Inspection on 11/12/08 for Willow Lodge

This inspection was carried out on 11th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Willow Lodge 05/05/10

Willow Lodge 18/02/10

Willow Lodge 17/11/09

Willow Lodge 21/12/07

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Willow Lodge 11-15 Stein Road Emsworth Hampshire PO10 8LB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ian Craig     Date: 1 1 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Willow Lodge 11-15 Stein Road Emsworth Hampshire PO10 8LB 01329836281 01329836287 andrew.geach@willow-lodge.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Christine Anne Jarrett Type of registration: Number of places registered: Mr Andrew Robert Geach,Mr Stephen Richard Geach care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 26. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Willow Lodge is registered to support and accommodate up to 26 older people any one of whom could have a diagnosis of dementia. The home is in the residential area of Southbourne, close to Emsworth. There are 14 single bedrooms and six double rooms, over three floors. The majority of the rooms have en-suite facilities, although most of en-suite baths are not currently in use. There is one communal bathroom with an Care Homes for Older People Page 4 of 28 Over 65 0 26 26 0 Brief description of the care home adapted bath on the second floor. The home has a large open plan dining room / lounge which opens out onto a large patio area and secure rear garden. Current fees range between 348.00 to 500.00 pounds per week. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection consisted of a site visit to the home of approximately 6 hours. This included a tour of the premises, interviews with 2 staff, discussions with 2 other staff and with the manager. 4 residents and 2 relatives of residents were spoken to. Records, documents policies and procedures were looked at. Surveys were sent to staff, residents and to health and social care professionals to ask their views on the service. These were returned by 4 residents, 2 health care professionals and by 4 staff. Care services are required by the Commission to complete an Annual Quality Assurance Assessment (AQAA). This was completed and returned to us. Care Homes for Older People Page 6 of 28 Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Potential residents are given information about the service and are able to look around the home to see if it meets their expectations. The home ensures that it only accommodates those whose needs it can meet by carrying out needs assessments, although the availability of these records needs to be improved. Evidence: The home has a Service Users Guide, which gives information about the home including the organisational structure, the facilities, the staff, the admissions procedure and the complaints procedure. Surveys completed by residents confirm that they received enough information before moving in to help them decide if it is the right place. The manager described the process of assessing the needs of those referred to the home for possible admission. An initial enquiry form is completed. This involves visiting the person at either their home, or in hospital, and the completion of assessment pro Care Homes for Older People Page 10 of 28 Evidence: formas. Copies of completed assessment pro formas were seen for two people who have been recently admitted to the home. These are comprehensive. In addition to completing their own assessment the home obtains copies of the referring social services department care managers assessment and care plan. Copies of these were seen. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the homes care plans are of a good standard there is evidence that residents dignity is compromised by a lack of response to residents personal care needs by staff on ocassions. Evidence: Assessments of need and care plans were looked at for 5 people who live at the home. These were found to be comprehensive and reviewed at monthly intervals. The following needs are included in the assessments and care plans: communication, important relationships, medication/general health, physical activities/moving and handling, memory, routines and preferences, nutritional preferences, medication needs, interests/activities, spiritual needs, end of life care, washing, dressing, continence care, hair care, bath/shower, shaving, optical and audio care and foot care. The care plans identify any risks and any action that needs to be taken to minimise this. Residents had been consulted about their plan of care which was recorded. A separate care plan for night time is recorded. In addition to the above, moving and handling assessments are completed as well as a barthel assessment of need, skin Care Homes for Older People Page 12 of 28 Evidence: condition assessments and nutrition screening. A district nurse said in a survey, The residents are comfortable and happy and all very settled. There is effective manual handling procedures in place to ensure the safety of both residents and staff. Records are maintained of any consultations with medical staff such as general practitioners and district nurses. The Commission received information about the care of residents that was referred to social services for investigation under the safeguarding procedures. These included lack of personal care, poor assistance with toiletting, lack of response by staff to call points and reference to staff shouting at residents when the resident asks for help at night. There was a similar pattern of information in surveys returned by residents. One resident said: I should not have to shout out when I need the toilet. I dont like being told off when I pull the buzzer at night. One other person said he/she was told off for pulling the cord at night and another person said that staff didnt respond to the buzzer at night time. Two other residents also said they have to call out when waiting to use the toilet. Discussions with relatives and two residents also confirmed the lack of attention to assisting residents when they need the toilet. Another person said that staff are sometimes slow to respond when the call point is activated and a health care professional said it is sometimes difficult to find a member of staff. Daily running records for one person show that continence needs were not being addressed. A health care professional said that the home respects the privacy and dignity of residents most of the time, but also added, Some individual care needs are not met until advice/assessments have been given. The care staff require some extra training in some areas of social and health care in order to provide the most effective care. A member of the care staff team said that there