Inspection on 14/09/09 for Willowbank Nursing Home

This inspection was carried out on 14th September 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Willowbank Nursing Home 21/08/07

Willowbank Nursing Home 19/06/06

Willowbank Nursing Home 01/11/05

Willowbank Nursing Home 19/04/05

Willowbank Nursing Home 07/02/05

Willowbank Nursing Home 10/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Willowbank Nursing Home Willowbank Nursing Home Pasturegate Burnley Lancashire BB11 4DE     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marie Matthews     Date: 1 4 0 9 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Willowbank Nursing Home Willowbank Nursing Home Pasturegate Burnley Lancashire BB11 4DE 01282455426 01282455345 willowbanknh@gmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sage Care Homes (Willowbank) Limited care home 53 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following categories of service only. Care home with Nursing - code N, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: - Dementia - Code DE Mental disorder, excluding learning disability or dementia - Code MD The maximum number of people who can be accommodated is: 53 Date of last inspection Brief description of the care home Willowbank is registered to provide both nursing and personal care for fifty-three residents with either a dementia or mental health problem. The home is set in a quiet, pleasant residential area approximately a mile from Burnley Care Homes for Older People Page 4 of 33 Over 65 0 0 53 53 Brief description of the care home town centre with shops, a post office, public houses and a convenient bus route nearby. The home is a detached two storey building with a purpose built extension set in 1.5 acres of garden, with attractive lawns, flower beds and patio areas. Work to improve all areas of the home, both inside and outside, was currently ongoing with minimal disruption to residents and their visitors. The majority of bedrooms are single and some have en suite facilities; others are located near to toilet facilities. There are a number of pleasant, comfortable lounge and dining rooms. Information about the services that the home offers is provided in the form of a service user guide and is available to existing and prospective residents and their relatives. A summary of the most recent inspection report is available within the service user guide. On the day of the key inspection the weekly fees ranged from £435.00 to £588.50. Items not included in the fee include newspapers, hairdressing and personal toiletries. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The key unannounced inspection, including a visit to the home, took place on 14th September 2009. The last inspection on this service was completed on 21st August 2007 with an annual service review taking place on 21st July 2008. The inspection process included looking at records, a tour of the home, discussions with the manager and regional manager, five visitors and four residents. The home sent us their annual quality assurance assessment (AQAA) before the inspection visit; this gave us a reasonable picture of what had improved over the last twelve months and where further improvements were needed. Information was also included from anonymous surveys completed by two residents and four staff. There were thirty-seven residents living at the home on the day of the inspection visit. Care Homes for Older People Page 6 of 33 What the care home does well: What has improved since the last inspection? During a tour of the home and the grounds it was clear that much work had been done to improve all areas; this provided residents with a safe, pleasant and well maintained place to live. Work was still ongoing but there was a plan to support this and to minimise any disruption to residents, visitors and staff. Care Homes for Older People Page 7 of 33 Management had considered good practice guidance from the dementia and Alzheimers societies to ensure the improvements were appropriate to meet the needs of the current residents. One visitor said they have done well with all the changes. Residents bedrooms were bright and comfortable; some residents had brought in personal items to enhance the homely feel. One resident said my room is very nice, it has been decorated. A relative said I am very pleased with the facilities. A new manager had been in post since January 2009; she had the skills and experience to manage the home but was not yet registered with the Care Quality Commission. Policies and procedures were being reviewed and updated to provide staff with safe guidance. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were given sufficient information about the service to help determine whether their needs would be met. Evidence: The information about Willowbank was clear and detailed and made available to new and existing residents and their relatives; this would help them to decide whether the home was the right place for them to stay. The information was not yet available in any other format but residents said they were given enough information about the home. The service user guide needed to include residents views about the service; this would help people get a wider view of the service. Three residents files were looked at in detail. Each resident had been given a copy of a contract or statement of terms and conditions with the home; this ensured they were aware of their rights and responsibilities whilst living at Willowbank. Care Homes for Older People Page 10 of 33 Evidence: New residents were only admitted to the home following a detailed assessment of their needs; this would help to determine whether they could be looked after