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Inspection on 09/11/06 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 9th November 2006.

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

One service user said `the staff are wonderful and I love living here`, another service user on respite care said `it is just lovely here and I never get bored`. Many service users commented positively on the good standard of care they received. The home has pleasant views of the city walls and Walmgate Bar which service users are keen to enjoy. Service users have access to a range of lounge areas to sit and socialise in, and there is a large dining room available which enhances the dining experience.

What has improved since the last inspection?

The home have their registration certificate on display and have improved their recruitment practices since the last visit.

CARE HOMES FOR OLDER PEOPLE Willow House - City of York Council Willow House Long Close Lane Walmgate York North Yorkshire YO10 4UP Lead Inspector Jo Bell Key Unannounced Inspection 9th November 2006 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.V313828.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.V313828.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) 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.V313828.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st February 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. 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. The home provides personal care for 32 residents aged at least 65, who do not require specialist care. The charges per week to reside at Willow House are approximately £426.92. There is also 1 short stay bed. 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. Willow House - City of York Council DS0000034914.V313828.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key inspection of the service took place on Thursday 9th November 2006. Prior to the site visit a pre-inspection questionnaire was completed by the manager and this was returned to the CSCI. The site visit took one inspector six hours to complete. During the visit three service users were case tracked. Staff and visitors were spoken with, observations of care practices took place and discussions regarding the needs of service users, health and safety, and staffing issues took place. The home provides a good standard of care in a pleasant environment. Service users spoken with enjoyed residing at the home and had many positive comments to make. Outcomes for service users could be improved through more effective care planning and the home seeking the views and opinions of each service user in a more robust manner. What the service does well: What has improved since the last inspection? The home have their registration certificate on display and have improved their recruitment practices since the last visit. Willow House - City of York Council DS0000034914.V313828.R01.S.doc Version 5.2 Page 6 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 - City of York Council DS0000034914.V313828.R01.S.doc Version 5.2 Page 7 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.V313828.R01.S.doc Version 5.2 Page 8 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 (Standard 6 is not applicable) Quality in this outcome area is good. Service users have their needs assessed prior to entering the home and this is carried out in a robust manner. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Assessments take place through the care manager. This was discussed with the home manager, three service user files were checked and the assessment document is a standard format throughout City of York Council. This information related to every aspect of care which is needed in a residential home. Annual review to identify any changes to social care needs takes place with the service user, family and care manager. Willow House - City of York Council DS0000034914.V313828.R01.S.doc Version 5.2 Page 9 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 & 10 Quality in this outcome area is adequate. Whilst the quality of care received is good with service users being treated with respect, the documentation underpinning this is poor which may lead to needs not been met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three service users were case tracked and in discussions all were happy with the care they received. This was echoed by other service users throughout the site visit. They confirmed they had access to a GP, chiropodist, and district nurses if needed. Service users also stated they are treated with dignity and respect and the staff have a pleasant and friendly manner towards them. Service users observed looked clean and well cared for, one lady confirmed she visits the hairdresser regularly and another stated the chiropodist visits on a regular basis. Willow House - City of York Council DS0000034914.V313828.R01.S.doc Version 5.2 Page 10 An initial assessment is carried out once the person enters the home. Whilst some information was in place there was incompleted documentation relating to personal care needs, bathing, social activities, likes and dislikes regarding food, continence needs and emotional and mental well being. It is therefore difficult to ascertain if these needs have been discussed or whether they have just not been recorded. The manager did state that new documentation is being introduced shortly which should improve this process. Risk assessments for manual handling were in place, though one person used bed rails and the rationale for this was unclear with no risk assessment in place. This was discussed with the acting manager and home manager. Staff discussed how they would know if a person was under or over weight, it was evident that staff knew the group of service users well and would be able to detect if any changes had taken place. However, though service users were weighed on a regular basis there was no nutritional assessment in place for any service user. This would help identify if they were at risk of being under or over weight and what action is needed to improve the situation. This needs to be addressed. The accident book was checked and generally this was completed satisfactorily, though the care leaders and managers must ensure they sign and date the incident forms. No serious incidents have occurred and the home send the CSCI Regulation 37 notifications when necessary. The medication system was checked. Service users confirmed the care leaders administer medication, this was observed during lunchtime. The home have a procedure in place which staff are aware of. Three service users medication charts were inspected and whilst there was one omission where medication had been administered but not signed for this did not have any negative effect on the service user. A stock balance takes place monthly by the care leader. On two