when other people may be able to hear. This will show that they are always aware, and demonstrating the importance of respecting people’s dignity and privacy. The home could look at those people who have a poor appetite and see if they can do anything else ‘in house’ to make sure they have enough calories. The completed questionnaires about what it is like to live at the home could be analysed and displayed. This will show that the home listens to what people say. The manager needs to see if any of the ideas can be implemented to show that people can influence how the home runs. The manager could introduce regular residents’ and relatives’ meetings so that people can have a regular say in how the home runs. This too could show that people living at the home are central to how the home operates. Willow House - City of York Council DS0000034914.V333726.R01.S.doc Version 5.2 Page 7 The manager could organise some fire drills at the home to satisfy herself that staff are aware of their roles in the event of a fire there. The manager could also re-look at the fire risk assessment to make sure things are in place at the home to reduce the risk of a fire happening. The home could look at the security systems at the home to make sure that clinical equipment, stored there, is not accessible to people who shouldn’t have access to it. This will contribute towards keeping people safe. 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 - City of York Council DS0000034914.V333726.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 House - City of York Council DS0000034914.V333726.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): 3 and 6 People who use this service experience good quality outcomes in this area. They can be reassured that their needs will be assessed before they move there to make sure that the home can care and support them properly. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: All people are assessed before they agree to move to the home. A care manager carries out this comprehensive assessment as well as either the manager of the home, or one of the care leaders. This assessment looks at the physical, emotional and social needs of the individual, to ensure that the home can provide the level of support that they require. People making enquiries about moving there are given information about the home, including the latest inspection report from the Commission for Social Care Inspection. This helps them in making a decision as to whether the home Willow House - City of York Council DS0000034914.V333726.R01.S.doc Version 5.2 Page 10 is right for them. They can also look around the home and talk with some of the people living there. All people who move to the home stay for a six-week trial. A meeting is then held to determine whether the person is going to stay there. Records looked at confirmed that this assessment had been done. One person’s records though showed that when they had moved to the home they had not met the category for which Willow House is registered. This was discussed with the manager. She needs to be certain that people moving to the home meet the requirements of being over 65 and requiring personal care only. This is to comply with the law. Intermediate care is not provided at Willow House. Willow House - City of York Council DS0000034914.V333726.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 this service experience adequate quality outcomes in this area. The personal and healthcare needs of people living there are well addressed, but there are not sufficiently detailed or individualised plans of care, so people may not always be receiving safe, consistent care. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People spoken with were very happy living at Willow House. They described the staff as very kind and helpful and felt that they were well looked after. One care manager wrote “people feel they are cared for very well by the staff, who try to meet their individual needs.” Three care records were looked at. These describe the care and support that people need, to live as independent a life as possible. These records are now put together in a new way so that information can be found more easily. Willow House - City of York Council DS0000034914.V333726.R01.S.doc Version 5.2 Page 12 There are now assessments in place to determine whether a person is at risk of falling or of losing weight because of poor appetite or a health problem. There are also assessments describing how people are to be moved in a safe manner. These however are all similar and do not actually describe why an individual may be at risk. For example a person may be more at risk of falling, because of poor understanding, poor eyesight, poor mobility, or poor balance. The plan of care identify this and say what the home is going to do to minimise that risk. Care plans have also been re-written, looking at the support and help that people need and are reviewed each month, to make sure they were still appropriate. These also need to be developed more, to make them more person centred and to describe what makes one person different to another. This will show that the home is making every effort to recognise people’s individuality, as well as promoting their independence and choice. One care record showed that discussions had been held about the use of bedrails for the individual. It had been decided that bedrails would not be used because they posed an added risk. It would be good practice to complete a bedrail risk assessment to show why this decision was taken. These documents record visits from the local doctor, chiropodist and district nurse. One person said that if they wanted to speak with their doctor the home would arrange it and they would be seen in private. The records of one person with diabetes were looked at. Although the home has good links with the community nursing staff, who visit regularly, there is no written guidance of when professional guidance should be sought to help manage the condition. People