properly at Willowbank. The assessments were completed by an experienced member of staff and information was gathered from a range of sources including the resident and their relatives; this would ensure all aspects of their needs were considered. People were sent written reassurance that their needs could be met. The training matrix did not show the current skills and competencies of staff (see also standard 30 and 38). However other records and staff survey showed that staff were generally provided with the additional training they needed. One new staff had not received an introduction (induction) to the home; this was needed to make sure they were aware of their responsibilities and were safe to practice. (see also standard 30). Prospective residents and their families would be invited to visit the home to view the facilities and to meet residents and staff before deciding to live there. Care Homes for Older People Page 11 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The detail in the care plans did not always reflect the care that was being given or clearly record how residents needs would be met. Medicines were generally managed safely and peoples privacy and dignity were respected. Evidence: Three care plans were looked at in detail. The plans were organised although did not always clearly identify the action to be taken by staff to ensure residents needs would be met. There was evidence that the plans had been updated to reflect current needs although this and the review of the care plans was inconsistent. Only one of the two care plans recorded involvement of residents or their relatives in the development and ongoing review of care; residents and their relatives should be involved in decisions about care to ensure they received the care they needed and wanted. Residents said they received the care and support they needed; one visitor said the care was very good and three visitors said they were kept up to date with any changes in their relatives health and well-being. Care Homes for Older People Page 12 of 33 Evidence: There was not enough information about residents personal likes, dislikes and preferences which made it difficult to determine how staff would meet their needs. Residents said they were looked after properly and it was clear from observation and discussion with residents that staff were aware of their needs although this was not supported by the records. There was evidence that residents health needs were monitored and appropriate advice sought if there were any concerns. Staff had received training in health care matters; this would help them to recognise any changes to health and to respond appropriately. Assessments to determine whether residents were at risk of falling were in place but a record of action to be taken to reduce the risk to residents were seen for only two of the three plans. There were assessments in place to determine whether residents were at risk of developing pressure sores and appropriate care and equipment had been provided to help reduce the risks; however the plan did not clearly record the action that staff would need to take to reduce the risk. One residents wound care treatment had changed although it was unclear who had made this decision or the reasons why. Nutritional assessments were still not in place despite a number of residents who could be at risk. One resident had a poor appetite but there was no evidence that this was being monitored and this could place him at risk. One plan referred to a poor dietary intake and stated ensure the kitchen knows about her likes and dislikes but there was no information recorded in the plan to guide staff as to what the residents food preferences were. Weights were monitored each month although it was unclear whether action had been taken to respond to any fluctuations in weight. The care plans included some useful information to help staff to communicate with residents and to respond to any difficult behaviours; this would help to keep staff and residents safe. Decisions regarding any limitations to choice were clearly recorded, agreed and discussed with the resident or their relative. Records showed that professional advice had been sought regarding the promotion of continence and necessary aids were provided. There were no systems in place to monitor whether staff were following procedures relating to record keeping or whether the individual care plans were up to date. Monitoring systems would help to identify whether residents needs were being met Care Homes for Older People Page 13 of 33 Evidence: and any gaps in the record keeping (see standard 33). The medication policies and procedures had been reviewed since the last key inspection and provided staff with safe guidance. The disposal of medicines procedure needed minor changes to reflect current practice in the home and to reflect that two signatures were needed on the disposal records; this would ensure there was no mishandling. Staff still needed a procedure to support them with handwritten entries or transcribing as it was noted that these had not always been witnessed and could result in errors being made. Medicines were stored safely and appropriately and records showed that medicines had generally been managed safely. Staff needed protocols or clear directions to support them with their decisions to administer PRN or as needed medicines; this had been recommended at the last key inspection. The application of prescribed creams had not always been recorded on the medication record and advice was given to the registered nurse and manager regarding how this could be managed; this would ensure residents received the treatment they had been prescribed. The