Inspection on 12/09/07 for Willow Tree Nursing Home

This inspection was carried out on 12th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Willow Tree Nursing Home 11/08/09

Willow Tree Nursing Home 11/08/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Willow Tree Nursing Home 12 School Street Hillmorton Rugby Warwickshire CV21 4BW Lead Inspector Sandra Wade Key Unannounced Inspection 12th September 2007 08:45 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.V347325.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.V347325.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 carolmatron@yahoo.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.V347325.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th October 2006 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. 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 extension works which has impacted on the garden and parking facilities but these will be addressed as part of the new extension works to the home which should result in more spacious and improved accommodation for the residents. There are currently 26 single bedrooms with either washbasins or full en suite facilities which include a washbasin, toilet, bath or shower. There are two lounges and two dining rooms in the home. The communal areas are situated at each end with bedroom accommodation integrated between them. The home is staffed by a complement of qualified nursing staff and care assistants. Willow Tree is close to local shops and a bus route. At the time of this inspection the fees for this home were from £456 to £640. Extra charges are made for hairdressing (£5.50- £25), Newspapers, Chiropody, some activities (entrance fees etc). Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 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 homes 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 from 8.40am to 6.50pm. Before the inspection the manager of the home was asked to complete an Annual Quality Assurance Assessment (AQAA) detailing information about the services, care and management of the home. Upon the receipt of this a number of questionnaires were sent out to service users and their families to ask their views about the home. Two service user questionnaires were returned and five relative comment cards. Information contained within these plus the AQAA are detailed within this report where appropriate. Three people who were staying at the home were ‘case tracked’. This 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, the Service User Guide, staff duty rotas, social activity records, kitchen records, accident records, financial records, health and safety records and medication records. A tour of the home was undertaken and the inspector spent time speaking with residents, visitors and staff within the home. What the service does well: All residents receive detailed assessments before their admission and the health care being provided is of a good standard. A GP who had completed a survey sent out by the home had written in response to the question “Are you happy with the care provided to your patients in the home”? “Very much so still the best in Rugby”. Staff have a good understanding of the needs of the residents and ensure specialist advice is followed up where required to ensure the health care needs of residents are met. Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 6 Comment cards from relatives were positive in their responses with two out of five stating that the overall care is good and one stating this is “excellent”. During the inspection residents were positive in their comments regarding the care they receive. One resident said “staff are very very good” another stated that staff were “all very good”. It was evident throughout the inspection that staff were caring and supportive towards residents. The full time Activity Organiser particularly has a good rapport with service users and it was clear they enjoy her company and the social care support she provides. Service users have a choice of meals and those residents who are less able are supported to eat their meals in a sensitive manner and are not rushed. It was observed that the manager has a good relationship with visitors to the home and it was evident from comment cards that relatives know who to speak to in regards to any concerns they may have. The home have 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. What has improved since the last inspection? The Service User Guide for the home has been updated and reviewed and now includes the Terms and Conditions for the home as well as the summary inspection report so that prospective residents have sufficient information to make an informed choice to stay at the home. Service users have been consulted on social activities and there is now a full time Activities Co-ordinator who provides social activities five days per week to help maintain the social wellbeing of the residents. The Activity Co-ordinator includes one-to-one social interaction for those residents who are unable to participate in physical activities in the home. Action has been taken to ensure carers in the home have attended training on the prevention of abuse to help ensure residents are safeguarded from this. Records and receipts are now in place for service users financial transactions so that there is a clear audit trail. The gas safety check has been completed and arrangements are in place to allow for the monitoring of water temperatures and the regular testing of electrical portable appliances to ensure the safety or service users in the home. There are now good systems in place for monitoring the quality of care and services provided through consultation with service users, visiting professionals Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 7 and relatives to ensure the home is being run in the best interests of the service users. 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 Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 8 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.V347325.R01.S.doc Version 5.2 Page 9 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.V347325.R01.S.doc Version 5.2 Page 10 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: Since the last inspection actions have been taken to review the Service User Guide and this was viewed. This now contains the summary inspection report and Terms and Conditions for the home to allow a prospective service user to access this information to make an informed decision on whether to stay at the home. Pre- assessments of all service users are carried out prior to their admission to the home to assess their needs so that the home knows these needs can be met. Copies of assessments carried out by the manager and Social Workers are kept on residents files. Assessments viewed were fully detailed and gave a good insight into the persons needs. Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 11 The manager says she writes letters to all service users following their admission to confirm their place in the home but copies of letters were not available on file to evidence this. Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 12 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 social care needs are not always set out in individual plans of care although health care needs are being met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents are happy with the care and are well cared for but the rating is adequate as some of the systems in place such as care planning and medication do not ensure that safe practices are maintained. All residents spoken to said they felt well cared for by staff. One resident said “staff are very very good”. Of the two comment cards returned to us from residents one said that they “always” receive the care and support they need and the other stated they “usually” did. A GP who had completed a survey sent out by the home had written in response to the question “Are you happy with the care provided to your patients in the home”? “Very much so still the best in Rugby”. Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 13 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. There is also on the same care plan a preprinted 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. This format can present the risk that specific care needed is not documented. The care plans for three residents were reviewed. The assessment documentation and other records relating to specialist appointments such as opticians are kept in a separate file. Both files were viewed for each resident. One care plan viewed contained clear information in regard to the moving and handling of the resident. This resident had a history of falls and a Handling Assessment and Plan had been developed which showed they were independent in transferring and mobile for short distances. This indicated the person needed the assistance of one member of staff and a wheelchair for transferring. It was clear that staff were evaluating this persons mobility on a monthly basis. This same person had a oral health care plan but it was not fully completed to show if they had their own teeth or dentures or what care intervention was required to meet their oral healthcare needs. The assessment records for this person indicated that they were diabetic and that their blood sugars were low in the morning. A diabetic care plan was in place which indicated the acceptable range of blood sugar readings and actions were indicated if readings should be too high or too low which is good practice. The care plan did not indicate that this persons blood sugar levels were low in the morning as stated in the assessment and it was also not clear how often the blood sugar levels should be taken. This information is important to ensure the care interventions required are carried out effectively. The care plan for eating and drinking gave no specific instructions on any particular dietary requirements to ensure the blood sugar levels for this person were kept stable records just stated that the resident was diabetic. Records of blood sugar monitoring in place showed that the residents blood sugar levels were being controlled within the range indicated suggesting that although records were insufficient, staff were managing this persons condition to ensure their diabetes remained stable. A care plan for a stoma indicated that the resident could suffer with redness and soreness. There were no actions in the care plan to address this. There Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 14 were also no clear guidelines within the care plan documentation on how the stoma should be managed. Staff had taken actions to fit bedrails to the bed of a person who was identified to be at risk from falling out of bed. It was not evident that a full risk assessment around the use of these had been completed to ensure the safety of the resident could be maintained. Records indicated that this resident “crawls to the bottom of the bed and “tries to walk unaided” but no actions had been indicated on how to manage this. The record on file to confirm consent to the use of the bedrails had not been signed by the residents family or representative. The manager agreed to address this matter. 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. Daily records for one resident indicated they had two sacral skin breaks. It was not evident a care plan had been devised to show actions to address these. Several residents in the home have been diagnosed with dementia and although records indicated some actions to help manage this such as encouraging input from families in regard to photos, memory books etc it was not evident that the care plans for dementia are person centred to ensure this aspect of their care is managed effectively. The manager confirmed that staff are in the process of completing dementia care training which should help to improve this area of care. A care plan for a person with depression indicated that resident was on medication but there was no indication within the daily records that the depression was being monitored and suitably addressed by staff. The evaluation of care suggested that the resident was still “depressed at times”. Another residents care plan identified that they were abusive occasionally and aggressive unpredictably. It was also found that this person suffered with depression. Staff actions identified were not to retaliate, use a calm manner and explain that abuse is undesirable. There were no actions detailed on how to calm or settle the resident or to monitor this aggression to identify any particular triggers specific to this resident. The staff actions to address the depression did not fully address the psychological care needs of the resident to help them through this. The care plan stated that staff should “encourage free expression of thoughts” and to establish a routine. This person was noted to openly talk to staff during the inspection and looked well cared for. Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 15 Specialist appointments such as dentist, opticians and chiropody were documented in service user files to show residents have access to these services when required. All appointments with GPs were also documented with details of the reason for the call out. It was noted during the inspection that staff have a good rapport with the residents and are caring and friendly in their approach. Residents reacted well to staff interventions and it was clear they felt at ease to make any requests in regards to their care. One resident was found to be reluctant to take some of their medication, staff confirmed that this was due to swallowing difficulties. It was evident staff had taken actions to obtain this medication in liquid form to allow the resident to take this medication. A review of medications in the home showed improvements following the last inspection. Inappropriate items had been removed from the medications cabinet and the maximum and minimum temperatures of the medication fridge were being recorded to show this was operating within safe guidelines. All medications had prescribing labels and sufficient records were available in the home for a resident who was on Warfarin so that it was clear this was being given as required. It was found that in some cases medications prescribed were in a blister pack as well as in a box which could cause confusion to staff when administering them. The Medication Administration Record had not been completed to say how much medication was available so it was not possible to easily audit these. A member of staff said that the medications in the boxes were due to be returned. Medications received are not routinely recorded on the MAR, the MAR only states the date when the medication was last received. This makes it difficult to audit medications each month without looking back at previous records. The MAR should confirm that medications available at the beginning of each prescribing period so that staff can effectively and easily audit medications to check the amount received, given and remaining are correct. Controlled drugs in use within the home were being stored and managed appropriately. It was noted during the tour of the home that during the morning the locked medication trolley had been left unattended with a box of eye drops and ear drops left on the top of the trolley. All medications should be kept secure at all times to ensure these are managed safely. Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 16 Several residents in the home had been prescribed Lactulose. It was found that staff were using one bottle for everybody as opposed to using the individually prescribed bottles. This is not an acceptable practice. Residents must only be given the Lactulose prescribed for them. One MAR chart only contained ticks in the boxes to confirm Aqueous cream had been used. A nurse said that this was because the carer had applied it and they had not observed this. The MAR chart must always be signed by the person who has administered the medication to ensure there is an audit trail. The privacy and dignity of the residents was maintained during the inspection with the exception that many of the doors were held wide open when some residents were in bed asleep or in night clothes awaiting staff assistance. Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 17 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. Service users find the lifestyle in the home matches their expectations and they are able to exercise some choices over their lives to maintain a level of independence in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection social care plans have been developed. These indicate the interests of the resident in the form of ticks against pre-printed boxes. One care plan viewed showed that the resident enjoyed TV, games/puzzles, worship and reading books. The care plan indicated that the family of the resident was supported them in regard to their religious needs. The home have also employed a full time Activity Organiser who plans activities on a weekly basis and advertises these on notices within the home. She works five days per week and consults with the residents in regards to what they would like to do. Activities that were taking place in the home included board games, skittles, shopping, group discussions, pamper sessions, sing-a-longs, trip to the pub, cake decorating and one to one discussions. Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 18 On the day of inspection the Activity Organiser agreed to go to the local shops to collect items that residents had requested. A large floor game of snakes and ladders was played in one of the lounges. She spent time talking to residents around the home which they clearly enjoyed and it was clear she had a good knowledge of the residents and their social care needs. A record of activities undertaken is kept and details of social activities each resident has participated in are also kept so that it is clear all residents are being given the opportunity to participate. The manager advised that they do have service users in the home from different cultural backgrounds and that music these residents particularly liked was regularly played in the lounge. This was evidenced during the inspection and all residents appeared to enjoy the music. The manager also reported that service users with specific religious needs, including those with different cultural backgrounds, are supported by families but also have access to regular religious services within the home. Residents personal choices in regard to activities of daily living are detailed within their care plans so that staff know when delivering care what their preferences are. This includes their preferences for male/female carer support and times they prefer to get up and go to bed. On the day of inspection staff were observed to respect the wishes of those residents who wished to remain in bed till late morning. Residents spoken to all said that they enjoyed the food, one person said the “food was very nice tonight, they give you plenty”. The main meal on the day of inspection was lamb hotpot or lasagne with cabbage, carrots and potatoes. The cook had prepared a desert of cheesecake and gateaux. Meals looked appetising and residents seemed to enjoy their meals. There were no menus available to residents in the home so that they know what meals they will be having. Staff serving the meals in one lounge were observed to give residents a choice but referred to the lamb hotpot as ‘steak’ illustrating that staff are not always clear on the meals being provided. It is evident that a choice of drinks are available and snacks can be provided but as there are no menus residents would not necessarily know of the full choices available and have to rely on staff to tell them. A comment card received from a relative stated in response to the question “How do you think the home can improve”? “each resident should be asked if they would like tea or coffee to drink instead of just giving them tea”. Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 19 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 good. Systems are in place to manage complaints and to ensure the protection of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been one complaint received by us which was forwarded to the home for a full investigation. This included allegations of poor management of diabetes and personal care. The home had investigated these issues and had responded to the complainant within an acceptable timescale. A record of this complaint had not been recorded in a complaints register although paperwork was available in the home in relation to this. A register of all concerns, complaints and allegations of abuse should be kept so that it is clear these are being taken seriously, monitored and responded to effectively. Comment cards from relatives showed that they knew how to make a complaint and information on complaints is detailed in the Service user Guide as well as on a notice board in the home. It was noted that the complaints procedure in the home did not contain our current address and telephone number details. Some staff in the home have undertaken specific training on abuse and the manager said that most staff will have covered this training in their National Vocational Qualification training. Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 20 Staff spoken to were clear on their responsibilities in regard to reporting abuse and actions they should take to safeguard residents. Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 21 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, 25 and 26 were assessed. Quality in this outcome area is adequate. Service users live in a comfortable environment which is subject to refurbishment to improve the facilities. Some actions are required to ensure the home is kept in a clean condition so that good infection control practices can be maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection works had commenced to start the extension to the home which will include new communal lounge facilities for residents as well as additional bedrooms for the home. It was advised that these works are expected to take around 6 months but this is highly dependent on the schedule of works being completed on time. The home had taken steps to try and minimise disruption to the residents including moving some residents to alternative rooms and making arrangements to take residents out of the home on social trips. Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 22 The home is situated in large grounds with some parking areas available, these have become restricting due to the works being undertaken to the home. The grounds to the front of the home consist of large stones so there could be some difficultly for wheelchair users to access the main doors of the building without assistance. A service user with a disabled scooter was able to leave and enter the home easily. A tour of the building was undertaken, rooms had been made to look homely with residents personal possessions including items of furniture. Rooms were decorated to a good standard but the carpets in some areas of the home looked worn and corridor carpets looked dirty. In one room there were cobwebs at the window, the manager said that the person in this room was reluctant to let staff clean it. Equipment checked including wheelchairs were found to be in a clean condition. The lounge areas were bright and airy and had various different types of seats for the comfort of residents. There are proposals for the lounge areas to change and the manager advised that large screen televisions will then be made available. Residents in the large lounge by the kitchen had blankets on their knees and said that it was not warm enough. Staff said that the doors had been open during the morning and that this had affected the temperature of the room. The lounge was viewed later in the day and still did not feel comfortably warm. This will need to be addressed. Radiators within the home have covers on them to protect residents from burn risks and hot water temperatures are controlled by thermostatic mixing valves to prevent scald risks to the residents. Hot water checked on the day of inspection was at a comfortable hand temperature and records in place confirmed that most water outlets had been checked in September and these were operating within safe guidelines. The manager explained that those water outlets in resident areas that had not been checked would be checked before the end of the month. There is a small dining area in one area of the home which is linked to the main kitchen. The manager said that it is planned for the kitchen to be made larger and for the current dining area to be within the new lounge. The kitchenette close to the one of the lounges was noted to have silver tape around the floor areas. The manager said that this area was due to be changed as part of the refurbishment plan. The main kitchen was viewed, some areas were in need of cleaning. This included the microwave and lower cupboards. The manager acknowledges that the paintwork is in need of attention but this has not received priority due to the planned changes to the home. Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 23 It was observed that the hairdresser continues to use one of the residents bedrooms in the home due to lack of space and areas for her to use. This matter will need to be addressed when changes to the home are made. There is limited signage around the home so that residents can easily locate their rooms, bathrooms and toilets. During the inspection at least two residents had to ask staff to remind them where the communal toilet was located. The laundry is small for the volume of laundry that needs to be done but there is one door to enter for the “clean” area of the laundry and one door to enter for “dirty” area. Two washing machines and two driers were available to cater for all laundry in the home. There is no dedicated hand wash sink in the laundry and a member of staff confirmed they washed their hands in the staff room. There should be a dedicated handwash sink within the laundry to ensure staff can maintain good hygiene practices. It was observed that there was a pile of clean laundry on the floor awaiting folding and putting away despite there being sufficient baskets in the laundry for this to be stored. This is poor infection control practice and it was acknowledged this should not have happened. The manager said that changes to the laundry were planned to allow for extra space and a handwash sink. Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 24 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 adequate. Service user needs are generally being met by the skill mix and numbers of staff available but recruitment systems are not fully sufficient to support the protection of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager confirmed that the home aim to work with two qualified nurses and 6 carers in the morning, one or two nurses and four carers in the afternoon and one nurse and two carers at night. The manager said that she felt these were sufficient staffing levels for the home. The manager should be supernumerary to these staffing ratios. The duty rota for the home does not clearly demonstrate that these staffing levels are being maintained. On some days one nurse is indicated unless the manager is counted and on some occasions there are five carers on duty during the morning and not six. On some days there are three carers on the late shift as opposed to four. There are dedicated staff to provide a cooking, cleaning and domestic service. The duty rotas show that there is mostly no domestic person to cover cleaning at the home during the weekends and it is not clear who is covering this duty. Duty rotas also do not show who covered laundry duties when the laundress was on holiday. Duty rotas must make this information clear so that the Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 25 home can demonstrate there are sufficient staff to provide care and services to the home consistently. Despite duty rotas being unclear in regard to staffing arrangements, service users were complimentary of the staff and residents looked well cared for. One service user said that the staff were “all very good”, another person said that staff have “treated me marvellously and I cant understand why” this person also said that staff “pop in to see if I am alright”. Comment cards received by us from relatives confirmed that two people out of five felt that staff “always” have the right skills and experience to look after people properly and two people felt they “usually” did. One person felt they could not answer this question but as far as their relative was concerned they felt staff did have the right skills and experience to care for their relative. Three out of five relatives felt that the service “usually” met the different needs of people and one person felt they “always” did. One person did not tick the response box to this question. New staff to the home commence a comprehensive induction training programme which incorporates the “Skills for Care Common Induction Standards”. This training requires staff to complete modules of training over a period of weeks so that they can build up their competencies to care for residents safely. The Annual Quality Assurance Assessment (AQAA) document completed by the home shows that there are 17 care staff employed by the home and 11 of these have completed a National Vocational Qualification (NVQ) II in Care. This exceeds the care standard for 50 of care staff to achieve this and is to be commended. An additional three staff are working towards this qualification and many staff are now working towards achieving their NVQ III. These qualifications help staff to provide more effective care to the residents. In regards to statutory training, the manager did not have a training schedule in place to be able to confirm that all staff in the home have completed all of the necessary training. From those records that were available it was evident most staff had completed moving and handling and fire training. The manager said that all staff had done food hygiene training and certificates were available in the individual staff files. The manager said that she had started to compile an “at a glance” training record so that she could easily identify any training outstanding that needed to be addressed. A review of three staff files was undertaken to confirm recruitment practices carried out are safe and appropriate. It was evident that for two of the staff files viewed, information was not fully up-to-date because these staff had worked at the home before and the home had retained the previous files. Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 26 This applied to providing a full service history on the application form and also the provision of two written references. One person who had recently been employed had one reference as opposed to two as required. Dates of employment for this person were not fully clear so it was clear the home had obtained a Protection of Vulnerable Adults (POVA) check prior to their employment. For one member of staff they had started employment two days before the POVA check had been received Criminal record bureau checks had been completed and appropriate information had been recorded in relation to obtaining these. Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 27 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, 37 and 38 were assessed. Quality in this outcome area is good. The home is run by an experienced, dedicated manager who is able to discharge her duties fully although some attention is required in regard to record keeping to ensure the home can demonstrate actions are being taken to safeguard residents. 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.V347325.R01.S.doc Version 5.2 Page 28 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 training on the Mental Capacity Act, Training the Trainer (this means she can train staff within the home), Palliative Care and other training linked to the nursing care needs of residents in the home. Records were seen to confirm satisfaction surveys are carried out so that service users, relatives and professional visitors to the home can comment on the care and services provided. The home had received numerous thank you cards from relatives one stated “There are never enough words to thank you all for the help, kindness, support, love and tenderness that you gave so willingly to mum”. One relative comment card received by us stated in response to the question “What do you feel the care home does well”? “It takes very good care of my wife”. Another two relatives stated “their overall care is good/excellent” and one stated “X has been very happy at Willow Tree nursing home”. The manager reported that they did not have resident/relative meetings as they frequently speak to relatives visiting the home and they had not been well attended when arranged. Service