need to be cared for in a safe consistent manner and this was discussed with the manager. Medication systems were looked at in the home. Nobody currently looks after their own medicines, although each bedroom has a lockable drawer so that tablets can be stored safely. Care leaders administer the drugs and this was observed at lunchtime. The home has recently changed to a new blister-packed system and there are still some teething problems. Medication record sheets showed no omissions however some areas still need addressing. One drug was required to be stored at room temperature, but was kept in the fridge. The date when eye drops are first opened should be written on the bottle so that staff know when it needs to be discarded. The care leaders currently count the numbers of non blister packed drugs once each month, to satisfy themselves that drugs are being given and signed for according to the prescription. This is good practice, however when discrepancies are discovered it means there is a much longer time period to determine when an error may have happened. The fridge has a thermometer, Willow House - City of York Council DS0000034914.V333726.R01.S.doc Version 5.2 Page 13 but there are no records to show this is being monitored, so they can be sure that the fridge is working properly. Care staff were generally observed treating people well. On discussion they were able to say how they made sure people were cared for in a respectful manner. However the carers were observed briefly talking about a named individual in front of other people living there and so they must be aware of maintaining confidentiality at all times. Willow House - City of York Council DS0000034914.V333726.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 this service experience adequate quality outcomes in this area. People are generally happy with their daily routine and meals, though there are limited opportunities for social activities both in and away from the home. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Those people spoken with seemed contented with their day-to-day life. One person said that they decided when to get up and go to bed. A bath list is organised so that people can generally bathe weekly and people spoken with were happy with that arrangement. A number of people are able to go out to nearby shops. One buys a paper each day and another was going to the betting shop that afternoon. Another explained that their visitor brought them fruit and magazines when they visited as they were unable to go out. Activities provided at Willow House are somewhat limited because there is no person employed with this responsibility. The home has to fund-raise to pay Willow House - City of York Council DS0000034914.V333726.R01.S.doc Version 5.2 Page 15 for any activities, and financial constraints inevitably affect what they can do. Care staff socialise when time allows and volunteer visitors chat with the people there. The television was on in both downstairs lounges during the site visit. There were no newspapers, magazines or other distractions to be seen in these communal rooms. People’s care records describe individuals’ hobbies and interests, and some bedrooms looked at contained items, which reflected those interests. There are regular visits from people representing the Roman Catholic and Church of England faiths, though a service is not held at the home. People’s relatives can visit anytime. The dining room is large and spacious. There are linen cloths and napkins and special cutlery and crockery are available for those people who need extra help. These aids help people to eat their meals independently. The lunch was a pleasant social occasion, with the care staff available to help if necessary in a discreet way. Staff did not wear protective aprons though, and this was discussed with the manager. City of York Council are currently carrying out a three month study to determine the best way of providing meals at their homes. The lunchtime meal at Willow House is provided as a ‘cook and chill’ service and needs to be ordered several days in advance. . On the day of the visit there was a choice of curried lamb, cottage pie or vegetable pasty for lunch. These were served with cauliflower, green beans and mashed potato. Sultana sponge and custard, or yoghurt were offered for dessert. Whilst people were generally happy with the meals there seemed to be no way that people requiring extra calories could have their individual meals fortified at the home. This could mean it would be more difficult for them to gain weight. It might be helpful to display the day’s menu each day, so that people have the chance to look forward to their favourite meals. Home baked cakes are available each day and fresh fruit is offered two or three times a week. Willow House - City of York Council DS0000034914.V333726.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service experience good quality outcomes in this area. People can be confident that their complaints will be addressed properly and staff are alert to signs of abuse which contributes to keeping people safe. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People spoken with felt very safe living at Willow House and said that they would speak with the manager if they had any concerns. They were confident that any complaints would be addressed. Neither the home nor the Commission have received any complaints in the last year. The manager, though, should consider keeping a record of any ‘grumbles’ that come up whilst talking to people. She could then identify any issues that keep recurring so that these can be addressed. Staff attend abuse awareness training when they first start working. Abuse awareness is discussed routinely in staff meetings as a way of reinforcing this information and this could be evidenced. Five staff were spoken with at the site visit. Four understood their responsibilities should they see or hear something, which may constitute ‘abuse’. The fifth person admitted they were unsure what they would do in this situation. The manager needs to satisfy herself that all staff working at the home are alert to signs of abuse, so that people can be kept safe. Willow House - City of York Council DS0000034914.V333726.R01.S.doc Version 5.2 Page 17 City of York Council carries out recruitment checks centrally. All staff have a police check before starting working for the organisation to make sure they have not been previously barred from working with vulnerable people. This good practice contributes towards keeping people safe. Willow House - City of York Council DS0000034914.V333726.