community pharmacist visited the home at regular intervals to monitor whether medicines were being managed safely although the home should consider developing their own systems to monitor and improve practice. Residents said they were treated well; one said Im looked after here. Staff were observed responding to residents and visitors in a friendly and respectful manner. It was clear from observation that staff had developed good relationships with residents and their relatives. One resident said she had been able to talk to her relative on the home telephone; another had been visited by her GP in the privacy of her room. Residents were dressed appropriately and able to choose their own clothing or clothing was chosen by staff with their dignity and best interests in mind. A concern had been raised that clothing had gone missing from a residents room; the manager was looking into this. Personal mail was delivered to the main office and then either given to the resident or their relative. Staff were provided with training to help them to understand the importance of maintaining residents privacy and dignity. Care Homes for Older People Page 14 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents diverse social needs and expectations were met and they were able to make choices and decisions regarding their daily lives. Residents were provided with a healthy, varied and nutritious diet that met their dietary needs and expectations. Evidence: An activity coordinator was employed to arrange activities, excursions and entertainments for the residents. Records showed that a range of daily activities were taking place and that they were tailored to meet individual and diverse needs. The care plans did not include much information to indicate residents likes, dislikes or routines although staff were introducing a personal history file for each person; this information would help staff to provide suitable activities for each resident. Records, discussion with residents and staff and observation showed that residents were involved in a range of suitable activities such as massage, crafts, games, exercises, knitting and jigsaws. Residents were also involved in everyday activities such as helping staff to tidy craft and games cupboards, having a coffee and a chat, shopping trips to the local town centre, walks in the gardens, polishing shoes and hanging the washing out. A few residents had helped in the garden creating rockeries and planting shrubs, flowers and trees. One visitor commented that the provision of suitable activities had improved. Care Homes for Older People Page 15 of 33 Evidence: The lounges were themed and residents could enjoy watching television, music or peace and quiet. Some residents were enjoying the view of the grounds from the quiet lounge and others were enjoying the musical entertainment in another lounge. Staff said the home offers a good range of daily activities including trips out; residents said the activities are good and we get up to all sorts, Ive never laughed so much. Residents were consulted about how the home was run and were able to make suggestions about the provision of activities and the menus. It was clear from records, observation and discussion with residents that people were able to make choices and decisions about their lives; a member of staff said we are able to respect peoples individual needs and choices and a resident said I can make my own decisions and do what I want. Residents were able to access any area of the home although some areas were still key coded for safety reasons. Visitors said they were always made to feel welcome and had been offered a drink. Residents said they could see their visitors in any area of the home; various comfortable communal or quiet areas were provided. The menu offered a choice of healthy and nutritious meals with alternatives provided. There were some gaps in the records of meals served; records were needed to support that all residents were offered a healthy and nutritious diet. Staff were aware of residents dietary preferences although this was not always recorded; one resident said they make me a curry now and then, they know I like it. Meals were discussed with residents at regular meetings and they were able to make suggestions for any changes to the menu. Residents said the food is excellent, the food is good and I enjoy the food Ive put on loads of weight. Residents said they enjoyed the lunchtime meal and staff were observed giving sensitive support and encouragement where needed. The dining areas had been improved since the last inspection visit; residents were able to dine either in their rooms or in a choice of bright and pleasant dining rooms. The kitchen had also been improved and a small kitchenette was available for visitors to make a cup of tea and for more able residents to make snacks and drinks. Care Homes for Older People Page 16 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints record did not always reflect all concerns and complaints that had been raised although the procedures were clear and people knew who to speak to if they were unhappy with the service. The safety and well-being of residents was protected by clear procedures and staff awareness. Evidence: The complaints procedure was clear and easy to understand and made available to residents and their relatives; this would give them the information if they needed to raise any concerns or complaints. Residents said they were aware of how to make a complaint and staff said they knew how to respond to any concerns or complaints; this would ensure peoples concerns would be dealt with properly. One resident said I tell them if its not right and its usually sorted