occasions the balance had either been incorrectly recorded or it was difficult to determine how many tablets there should be. The controlled drugs register was checked and consistently medication was recorded correctly. District nurses are contacted if controlled drugs through a syringe pump need to be administered or if a dressing needs to be carried out. Currently there are no service users with pressure sores. Staff confirmed that they have received medication training through Selby College, and the home used a blister pack system for administering medication. A medication audit needs to take place to ensure any errors are identified and appropriate action is taken to address these. This was discussed with the home manager. Willow House - City of York Council DS0000034914.V313828.R01.S.doc Version 5.2 Page 11 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 & 15 Quality in this outcome area is adequate. Visitors are welcomed into the home and some contact with the community is made. Though this would be enhanced through a greater range of activities being offered in the home. Service users stated the meals provided are variable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A range of service users were spoken with regarding activities, autonomy and choice and the meals provided. Overall outcomes were adequate. Activities previously offered included entertainers, dominoes, sing a longs, TV and newspapers. Currently it is the carers responsibility to provide activities when they have time. Service users care plans do not have a specific area to discuss social history and likes and dislikes in this area. Any activities that do take place need to be funded through the home raising money. Service users commented they would like to go outside more. The city walls are nearby though the staffing levels on an afternoon would make it difficult to release staff. There is a vicar that visits which service users confirmed and visitors are welcomed at any time. A more focused approach with a dedicated organiser would be beneficial to service users. Willow House - City of York Council DS0000034914.V313828.R01.S.doc Version 5.2 Page 12 Three service users discussed their daily routines and confirmed they can get up and go to bed when they want, generally a bath is offered on a weekly basis. Staff are keen to promote independence, and this was evident at lunchtime when one gentleman was helping serving the drinks. The mealtimes were discussed and the responses were variable regarding the choice of food offered and whether it was liked or disliked. The food at lunchtime is provided by the local hospital, at the visit a choice of four main courses were offered. This included shepherds pie and pork and peppers. Some of the vegetables are frozen and the desert was either bread and butter pudding or tinned pears. Portions sizes were good and some service users were observed enjoying the food whilst others left part of the main course. The dining room is large with plenty of tables and chairs to accommodate all the service users at once. Special crockery is available and staff are aware of who to assist. One gentleman spoken with said he was diabetic and he is always given a special diet. A general assistant was working in the kitchen and confirmed food hygiene training had been completed. The kitchen was clean and tidy and no concerns had been raised through environmental health. Willow House - City of York Council DS0000034914.V313828.R01.S.doc Version 5.2 Page 13 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 & 18 Quality in this outcome area is good. Service users are confident their concerns will be listened to and acted upon and they feel safe and well cared for. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users all spoken with said they had no complaints or concerns about the service. They confirmed informal discussions take place with key workers and care leaders and they would feel happy to discuss any issues with them. No formal complaints have been received by either the home or CSCI. The City of York Council do have a complaints procedure in place. Service users were keen to confirm that they are treated in a dignified manner and they feel safe in their surroundings. Staff had a good understanding of adult protection and the types of abuse which may occur. Adult protection training is offered during induction and the home have a policy and procedure in place to underpin this. The manager was aware of what action to take should an allegation of abuse be suspected. Willow House - City of York Council DS0000034914.V313828.R01.S.doc Version 5.2 Page 14 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 & 26 Quality in this outcome area is good. Service users enjoy living in this environment which is clean and well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The environment is suitable to meet the needs of this client group. There are plenty of communal areas with views across the city walls to enjoy. The City of York Council have a contract maintenance system where they can access personnel for repairs or refurbishments. The home smelt clean and fresh and service users commented positively on living in the home. Service users confirmed they have their clothes laundered by the home. Currently this is the responsibility of the care staff as there is no designated laundry person. The laundry room was inspected and this was found to be well maintained, there were two washing machines and two driers available and Willow House - City of York Council DS0000034914.V313828.R01.S.doc Version 5.2 Page 15 night staff help with washing and ironing as required. Care staff spoken with felt much of their time was spent completing laundry and domestic duties when it would be more beneficial if time could be spent with the service users undertaking activities. The manager needs to ensure infection control training is up to date, this was discussed with the manager. Willow House - City of York Council DS0000034914.V313828.R01.S.doc Version 5.2 Page 16 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 & 30 Quality in this outcome area is adequate. Staff are competent and skilled in meeting the needs of service users though this could be enhanced through further training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the site visit there were sufficient staff on duty. One care leader and three care staff were available with general assistants and support workers on duty during the morning, though this was reduced in the afternoon. A few service users commented that the home was short staffed this is partly due to staff not having the time to spend with service users during the afternoon on a one to one basis. The home need to develop staff’s skills and knowledge through completion of NVQ Level 2 or above in care. One member of staff said she had been waiting a long time to