has been some difficulties in the way care staff provide care. Health care professionals said that the home respects individuals privacy and dignity. A further comment was made that individuals health care needs are usually met and that the home contacts medical services when needed. It was also said that staff are kind to the residents. A resident said that his/her call point does not work and that he/she had raised this with the home. The call point was tested and found not to work. The manager made arrangements for the immediate repair of the call point. Another call point was tested and worked but staff failed to respond. When a third call point was tested a staff member responded. The manager provided a response to the issues regarding care and toileting needs with an action plan to address the areas of concern adding that extra care will be taken to Care Homes for Older People Page 13 of 28 Evidence: monitor the effectiveness of staff. The home is also seeking advice from the continence nurse service. Privacy screens are provided in shared rooms and residents can have a key to their bedroom door if they wish. Residents are also able to have their own telephone in their room. Two residents commented in surveys that their clothes get lost in the laundry and have been washed at the wrong temperature causing shrinkage and colour runs. The homes medication procedures were looked at. Staff who handle medication receive training from the manager and from a local college course. Records are maintained each time a staff member administers medication to a resident. Stocks of medication show that medication is administered as prescribed. Procedures for the storage and handling of controlled medication follow Royal Pharmaceutical guidelines. A member of staff has responsibility for monitoring medication and described how regular checks are made and any errors in recording followed up. Records and confirmation of medication changes made by general practitioners are held with records. The Commission was told that one persons medication was not dispensed. this could not be verified at the visit. Another person states that his or her skin cream is not always applied. This also could not be verified. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have opportunities for pursuing social, religious and cultural interests. Residents are able to make choices in how they spend their time. Evidence: The home has introduced an activities programme which started in November 2008. The December activities programme includes arts and crafts, quizzes, reminiscence, films, bingo, skittles, and floor games. At the time of the visit residents were joining in with a Christmas party also attended by residents relatives. Entertainment was provided by a guitarist/singer. A record is kept of those residents who take part in reminiscence activities. The surveys state that activities are usually or sometimes provided. One person referred to an outing and entertainment from a singer. The manager states that this is provided every 6 weeks. Communion is provided once a month. There are trips to shops and to a local country house. One person said that activities are provided but that he or she prefers not to join in. A staff member described the importance of providing activities and stimulation for the residents. Residents have personalised their rooms according to their own tastes often using their own furniture. Care Homes for Older People Page 15 of 28 Evidence: Reports regarding the meals varied. A district nurse commented, Good dietary meals are provided and regular fluids offered. Three residents state that the early evening meal could be improved by being more varied and in larger portions. Two residents said that the early evening meal is often cold or luke warm. One person said that there is home made produce and that the cook is good. On the day of the inspection residents were observed being helped by staff with eating. The meal looked apetising. Two residents were not aware of a choice of food for the midday meal, indicating that this could be improved. At tea time, the residents are asked what they would like to eat and a record is made of this. A record is made of each persons likes and dislikes for food. Each person has a card with their preferred breakfast. Food records show that special diets such as vegetarian food are catered for. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints process that shows the concerns of residents and their representatives are acted upon. Measures to protect residents fro harm are taken but these need to be improved. Evidence: The homes complaints procedure is contained in the Service Users Guide and is also displayed in the home. Residents and their relatives state that they know how to make a complaint. One person said that he or she did not feel comfortable when making a complaint to the manager and another person said that the response to his or her complaint was dismissive. Another person stated that the manager responded to a complaint that was made. The home maintains a record of any complaint that is made with details of the investigation and the outcome. A residents relative states that some of the staff are kind and listen to the residents. A relative also stated, I feel that my mother/father is safe at the home. The Health and Personal Care section of this report refers to the reports from residents and relatives of a lack of response by staff to care need needs. Care Homes for Older People Page 17 of 28 Evidence: Staff receive training in the safeguarding of vulnerable adults which was confirmed from records, discussions with the manager and from staff themselves. the manager also states that in response to the allegations about the care of residents that additional instruction in protecting vulnerable adults will be provided. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is homely, safe and clean promoting the dignity of the people who live there. Evidence: A tour of the premises was undertaken. A number of bedrooms were seen as well as communal areas such as bathrooms and lounges. The home was found to be clean and well maintained with evidence of redecoration of bedrooms, recarpetting and ongoing improvements to areas such as bathrooms. There are no unpleasant odours caused by incontinence. There is a well maintained garden with lawns, shrubs and trees as well as patio area with tables and chairs for residents to use. Three surveys refer to the need for improvements to the environment. Two people referred to a period when the lift was inoperative due to a fault. The Commission also received a complaint about this which was forwarded to the manager. The lift is now repaired. Residents referred to the time span to repair the lift of 10 days, during which those on the top floor had difficulties getting downstairs to the lounge. The manager acknowledged that the repair to the lift took too long but that the delay was caused by the repairs and work as described by the engineers completing the work. There is an improvement plan for the environment. 