and another resident said I have told them many times but it doesnt make any difference. Residents said the manager visited them to ask if they were happy with the service. Visitors comments included they always get things sorted and I have raised issues in the past and they have always been sorted whilst another said they had raised concerns in the past but that nothing had changed. One staff said we try to help residents to be as happy as they can be. The record of complaints showed one recent complaint that was being investigated; the issues were also looked at during the inspection visit and were included under Care Homes for Older People Page 17 of 33 Evidence: individual sections of the report. It was clear from discussions that people were able to express their views and had raised concerns and complaints if they were unhappy with the service. The manager was advised that all concerns and complaints and any action taken to respond to them should always be recorded; this information could then be used to identify any gaps in the provision of service and to improve the service. Concerns or complaints were monitored each month and the information used to help to improve the service. The safeguarding procedures (formerly adult abuse procedures) were clear and gave safe guidance for staff. It was recommended that the contact information of local agencies who would be involved in any safeguarding incident should be included in the procedure; this would ensure staff had the correct information to refer incidents promptly. It was not clear how many staff had received training that would help them to recognise and respond to any abuse and neglect; records suggested only eight staff had received appropriate training and this could place residents at risk. However since the last key inspection visit there had been a number of safeguarding referrals made to the appropriate agencies; this showed that managers and staff were aware of and had followed safe procedures to keep residents safe. The manager advised that safeguarding training was being planned for all staff. There were procedures to support staff with reporting any poor practice within the home; this would help to identify any abuse or neglect. There were also procedures to support staff with the use of restraint, dealing with residents finances, and responding appropriately to verbal or physical aggression; the procedures would help staff to protect residents best interests and to keep themselves and others safe. Staff needed training to support them with dealing with verbal and physical aggression; this would help them to respond properly and would keep everyone safe from harm. Staff had access to information about the Deprivation of Liberty Safeguards and Mental Capacity Act; this would make staff aware of their responsibilities when supporting residents with their decisions and choices. Care Homes for Older People Page 18 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents lived in a safe, comfortable, clean and well maintained environment. Evidence: During a tour of the home and the grounds it was clear that much work had been done to improve all areas; this provided residents with a safe, pleasant and well maintained place to live. Work was still ongoing but there was a plan to support this and to minimise any disruption to residents, visitors and staff. Improvements had been undertaken with the resident needs in mind and they had been consulted about the changes at regular meetings; this showed they were involved in decisions about the day to day running of the home. Major improvements included an extended and refurbished kitchen, a self contained unit with games room and kitchenette for more able residents, a new dining area, an extension to the side entrance including accessible office areas and development of single bedrooms with en suite facilities. Other improvements included ongoing redecoration and refurbishment of existing facilities with plans to develop these area further, the provision of more en suite rooms and relocation of the passenger lift to the entrance. Management had considered good practice guidance from the dementia and Alzheimers societies to ensure the improvements were appropriate to meet the needs of the current residents. One visitor said they have done well with all the changes. Care Homes for Older People Page 19 of 33 Evidence: The fire safety officer, buildings officer, health and safety officer and environmental health officer had been consulted about the changes; this would ensure the home complied with safety requirements. The extensive grounds were safe, accessible and well maintained. Residents and their visitors were able to walk or sit in the grounds and enjoy the attractive gardens or the local wildlife. There was a seperate secure patio area at the rear of the building; residents had been involved in building rockeries and making planters and it was equipped with a water feature and washing lines where residents could hang their clothes. It was noted that the slope was quite steep and uneven in areas but the manager was aware of this and said it would be addressed. The manager completed a monthly tour of all areas to ensure the home was well maintained and any areas in need of attention were communicated to the handyman. The handymen were responsible for minor repairs and improvements and coordinating some of the more major improvements; records showed that repairs were done promptly and staff confirmed this. There were a small number of areas in need of repair or attention; these were pointed out to the manager during the tour. Communal areas had been been improved and made more accessible to all residents. Residents