Inspection on 11/08/08 for Willow Tree Nursing Home

This inspection was carried out on 11th August 2008.

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

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.

Other inspections for this house

Willow Tree Nursing Home 11/08/09

Willow Tree Nursing Home 12/09/07

Willow Tree Nursing Home 09/10/06

Willow Tree Nursing Home 18/10/05

Willow Tree Nursing Home 20/06/05

Willow Tree Nursing Home 10/11/04

Willow Tree Nursing Home 06/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOMES FOR OLDER PEOPLE Willow Tree Nursing Home 12 School Street Hillmorton Rugby Warwickshire CV21 4BW Lead Inspector Sandra Wade Key Unannounced Inspection 11th August 2008 08:00 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 Tree Nursing Home DS0000004415.V369449.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 Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Willow Tree Nursing Home Address 12 School Street Hillmorton Rugby Warwickshire CV21 4BW 01788 574689 01788 551791 carol.mccullough@redwoodcare.co.uk 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) Culpepper Care Limited Carol Anne McCullough Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th September 2007 Brief Description of the Service: Willow Tree Nursing Home is registered to provide personal and nursing care for up to 34 service users over the age of 65. The home can offer care for a variety of medical conditions including side affects from a stroke, naso-gastric feeding, wounds, paralysis, incontinence, Parkinson’s Disease, Diabetes, and other conditions. Willow Tree is a single storey establishment converted from a domestic bungalow and extended to include single and shared accommodation and is situated in a local suburb of Rugby approximately 3 miles from the town centre. It is close to local shops and a bus route. The home is set back from the road and has some parking near to the entrance of the home. The home is currently subject to further extension works, which are almost complete. This will further increase the size and facilities of the home to allow for additional people to be accommodated by the home. This is subject to registration by us. There are currently 26 single bedrooms and four twin rooms with either washbasins or full en suite facilities, which include a washbasin, toilet, bath or shower. Each room has a call bell facility so that residents can alert staff they need assistance. There are two communal lounges and a dining room and the communal areas are situated at each end with bedroom accommodation integrated between them. Residents have access to a courtyard type garden and other areas of garden are nearing completion as part of the extension works to the home. The home is staffed by a complement of qualified nursing staff and care assistants. The fees for this home are from £300 to £785, these are published in the Service User Guide. Extra charges are made for hairdressing, newspapers, chiropody and some activities (entrance fees etc). Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This unannounced inspection took place between 8.00am and 7.30pm. Two people who were staying at the home were ‘case tracked’ and the files were checked of other residents to follow up specific information on care needs. The case tracking process involves establishing an individual’s experience of staying at the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. Records examined during this inspection, in addition to care records, included staff training records, staff duty rotas, kitchen records, accident records, complaint records, financial records, maintenance records and medication records. A period of time was spent in one of the lounges to observe residents. Both breakfast and lunchtimes were also observed. A tour of the home was undertaken to view specific areas and establish the layout and décor of the home. What the service does well: All residents are assessed prior to them living at the home so that their needs can be identified and a decision can be made on whether these can be met. The staff are friendly, caring, approachable and have a good rapport with the residents. Responses to questionnaires sent out to relatives by the home were all very positive stating that staff were “excellent, helpful, attentive, friendly” and “caring”. Residents observed and spoken to during the inspection seemed content and happy with the care they are receiving. Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 6 Residents receive choices of meals which are appetising and which they enjoy. One relative commented that the meals were “wonderful” and said that the home has “their own cooks” and choices are always provided. There are a variety of social activities that are planned and provided by a dedicated Activity Organiser. There are also outside trips and entertainers organised when possible to ensure the social care needs of residents are met. Staff had a good understanding of the needs of the residents and records showed that specialist advice is sought when needed. The home has exceeded the standard for 50 of all care staff to achieve a National Vocational Qualification II in Care, this assists care staff in providing more effective care to the residents and is good practice. The residents were seen to be enjoying the extra spacious lounge and dining facilities as well as in the new large screen television and comfortable furniture. The choices of residents were being respected, it was clear where specific requests had been made in care plans that these were being carried out. What has improved since the last inspection? Records are now kept to demonstrate that following the assessment of a resident, they receive a letter confirming the home can meet their needs. Risk assessment records are now in place to show where there is a risk to the health of the resident. All of the required recruitment information is now obtained prior to staff commencing employment at the home to ensure residents are safeguarded. Twelve staff have achieved the Dementia Care Course for Managers to help them provide more effective care to those residents who develop this condition. The home has been awarded “Gold” for their food hygiene inspection demonstrating they are working to high standards in the kitchen. The new lounge has opened with new furniture, large screen television, hearing loop and amplifier. It also has under floor heating and an accessible patio through French doors to benefit residents. A new kitchen has been installed to help improve the catering facilities to service the home. Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 7 A summary section has been added to the care plans so that it is easier to identify specific needs of residents which cannot easily be demonstrated through the current pre-printed care plan format. 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 Tree Nursing Home DS0000004415.V369449.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 Tree Nursing Home DS0000004415.V369449.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): Standards 1,3 and 4 were assessed. Quality in this outcome area is good. Information is available to residents about the home prior to their admission and residents are being assessed to ensure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is an up-to-date Service User Guide available in the home which gives information on the care and services provided. This also contains the summary inspection report and a Statement of the Terms and Conditions for the home to allow a prospective resident to make an informed decision on whether to stay at the home. Pre- assessments of all residents are carried out prior to their admission to identify the needs of the residents so that the home knows these needs can be met. Copies of assessments carried out by the manager and Social Workers are kept on resident’s files. Assessments viewed were fully detailed and gave a good insight into the persons needs. Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 10 It was evident from files viewed that the manager writes letters to all prospective residents following their assessment to confirm their admission has been accepted. Willow Tree Nursing Home DS0000004415.V369449.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): Standards 7,8,9 and 10 were assessed. Quality in this outcome area is adequate. Residents personal, health and psychological care are detailed in plans of care but it is not clear care needs are always reviewed and updated accordingly to show that health care needs are being met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents looked well cared for and relatives and residents spoken to were positive about the care provided. Two visitors to the home said they were happy with the care being provided and felt that staff were friendly and approachable. One said that when they asked their relative if they wanted to go home they said “no” which indicated to them they were happy in the home. All residents in the home have care plans in place. These consist of preprinted care plans which list care needs and which staff then tick to indicate what the residents needs are. On the same care plan there is a pre-printed Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 12 staff support section which is ticked on the sections where staff support is needed. This format of care planning is less person centred as staff are geared to ticking a box to indicate a care need as opposed to writing down specific details in relation to the person. Since the last inspection the manager has taken action to include a short summary alongside the care plans detailing the extra information that cannot be demonstrated by the use of the tick boxes. This is helpful in gaining a better insight into each residents needs. It was found that the care plans took a long time to read and take in all of the information presented to get a clear picture of how the resident is being cared for. The manager said that staff were used to this format of care plans and they did not present any problems for staff using them. A care plan for nutrition clearly identified all the implements this person needed to support them to eat independently which is good practice. Care plan records also stated the person occasionally needed help with eating. It was identified on the day of inspection that staff were required to give repeated prompting and encouragement for this person to eat, staff also offered to help the resident eat. Weights of residents are being regularly taken to ensure any weight losses can be identified and acted upon. One care plan showed that prior to the resident’s admission there were several instances of inappropriate behaviour which included challenging behaviour, fluctuating moods and hallucinations. The manager said that this person no longer displayed inappropriate behaviour and it was felt the change in support and care being given by the home had helped to improve this. This was not fully clear from the evaluation records in place. Another care plan viewed showed that the hallucinations were occasional and that staff should ensure they dealt with any abusive behaviour in a calm manner. There were no instructions to monitor and record any instances of this to ensure a clear picture of the person’s behaviour could be identified. This helps when reviewing the care needs and support the resident requires. This resident had been diagnosed with Alzheimer’s but daily records were not being completed each day to show the mood of the resident as well as any psychological type needs expressed by the resident. The manager said that the care records are signed each day to demonstrate that the care given is as per the care plan. She explained that daily entries are only made if there is something specific that needed to be recorded. This prevents a clear picture of the person’s health being identified over a period of time as well as the care interventions that the person has received each day to meet their needs. During the inspection the resident was noted to sit in the lounge for most of the day listening to the television or music being played. Staff were attentive to the needs of the resident and they seemed content. The care plan stated that this resident should be seated on a pressure relief cushion when in a wheelchair or using an armchair. It was noted that the resident did not have a cushion when seated in an