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use this service experience good quality outcomes in this area. The home is clean, warm and homely, which enhances the experience of living there. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home is purpose built and meets the needs of the people living there. It was noted to be clean, warm and homely, with no unpleasant smells. The rooms are all for single use and there are adequate numbers of toilets and bathrooms. There are a number of communal areas, including two lounges, which are used by people who smoke. The home has been allocated some monies from a government grant and plans to erect a conservatory and enclose the garden. This will enhance the communal areas and provide a safer outside space for the people living there. Willow House - City of York Council DS0000034914.V333726.R01.S.doc Version 5.2 Page 19 The bedrooms looked at contain personal effects including items of furniture. Call bells are installed, although one person commented that if they fall in their room they can’t then reach their bell. This was discussed with the manager as to how the home could support the person better. The decorator was at the home and several rooms have already been repapered. One person confirmed that they had been asked about the choice of wallpaper for their room. Some carpets have been replaced and there are plans for more refurbishment. There is a well-maintained laundry at the home. There is no dedicated laundry person though, with all care staff sharing that role. People confirmed that laundry was managed appropriately, although one person was reluctant to send their jumper to be washed, because they were afraid it would ‘get lost’. This was also discussed and staff agreed to talk with the person to explain how they would ensure that their belongings did not do missing. Nearly all the staff have attended training this year about how to prevent the spread of infection within the home. Care staff were observed wearing gloves when entering people’s rooms to provide personal care. This practice contributes towards people being kept safe. Willow House - City of York Council DS0000034914.V333726.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use this service experience good quality outcomes in this area. Staff have the skills and knowledge to care and support people properly and the recruitment process is generally robust so that people are being protected from harm. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: On the morning of the site visit there was a care leader and three care staff on duty as well as the registered manager and an administrator. There are three care staff in total on the late shift and two at night. More than 50 of care staff have a National Vocational Qualification Level 2 in Care, meaning that people are more likely to receive safe, consistent care, however with no dedicated laundry person, nor activities organiser the care staff have these roles as well as care giving. One person spoken with said, “sometimes they’re a little short-staffed”. Another said “the staff are very kind”. There are kitchen staff and domestic staff, although there is still no domestic working on a weekend, which means that care staff also have to carry out any urgent cleaning work, which takes them away from direct care-giving. One staff member said they wished they had more time to socialise with the people Willow House - City of York Council DS0000034914.V333726.R01.S.doc Version 5.2 Page 21 living there, and to be able to support people to maintain their hobbies and interests. At the last inspection it was noted that some staff wore uniforms and others, their own clothes for work. Care staff now wear tunic tops and name badges, which helps people living there to know who they are. The staff, spoken to, have a good understanding of their role and many have worked at the home for some time. Some mandatory training has lapsed in the last year, which corresponded with a period when there was no City of York trainer in post. This has now been rectified and there are training sessions planned for later this year. The manager has a training plan so that she can keep track of when staff need refresher courses so that people are more likely to be cared for in a safe, consistent way. One recruitment file was looked at. The recruitment process is managed centrally by City of York, though the manager interviews the prospective employee. The recruitment documents were in place, and there was written evidence that the police check was completed before the person started work. The two references though provided very different views about the applicant and the application form did not provide a clear employment history. Although the manager was able to explain these ‘anomalies’ there was no written evidence that a discussion had been held with the applicant. This would be good practice and it was discussed with the manager, as a way of showing that people are checked very carefully prior to starting work as a way of keeping people safe. One member of staff was spoken with about their recruitment and induction process. They confirmed that they had received some training prior to starting work and had a period where they ‘shadowed’ another person to observe and learn about their role. Willow House - City of York Council DS0000034914.V333726.