4 bedrooms have been Care Homes for Older People Page 19 of 28 Evidence: redecorated in the last 12 months. Bedrooms contained items of personal belongings such as books, pictures and televisions. One person said how much he/she likes his/her room and prefers to spend his/her time there. Privacy screens are provided in shared bedrooms and residents are able to have a key to their bedroom door. 17 of the 20 bedrooms have an en suite facility of either a toilet with a wash basin and some with a bath or shower. The baths are not used as residents require assistance with bathing. Each floor has a communal bathroom and there are assisted bath facilities as well as a walk in shower for those with mobility needs. The home has lifting equipment for helping residents and these include hoists and other aids. Staff were observed using a hoist to help a resident in the lounge. Staff receive training in health and safety, infection control and food hygiene. Staff were observed wearing aprons. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are supplied in sufficient numbers to meet residents needs and receive training appropriate to meeting care needs. The performance of staff is variable which has affected the standard of care. Staff recruitment procedures are good. Evidence: The home aims to provide the following staffing levels: 5 care staff from 8am to 2pm each day and 3 care staff from 2pm to 8pm. The hours worked by the registered manager are in addition to this. The home also has a cook and kitchen assistant as well as a trainee cook on the day of the visit. These staffing hours were reflected in the staff rota and were also evidenced by observation on the day of the visit. Night time staffing consists of 2 waking staff. Additional staff have been recruited since the last inspection including a kitchen assistant. The home has a staff training programme showing the following courses attended by staff: infection control, health and safety, food hygiene, first aid, moving and handling, dementia, challenging behaviour, fire safety, contamination of substances hazardous to health, safeguarding procedures, medication and palliative care. 73 of the staff have the National Vocational Qualification (NVQ) level 2 or 3 in care and 4 staff have Care Homes for Older People Page 21 of 28 Evidence: NVQ level 4 with one other person studying this at the time of the visit. Staff confirmed that there is a variety of training courses to attend. Records, staff surveys and discussion with staff show that newly appointed staff have an induction to prepare them for work in the home. There was comment from some staff regarding the knowledge and skill base to meet residents needs which it is reported is being addressed by the homes management. Surveys show that staff do not receive regular supervision which was also evidenced from records and discussions with the manager. The manager states that a more systematic schedule of supervision of staff is being introduced. Residents gave varying views on the standard of care and support they receive from staff. Slow response to care needs is mentioned in the Health and Personal Care section. Residents and their relatives, as well as a general practitioner, also said the staff are kind and helpful. one person said, Two staff take time to chat to my mother/father. All the staff are good Staff were observed to treat residents in a calm, patient and kind manner. Recruitment procedures were looked at for 3 staff who have recently started work at the home. These show that the required checks are carried out including obtaining 2 written references, criminal record bureau (CRB) and protection of vulnerable adults (POVA) checks before the person starts work. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed with the notable exception that management of some staff, as well as the system of staff supervision, needs to be improved so that residents needs are met. The health and safety of residents is promoted. Evidence: The registered manager has a Business Management and Care NVQ level 4 and is an NVQ assessor and verifier. She has also attended the partnership in care training courses with a local authority in dementia, adult protection, infection control, the mental capacity act 2005 and medication. A health care professional said, I generally feel that the home is very well run. The AQAA was returned to us and contians the information requested. The home has systems for auditting its own performance by the use of surveys and has recorded plans for it future development. This report also, however, identifies areas where the homes management need to address matters regarding the daily care of residents and the responsiveness of staff. The home looks Care Homes for Older People Page 23 of 28 Evidence: after the valuables of some residents. These are held in a secure place and records are kept of any amounts being depositted or withdrawn plus a corresponding balance. Records and discussion with staff and the manager show that individual staff supervision does not take place regularly. Staff receive training in moving and handling, fire safety, first aid and food hygiene. Temperature controls are installed on baths to prevent scalding from hot water. These are not installed on the baths in en suites but these taps do not work as residents do not use them. Covers are not yet installed on all radiators. The home is in the process of completing this and has temporarily switched off those radiators that do not have a cover. Restrictors are installed on first and second floor windows to prevent possible falls. The AQAA confirms that the appliances and equipment are serviced by suitably qualified persons. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 10 12 Staff must respond to the care needs of residents when they use the call point system to ask for assistance. So that residents care needs are met. 16/01/2009 2 10 12 Arrangements must be made to ensure that residents dignity is promoted by meeting individuals continence needs. So that residents have regular opportunities for using the toilet at regular intervals. 16/01/2009 3 36 18 Staff must receive regular formal supervision. So that staff performance is monitored to ensure that staff are meeting residents needs. 12/02/2009 Care Homes for Older People Page 26 of 28 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - 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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