armchair. The manager Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 13 said that the new chairs that had been purchased for the new lounge had integrated pressure cushions so an extra cushion was not needed. She explained this was only the case for people at low risk of developing pressure damage to the skin. The care plan will need to be updated to reflect this. It was evident that since the last inspection the care records have been improved in regard to care needed to manage diabetes and a stoma. The diabetic care plans now show staff actions to be carried out should the resident’s blood sugar level rise or reduce to unacceptable levels. One care plan said that the resident had a problem with their right and left knee but it was not clear what the problem was. The care plan did say that the person had a history of leg ulcers and a member of staff said they had an ulcer on their heel. On 20.7.08 the evaluation records stated the skin was “intact” but there was a small skin peel to one of the legs. Another care plan which referred to the skin showed that the resident actually had a grade II pressure sore although it did not say where it was. It stated that the last dressing change was on 23.7.08 suggesting that this resident’s skin may not have been in tact on 20.7.08. It was established this wound was on the resident’s heel. A body chart was not seen on the file to show the location of the wounds as well as the dates and any progress or deterioration of the wound. A review of medication was undertaken. This was difficult to audit effectively because the amount of medication available at the start of the medication period was not always recorded on the Medication Administration Record (MAR). This prevented a count of the medication received, given and remaining to confirm medications are being given as prescribed. It was evident in many instances that there was more medication available at the beginning of the medication period than had been recorded on the MAR. In some cases there was less. The medication records were viewed for four residents. It was evident in some cases that staff are signing the MAR’s as well as trying to fit in a code to indicate a reason why the resident may not have taken their medication. This made some of the MARs difficult to read to assess the amount of medication actually taken, refused or not given. This also applied to medication to be given “as required”, staff were trying to fit in a time next to the signature which again made the MARs difficult to read and audit. This was discussed with the manager with a view to ensuring MARs are fully legible and are not used inappropriately. The boxes on the MAR should be used for codes or signatures only. On two records viewed there were gaps on the medication chart so it was not clear if the medication had been given or not. Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 14 One person had been prescribed Lactulose but there was none available for staff to give. One person had been prescribed Tramadol three times a day. These had been provided in blister packs for morning noon and evening. It was evident that there were no morning or evening Tramadol tablets to give. The blister packs were empty. The lunchtime Tramadol had tablets missing from different places when comparing to they days they should have been missing against the medication record. This could mean staff have been using the lunchtime doses for the morning or evening doses. Medication provided to the home in blister packs should be used as indicated. This is to ensure medication can be effectively audited to ensure residents receive this as the doctor has prescribed and to help prevent medication errors. One person who had been prescribed paracetamol had not been taking these regularly but had 298 tablets available to give. This suggests more had been ordered than required. The trolley for the storage of medication was found to be too small to store all medications for residents. Staff were storing some of the medication in a cupboard and said they managed by swapping the medications around according to the times of day when it was to be given. The manager said that another medication trolley had been requested which would help medications to be managed more effectively. The care plan for one resident stated that the resident should have a bath weekly and Oilatum applied to all dry skin areas. It was not evident from the Medication Administration Record that this had been prescribed and was being used. It was evident that Sudocream had been prescribed twice a day and was being used. The privacy and dignity of the residents was maintained during the inspection and no concerns were noted during this visit. Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 15 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): Standards 12,13,14 and 15 were assessed. Quality in this outcome area is good. Residents find the lifestyle in the home matches their expectations and they enjoy the meals provided. They are able to exercise choices in regard to the care and services delivered to maintain a level of independence and wellbeing within the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection there has been further progress made in improving and increasing the format and variety of activities. There is an Activity Co-ordinator employed for five days per week from 8am to 3.15pm. She works in the morning and assists as a Breakfast Assistant and following this she spends time organising and providing social activities. This was observed to happen during the inspection. Since the last inspection she has attended a course on Activities Management to help her gain a better insight into activity organisation and management. Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 16 She consults with the residents in regards to what they would like to do and although there are activity schedules in place, this does not necessarily mean they always do the ones detailed if the residents prefer to do something different. During this inspection residents did activities linked to the Olympics including colouring the flag and they watched the Olympics on the large screen television in the new lounge. There is an activity folder which contains all the activity schedules and organised activities. This showed that activities included colouring, listening to music, hairdresser, gardening, coffee and cakes in the courtyard, quizzes, wordsearches, newspaper evaluation from 1912, film afternoons, church service, cake decorating, chair aerobics and reminiscence DVD’s. Outside entertainers had also been organised and included two singers and an event called “the magic of the movies” with singing and dancing. There had been a clothes party and also a person that comes into the home once a month to do creative mobility which are floor games. The Activity Organiser said there was also a person who came into the home to provide wheelchair mobility every Wednesday. She explained that they do go to town shopping when they can and some of the residents had recently been to Skegness and some had visited a zoo. She explained that most of the residents enjoyed one to one time and she regularly chatted to residents about things of interest to them. A relative visiting the home confirmed that residents were taken for a walk to the shops and had visited a zoo. Records were being kept of all activities residents had participated in including one to one time. Records seen showed that all residents regardless of their needs had been involved at some time each week doing a social activity. Resident choices are detailed within their care plans and show information such as how many pillows they like and what drink they like before going to bed. One resident liked an alcoholic drink and biscuits at a certain time of day. Staff were observed to ask the resident if they wanted this and were seen to provide it. At breakfast time residents were seen to have cereals including hot porridge followed by toast. A cooked breakfast was also offered and one person chose to have eggs and bacon and another chose to have bacon and some bread and butter. There was no set time for breakfast and residents were able to have this when they wanted. At lunchtime residents were given two choices of meals, these were sausage, chips and beans or fish chips and peas followed by bakewell tart and custard. The meals looked appetising and one person said “I enjoyed that”. Lemon squash was provided to drink and staff asked residents if they wanted this. Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 17 Most of the residents were seated together in the new dining room, some sat at the table in their wheelchairs. Some were wearing bibs and some had serviettes on their lap. The residents chatted amongst one another while having their meal. The manager came into the lounge to help feed one of the residents and she also asked another if they also wanted help. This was observed to be done with sensitivity and patience and the residents were not rushed. The television was turned off and the music put on. The residents do not currently have menus which show them all meals, snacks and drinks available to them each day. The manager said that she had obtained display frames to be able to do this. Since the last inspection a new kitchen has been installed with all new equipment. The food store and fridges were adequately stocked and fridge and freezer temperatures were operating at appropriate levels for the safe storage of food. The manager advised that the home had been awarded “Gold” in regard to the recent food hygiene inspection that had been carried out. This demonstrates that the staff who work in the kitchen are working to high standards. The only area requiring action was in regard to dried food storage. Some of the dried food such as jelly mix, cake and crumble mix were in opened packets. These should be stored in airtight containers so that they are pest proof. Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 18 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): Standards 16 and 18 were assessed. Quality in this outcome area is adequate. It is not clear that procedures for the management of concerns and abuse reflect current guidance to ensure they are managed appropriately and effectively to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection we have received three complaints all of which were forwarded to the home for investigation. All complainants stated that they had approached the home and were copying us into the letters sent due to their dissatisfaction with the home. These all included concerns about level of care provided. Two of the residents had fallen in the home, there were concerns regarding the management of diabetes and incontinence and one person felt there was no hot water for their relative to wash in. The complaints records for the home were requested to confirm the home were recording complaints and investigating these appropriately. It was found that an appropriate record of complaints was not being kept. During the last inspection the home were advised to develop a register of all concerns, complaints and any allegations of abuse should so that it is clear these are being taken seriously, monitored and responded to effectively. There were only details of two actual complaints received on the file viewed and no other documentation in regards to any investigation. Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 19 The manager made contact with the organisation to obtain copies of the responses sent to the complainants due to these not being available in the home. These were emailed to the home during the inspection and were viewed. These showed that an investigation did take place and the responses to the complainants were sent within the required 28-day timescale. The home will need to ensure that there are sufficient records in place to show complaints received, investigated and responded to. Records should also show if the complaint was upheld or not upheld. During the last inspection a requirement was made in regards to improving records in relation to the management of diabetes and it was found that this had been acted upon during this inspection. The hot water in some rooms seemed less than the 43°C and the manager was requested to investigate this. Care records showed residents at risk of falls and where this was the case, risk assessments had been devised to try