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use this service experience good quality outcomes in this area. The home is well managed, however there needs to be a more regular and transparent system of obtaining people’s views about the home, so that all people who have an interest in how the home operates can influence how it runs. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The manager is experienced in caring for older people and has completed extra qualifications to support her in this role. People spoken with said that the manager regularly walked around the home and speaks with people. During a discussion one person knocked on the office door to talk with her. Willow House - City of York Council DS0000034914.V333726.R01.S.doc Version 5.2 Page 23 Staff spoken with said she was approachable and they would feel confident in speaking to her about any concerns. The manager has set up a system of regular checks to see how the home is running. She audits a number of care planning records each month and medicine records are also looked at to make sure drugs are being given and signed for appropriately. Reviews are held with people living there and their relatives six weeks after moving to the home and at least yearly after that. This is an opportunity to discuss whether people are happy living there and if they have any concerns. A questionnaire was circulated earlier this year asking people about their views of the home. This information was obtained, but the results have not been made available. This system needs to be much more transparent. Information needs to be assessed and displayed in the home, with a plan to show how suggestions could be implemented. It would be good practice to hold regular resident’s and relative’s meetings so that discussions can be held about how the home runs. Finance systems were not formally looked at. City of York homes have a system where individual pocket money wallets are available for each person. Paper records, which records money changing hands, were seen. Health and safety issues at the home were discussed. Currently City of York uses contractors for all health and safety checks and maintenance/repair work. There is discussion at this time about whether a maintenance person should be employed to service all the care homes. This would enable routine maintenance work to be done in a planned manner. Two random service certificates were checked and found to be in date. Fire safety training, provided by the external trainer, is generally up to date and fire alarm checks are carried out weekly. There have been no fire drills though, for several months, and this needs to be organised to check that staff are still aware of their roles, in the event of a fire, to protect people from harm. The fire risk assessment has not been reviewed for over 3 years and this also needs addressing to show they are keeping people safe. Finally one of the offices contains an unlocked cupboard with clinical equipment, which is used by the community nursing staff or visiting doctor. As the office door is not routinely kept locked the home must introduce a safer system to make sure that unauthorised people cannot access the cupboard, so that people are kept safe. Willow House - City of York Council DS0000034914.V333726.R01.S.doc Version 5.2 Page 24 Willow House - City of York Council DS0000034914.V333726.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Willow House - City of York Council DS0000034914.V333726.R01.S.doc Version 5.2 Page 26 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 OP9 Regulation 13(2) Requirement Medicines must be stored at the advised temperature so that the efficiency of the drug is not affected. Staff must be more aware of talking about individuals in places where other people may be able to hear, so that people can be confident that their privacy and dignity is always respected The fire risk assessment for the home should be reviewed to show that people’s health and safety is being protected. The manager should consult with the fire safety officer to gain advice as to how often fire drills should be carried out at the home, so that people are protected from harm. There must be a more secure way of storing items used by visiting healthcare professionals so that unauthorised people DS0000034914.V333726.R01.S.doc Timescale for action 23/10/07 2. OP10 12(4) 23/10/07 3. OP38 13(4) 30/11/07 4 OP38 12(1) 31/12/07 5. OP38 13(4) 30/11/07 Willow House - City of York Council Version 5.2 Page 27 cannot gain access and put themselves at risk 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 OP7 Good Practice Recommendations The care plans could be expanded, to identify what makes one person different to another. This would help staff to support people to stay in control of their life as much as possible. It would be good practice for the temperature of the fridge, where medicines are stored, to be checked and recorded daily, so that staff can be confident that it is keeping those drugs cool enough. There should be continued effort to provide a social programme to make life more varied for the people living there. The home needs to continue to work with the present meal provision so that people who need extra calories, or indeed fewer calories, can receive a diet that is appropriate for those needs. There should be further consideration given for a person to be responsible for the laundry, so that staff can have more time for direct care giving and organising social events at the home The results and action plan, from the completed questionnaires, need to be displayed so that people think their views are being listened to. Organising regular residents’ meetings would give people the chance to what matters to them. 2 OP9 2. 3. OP12 OP15 4. OP27 5 OP33 Willow House - City of York Council DS0000034914.V333726.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 - City of York Council DS0000034914.V333726.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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