be enrolled on this course though she was keen and enthusiastic. Service users did strongly feel that staff were competent and knew how to meet their needs. Staff again commented on the lack of domestic staff on a weekend, this was discussed with the manager. It was apparent at the site visit that no members of staff had name badges and it was unclear for service users as to the role of each staff member. This was exacerbated by the fact that some staff wore a uniform, others wore a tunic top with jeans whilst others wore all their own clothes. Two members of Willow House - City of York Council DS0000034914.V313828.R01.S.doc Version 5.2 Page 17 staff had different coloured tunics though their role was exactly the same. Whilst in the laundry a person entered with jeans and a t-shirt, it was thought they must have been a visitor, though when asked they were a member of staff. This is extremely confusing for service users, visitors and health professionals. Consideration should also be given to health and safety as a range of footwear and jewellery were observed being worn by members of staff. Recruitment issues were discussed and the process for employing a member of staff was raised and the need to have CRB/POVA checks prior to commencement of employment. Three staff files were checked, these were variable. Human Resources deal with recruitment issues and information is then sent to the home for the manager. On one occasion only one written reference was available and reference to whether a POVA check had been completed was not available in the standard documentation. This is an issue for City of York Council to address, which will ensure the manager has sufficient available information. The files were not well maintained or easy to follow. The induction training linked with Skills for Care has recently changed and is in the process of being implemented. This will involve mandatory training being completed within a six week period from commencement of employment. Staff confirmed induction training takes place in the current format. Willow House - City of York Council DS0000034914.V313828.R01.S.doc Version 5.2 Page 18 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 & 38 Quality in this outcome area is adequate. The home is well managed, though views and opinions of service users are not sought in a robust manner. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has completed an NVQ Level 4 in management and is experienced in caring for older people. Service users spoken with all had positive comments to make regarding how the home is run. Currently there is no quality assurance system in place. Informal discussions take place with key workers and care staff to identify and concerns or issues. Staff have meetings though service users or relatives meetings have not taken Willow House - City of York Council DS0000034914.V313828.R01.S.doc Version 5.2 Page 19 place. The manager needs to carry out a range of audits regarding mealtimes, care planning, and medication. Views and opinions of the service provided should be sought on a formal basis and action taken regarding the results of this. Service users finances were checked and found to be in order. A pocket money system is available and individual wallets are available for each service user. This is discussed with the service user when they enter the home. Money is generally used for hairdressing, chiropody, newspapers or toiletries. No individual bank accounts are operated by the service. Health and safety was discussed. The pre-inspection questionnaire gave details regarding fire safety, emergency lighting and a range of safety certificates. Staff are responsible for checking water temperatures on a monthly basis and also prior to a full immersion bath. There is a fire alarm test on a weekly basis and doors are kept closed during the day and night to service user’s rooms. The City of York Council has contractors to service hoists and lifts and make repairs as needed. Mandatory training was discussed and three staff files were examined. Individual certificates for moving and handling, fire safety, COSHH and food hygiene were available. A print out of the training received was in place for each staff member. Some staff spoken with said they had not received moving and handling, infection control or COSHH training for a while. The files inspected confirmed some moving and handling training had last taken place in March 2005. The manager confirmed further training was planned though this is outside the timescale of either 12-18 months and must be addressed. Willow House - City of York Council DS0000034914.V313828.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 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 2 29 2 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.V313828.R01.S.doc Version 5.2 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. 1. Standard OP7 Regulation 13 Requirement Service users who have bed rails must have documentation in place to support the use of this equipment. The risk assessment must be reviewed and consent must be obtained from the service user and/or their advocate Service users must have their needs written in the care plan. These must be reviewed and signed on a monthly basis. The home must carry out care plan audits on a regular basis to ensure there are no omissions, and that the care the service user receives is the care that is documented. Medication audits must take place on a monthly basis to ensure no errors have occurred. Medication must be signed for once administered. A review of when the stock balance of medication is counted needs to takes place Willow House - City of York Council DS0000034914.V313828.R01.S.doc Version 5.2 Page 22 Timescale for action 23/11/06 2. OP7 15 23/11/06 3. OP9 13 23/11/06 Staff must use the correct code when ‘as required’ medication is discussed. 4. OP38 23 Staff must receive mandatory training within the required timescale, (either 12 or 18 months, depending on CYC guidance). 09/12/06 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 OP8 OP27 Good Practice Recommendations Staff must have a system in place to assess whether service users nutritional needs are being met. This should include a nutritional assessment tool. Consideration should be given to employing a laundry assistant. Staff should consider wearing a name badge and a review of the uniform policy should take place. The home should ensure the staff files are in good order with easy to find information. A quality assurance system should be implemented which would cover seeking the views and opinions of service users. 3. 4. OP29 OP33 Willow House - City of York Council DS0000034914.V313828.R01.S.doc Version 5.2 Page 23 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.V313828.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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