and minimise the risks. Care files also showed how often residents should be supported with personal care such as toileting and residents were asked during the inspection if they needed assistance to be taken to the toilets. A relative confirmed they knew who to speak to should they need to make a complaint and confirmed that any requests made of staff were always carried out. The Service User Guide for the home shows the procedures for making a complaint including the name and address of the provider for those wishing to make a formal complaint in writing. The manager confirmed that staff training had taken place on identifying abuse and protecting residents but there were six staff who still needed to complete this. Policies were available in the home regarding abuse and how this should be managed but it was not clear that there were procedures in place which showed how this should be reported and followed up other than reporting it to the provider. A member of staff spoken to was not aware of who abuse should be reported to other than the manager. They were also not clear what immediate actions they should take in regard to safeguarding a resident should they observe a resident being subjected to abuse. This was discussed with the manager with a view to ensuring all staff are clear and understand what happens when abuse is reported to ensure residents are safeguarded. Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 20 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): Standards 19 and 26 were assessed. Quality in this outcome area is adequate. Although there have been significant improvements to some areas of the home, there remains some areas that still need to be refurbished to ensure the home is comfortable and homely for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The accommodation consists of two communal lounges and a dining room and 26 single bedrooms and four twin rooms. The bedrooms have either washbasins or full en suite facilities, which include a washbasin, toilet, bath or shower. There are also communal toilets, baths and showers to support residents in other areas of the home. Each room has a call bell facility so that residents can alert staff they need assistance. Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 21 Since the last inspection the extension works to the home have been further developed and there is there now a new large lounge/dining area, which has replaced one of the previous lounges. This has been completed to a very high standard with new furniture, a large screen television and hearing loop. It has been fitted with under floor heating and also has an accessible patio area through French doors leading from the lounge. Most of the residents on the day of inspection were occupying this lounge and all looked comfortable and content watching the new large screen television and listening to the music at various times of the day. The new lounge has been organised so that there are separate seating areas, the floor is wood panelled throughout as opposed to carpet, which some residents may be used to. Staff said this makes it easier to clean and to use the hoist. Some residents asked what day and what time it was, there was no clock or calendar in the lounge. The manager said there were additional items to be provided for the lounge including these items. It was noted that two of the chairs in the lounge were not new and had big rips on the cushion part of the chair. Residents used these during the inspection which clearly would have been less comfortable. These chairs should be replaced as required. The manager advised that the extension parts of the home are now in the final stages and it was hoped these would be completed within a matter of weeks. The manager was able to show the inspector the new bedrooms, one of which had been fully furnished. The bedrooms also have been completed to high standards with new hospital beds containing integrated bed rails to ensure those residents who need these can be cared for safely. A new commercial kitchen has been installed with all stainless steel equipment and this is based next to the lounge. A new food storage area has also been created although this was not accessible to staff at the time of inspection so food was in a temporary area next to the kitchen. The home in general was clean and staff said that the residents had coped very well with the building works. Due to the changes in the accommodation and the creation of a new building, there are areas of the home that have been reconfigured on a temporary basis. This includes the second lounge being made smaller and temporary fixes for the food storage areas until building works are complete. During the tour of the building it was evident that bedrooms had been made to look homely with residents personal possessions including items of furniture. Although most were decorated to a good standard, there were some bedrooms identified that were in need of refurbishment including replacement carpets. The manager said that following completion of the extension works, the focus would then be placed on refurbishing the other areas of the home. Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 22 Satisfaction surveys sent out to relatives by the home showed that two people out of the three felt the environment was “good” and one felt it “could do with updating”. They acknowledged it would be better when all the building work had been completed. The residents have access to a pleasant courtyard type garden and other outside areas are in the process of being completed for residents. All areas within the home are accessible to wheelchairs but the grounds on approach to the home are still large stones. The manager advised this area is due to done and this will incorporate a large area for car parking as well. She advised that there was alternative access for wheelchairs if needed. The laundry area has been made bigger since the last inspection, there is still some work needed to finish the part that has been extended. This had not affected the provision of a laundry service to the residents. Staff were completing ironing in another room next to the lounge as a temporary arrangement until works were complete. An unpleasant odour was noted in the toilet next to the new lounge. The manager said that this was due to work being undertaken on the drains. Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 23 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): Standards 27,28,29 and 30 were assessed. Quality in this outcome area is good overall. The needs of residents are being met by the numbers of staff employed although it is not clear laundry and domestic services are being provided consistently. Staff training is provided on an ongoing basis to ensure safe and effective care is provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection visitors to the home were positive about the staff within the home. One said the staff were friendly and approachable. Another said that any requests made of staff were always carried out and that staff kept them informed about their relative. During the inspection staff were observed to be friendly and supportive towards residents and regularly interacted with them. Responses to questionnaires sent out to relatives by the home were all very positive stating that staff were “excellent, helpful, attentive, friendly” and “caring”. The manager confirmed that there were 27 residents in the home and that they aimed to work with five carers and one nurse in the morning and four carers and one nurse in the afternoon and two carers and one nurse at night. Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 24 Duty rotas viewed showed that most of the time these staffing levels were being achieved. There were some occasions there were only four carers on duty as opposed to five in the mornings. Duty rotas also showed that there is always a nurse on duty during the day but on several occasions the manager of the home is working as the nurse. This is not good practice, the manager should work in a supernumerary capacity and be available to deal with any urgent matters or issues concerning the management of the home. The manager advised that this practice would cease once the home had been registered to accommodate additional residents. In addition to staff who provide care and nursing support there are also dedicated kitchen, cleaning and domestic staff. Duty rotas showed that there is a cook who works every day and there is also a kitchen assistant and breakfast assistant who support the cook in providing meals to the residents. Duty rotas also showed that the laundry is usually completed five days per week. It was not clear from rotas who completes this if necessary on the other two days a week. In regards to domestic staff, there is one person who is on long term sick and one domestic who works five days per week. Carers are being allocated specifically on the rotas to complete this on some days but there were some days on the duty rota where there is no domestic person indicated so it is not clear if the home is being cleaned on these days. This issue has been highlighted on previous inspections to the home and although there has been a slight improvement in the provision of these services, action will need to be taken to show these services are available consistently. The manager said that there was laundry and cleaning being completed each day but this could not be demonstrated from duty rotas in place. The manager confirmed there were 20 carers working at the home and eight nurses. She said that twelve of the carers had achieved a National Vocational Qualification (NVQ) II in care and four were working towards achieving this to help them provide more effective care to the residents. This exceeds our standard of 50 of staff to achieve this and is good practice. Since the last inspection there have been new staff recruited. The files for three of these were viewed to confirm that the appropriate recruitment procedures are being followed to safeguard residents. These all contained the required information including two written references, a Criminal Record Bureau (CRB) check and a check against the Protection of Vulnerable Adults Register (POVA) checks. Induction records were not available on the files as staff had them with them. The manager was able to produce a copy of the induction records used which demonstrated the training incorporates the ‘Skills for Care’ common induction standards. This training allows staff to build up their competencies over a number of weeks so that they can care for residents Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 25 safely and appropriately. Staff spoken to confirmed they had completed induction training. In regards to statutory training, it was evident that ongoing training is provided by the home but this was demonstrated on individual files as opposed to an ‘at a glance’ training schedule. This made it difficult to be sure that all staff had completed this training as required. The manager advised that most staff had completed moving and handling training and food hygiene and all had completed fire training. She advised that all had done some training on infection control and dementia. Twelve staff had achieved the Dementia Care Course for Managers, which is good practice, as this will help staff to more effectively care for residents with this condition. Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 26 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): Standards 31,33,35 and 38 were assessed. Quality in this outcome area is generally good. Residents live in a home which is managed by a person of good character and which is run in the best interests of the residents. Some attention to health and safety checks is required to ensure the home is fully safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home is both qualified and experienced to manage the home. She has attained the National Vocational Qualification IV in Care as well as the Registered Managers Award and has worked in the home for approximately 9 years. She became the manager of the home in 2002. Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 27 The manager regularly attends training to update her knowledge to ensure the home can continue to be effectively managed. Since the last inspection she has completed statutory training including fire marshall training, health and safety and dementia care. Staff spoken to said that they felt well supported by the manager. Resident satisfaction surveys are carried out to incorporate one relative and three residents each month. Some of the resident surveys were being completed with staff support, which impacts on their independent viewpoint. It was also evident that some people were not completing them, which could be due to the frequency they are being asked to complete them. The completion of surveys in small numbers can also prevent people from retaining their anonymity, which in some cases can help to increasing response rates. In March ten were sent out to friends/relatives and three were returned. Responses were very positive with two stating the standards of care were “very good” and one stating they “cannot fault the care”. Two felt that the management of the home was “excellent” and one felt the management was “very helpful” and “very good”. The manager had completed some audits in relation to infection control; catering and medication to ensure these were being managed effectively. It is not clear that the residents are receiving a consistent laundry and domestic service. Of the three satisfaction survey responses received by the home two felt the laundry service was good but one felt that clothes were not being washed according to washing instructions. The manager said that they had one relative meeting in November 2007 but there was a low number of people who attended. She said that she sees relatives when they visit the home on a regular basis and is able to update them on anything in relation to the home. Staff meetings are held regularly and notes are kept of these showing what was discussed and any action points. A review of some resident personal allowances was undertaken. Records in place and money checked were found to be accurate. Receipts had been obtained for any transactions carried on behalf of the resident such as hairdressing and chiropody. A review of health and safety checks was undertaken for the home, some were up-to-date and some were not. Hot water temperatures had been tested on 5.8.08 and all were within or below the recommended temperatures of 43°C to prevent any scald risks to residents. Some when tested were on the cool side, the manager will need to ensure this is monitored to make sure the water is always hot enough for residents to wash in. The last water check for legionella was undertaken in 2006 and the gas check May 2007, both checks were out of Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 28 date. The manager said these would be done for the whole home when the extension works were complete in a few weeks time. The fire safety and electrical safety check had been completed for the home as appropriate and the hoists had recently been checked to ensure they were safe for residents to use. Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 29 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 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 30 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 12 Requirement Evaluations of care need to clearly show any changes in the residents needs so that it is clear where staff support is required. This applies to both psychological needs as well as any challenging behaviour. A full assessment of medication management must be undertaken to ensure that the ordering, storage, recording, administration and disposal of medication is in line with regulation and is carried out as prescribed by the GP. This will ensure the safety of residents. 3. OP38 13 Action must be taken to ensure all health and safety checks in the home are up-to-date to ensure the safety of the residents. This includes the legionella water check and gas. 30/09/08 Timescale for action 30/09/08 2. OP9 13 30/09/08 Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 31 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 Care records need to demonstrate that the care needs of residents are being met consistently. This includes indicating the staff support stated is being provided as well as showing any changes in the resident’s health. It is recommended that the home develop a menu that indicates all choices of food, drink and snacks provided on a daily basis. This is so that residents in the home know what meals they will be having and what options in regard to snacks and drinks are available to them throughout the day. There needs to be clear records kept of any complaints received, investigated and resolved. Records should show the timescales, investigation process and outcomes to demonstrate these have been managed effectively. The procedures for managing any allegation of abuse need to clearly state the reporting process and how these are to be managed in addition to reporting any incidents to the provider. This is so that staff are fully aware of what happens when an allegation of abuse is reported and are clear on their responsibilities in protecting the resident. The ongoing refurbishment plan for home should include replacement of the two damaged chairs identified in the dining room and any worn or marked carpets in bedrooms around the home as appropriate. This is to ensure residents continue to live in a pleasant, homely environment. Action needs to be taken to ensure the unpleasant odour in the toilet next to the new lounge is removed as soon as possible. The manager should work in a supernumerary capacity within the home to ensure she is available to deal with management issues and any emergencies that could arise in the home. DS0000004415.V369449.R01.S.doc Version 5.2 Page 32 2. OP15 3. OP16 4. OP18 5. OP19 6. OP26 7. OP27 Willow Tree Nursing Home 8. OP27 Duty rotas need to be consistent in showing who is covering ancillary duties such as laundry and cleaning each day to demonstrate this is sufficient to service the needs of the home. It is recommended that an ‘at a glance’ training schedule is devised so that it is clear all staff have completed the required training. 9. OP30 Willow Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Tree Nursing Home DS0000004415.V369449.R01.S.doc Version 5.2 Page 34 - 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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