users are asked on a three monthly basis to complete a quality questionnaire about their care so that any concerns can be identified and addressed. The home also have a Quality Manager who visits the home regularly and speaks with residents and staff and who also sends out quality satisfaction surveys on a six monthly basis. Responses seen to questionnaires were positive in the majority of cases. It was not clear that the results of surveys are made clear in a report and that these are available to service users and other interested parties with any proposed actions where applicable. It was observed during the inspection that staff have a good relationship with relatives and visitors to the home and feel at ease to discuss any matters they are concerned about with the manager. One visitor to the home invited the inspector to read a letter they had written praising the care and services provided to a service user. This stated that the service user had “improved out of all recognition” and this was “a tribute to the nursing skill and care X has received”. A review of service user personal allowances was undertaken. Records in place and money checked were found to be accurate for all residents checked. It was established during the inspection that not all accidents and incidents are being notified to us as is required by the Care Home Regulations. This matter was raised during the last inspection and remains outstanding. The manager agreed to review this. Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 29 Health and Safety checks are being carried out and records confirmed the following:Gas was checked in May 2007 Electrical Portable Appliance testing was done in January 2007 Hoists – 1.6.07 5 Year Electrical Testing 31.5.07 The Annual Quality Assurance Assessment completed by the home confirms that fire equipment and call bells were checked in July 2007. The home have a ‘handyman’ who checks all of the wheelchairs in the home regularly to ensure they are safe to use and records are kept of these checks which is good practice. Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 30 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 2 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 3 17 X 18 3 2 X X X X X 2 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes 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 15 Requirement Care plans must be developed for each identified need in terms of health and personal care needs. This is to ensure there is no oversight in care for the resident and care needs are met consistently. (part met from 2005 inspections) 2. OP7 13 Risk assessments must be developed where a risk to health is recognised. (part met from October 2005 inspection) 3. OP9 13 Medication management is to be reviewed to ensure this is managed safely consistently. This includes :Only using medicines prescribed for the person they have been prescribed for. Ensuring medications are kept secure at all times and not left Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 32 Timescale for action 30/11/07 31/10/07 31/10/07 unattended. Ensuring all medications available at the beginning of the prescribing period are indicated on the Medication Administration Record (MAR). Ensuring the MAR is signed consistently to confirm creams have been administered as prescribed. 4. OP26 16 All areas of the home must be maintained in a clean condition to ensure effective infection control practices can be maintained to protect residents. A further review of staffing is to be undertaken to ensure there are sufficient ancillary staff available to support the needs of the home. This in particular applies to domestic and laundry staff. Timescale of 31/12/06 not fully met. Duty rotas for the home must be clear in demonstrating any staff undertaking ancillary duties when ancillary staff are not available so that it is clear there are sufficient services being provided by home consistently. 6. OP29 19 All of the required recruitment information must be obtained prior to staff commencing employment at the home. available. This in particular relates to POVA checks, dates of commencement and references. Timescale of 31/12/06 not fully met. 30/11/07 31/10/07 5. OP27 18 30/11/07 Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 33 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 OP4 Good Practice Recommendations Records need to demonstrate that following the assessment of a resident, they receive a letter confirming the home can meet their needs. It is advised that the practice of leaving all service user doors wide open when they are in bed or in underclothes is reviewed to ensure the privacy and dignity of residents is not compromised whilst also ensuring that the residents wishes are considered and demonstrated. 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. It is recommended that the manager records concerns voiced by staff, residents and their relatives with actions taken as part of the complaints process. The registered person should identify adequate communal space for recreational purposes such as hairdressing to prevent a service users bedroom being used for all residents. 5. OP19 Consideration should be given to improving storage facilities for toiletries in some of the resident bathrooms. Consideration should also be given to signage around the home to assist residents in locating their rooms, bathrooms and toilets. 6. OP19 It is advised that a refurbishment plan is devised stating works to be carried out to the home and detailing how this is to be carried out with minimal disruption to residents. DS0000004415.V347325.R01.S.doc Version 5.2 Page 34 2. OP10 3. OP15 4. OP16 Willow Tree Nursing Home All environmental issues as detailed within this report should be considered when devising this plan. 7. OP25 It is advised that the temperature of the lounge by the kitchen it monitored to ensure this remains sufficiently warm for the residents. It is also advised that actions are taken to test those hot water outlets in residents rooms which have not been checked to ensure these are operating within safe levels to prevent burn risks to residents. 8. OP37 Arrangements need to be made to ensure all Regulation 37 notices relating to all accidents and incidents in the home are forwarded to us. This is to demonstrate the home are taking appropriate actions to address these to safeguard service users. Timescale of 30/11/06 not met. Willow Tree Nursing Home DS0000004415.V347325.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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. 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