were now able to choose from various themed lounges including a music room, quiet room and a room with satellite TV; visitors were seen in different areas of the home and a number of quiet seating areas were provided around the home. Toilets and bathrooms were suitably equipped to meet residents needs and located near to communal and bedroom areas; some bedrooms benefited from en suite facilities and there were plans to make en suite rooms available to more residents. One resident said its good to have my own bathroom, its very private. There were aids and adaptations to meet the diverse needs of the residents and residents could access all areas of the home by means of ramps or a passenger lift. Key pads were in place on some doors with residents safety in mind; some residents were aware of the codes allowing them free access. There were designated storage areas for aids and equipment including wheelchairs and all rooms were fitted with an accessible alarm facility to enable residents to call for assistance from staff; non provision of call leads had been risk assessed and recorded in the care plan. Residents bedrooms were bright and comfortable; some residents had brought in personal items to enhance the homely feel. One resident said my room is very nice, it has been decorated. A relative said I am very pleased with the facilities. Residents Care Homes for Older People Page 20 of 33 Evidence: were provided with a lockable storage space to store personal items and bedroom doors were fitted with suitable locks; this would ensure residents rights to privacy. The home was clean and free from offensive odours; residents said the home was fresh and clean. The laundry was situated away from communal and bedroom areas and equipped with the appropriate equipment to ensure residents clothing could be cared for properly. One visitor had raised concerns that clothing had gone missing and other residents were seen wearing them; this was discussed with the manager who was taking action to ensure this did not happen again. One resident said my clothes are looked after, some did go missing but staff have sorted it and another said staff should take more care with hanging clothes in the wardrobe. It was clear that improvements could be made in this area. Care Homes for Older People Page 21 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff were provided in sufficient numbers to meet the needs of the current residents. Failure to follow a safe recruitment procedure could place residents at risk of being cared for by unsuitable people. Evidence: Staff rotas reflected a good skill mix of staff to meet residents needs; any shortfalls had usually been covered by existing staff which would ensure residents were looked after by staff who knew them. Three staff said there were usually enough staff and one said never enough staff. Residents said there were enough staff; one said there are enough staff but they dont always arrive but we still get looked after. Most of the staff had achieved a recognised qualification in care and other staff were working towards one; this would give them the skills and knowledge to meet peoples needs and showed that the organisation were committed to improving the standards of care by provision of training. Three staff employment and training files were looked at in detail. There were concerns that safe recruitment procedures had not been followed and that this could place residents at risk of being cared for by unsuitable people. Examples included one care staff had commenced employment prior to suitable references being obtained and without an up to date criminal records bureau (CRB) check, the second file showed Care Homes for Older People Page 22 of 33 Evidence: some issues following a police check but there were no records to support they had been discussed and the third file showed that a gap in employment had not been explored and the member of staff had been employed prior to a CRB check. It was recommended that all staff files were audited to ensure they included all the required checks. The reference forms needed minor review as they did not clearly indicate the details of the referee in relation to the application form and references should be verified with a telephone call to check the validity of the information. Staff had been given a contract of employment and a job description; these records would make staff aware of their rights and responsibilities whilst employed at Willowbank. Records of the interview were not always maintained; this would help to show that the selection process was fair. Residents should be given the opportunity to be involved in the recruitment and selection process; this would allow them to choose the people who they would like to look after them. One of the new staff had not received an induction or introduction to the routines and practices of the home (see standard 4); new staff need this information to ensure they were aware of their responsibilities and able to keep themselves and others safe. The records did not support that all staff were provided with ongoing training to give them the skills and knowledge to help them to meet residents needs and to keep people safe. Staff said they received the training they needed to meet peoples needs. The manager was aware of the gaps in the provision of training and a training plan was to be developed following further consultation with the training provider. The supervision of staff had improved and ensured staff practice was monitored; this would help to identify any additional training and development needs. Regular staff meetings were held to keep them up to date and to give them the opportunity to be more involved in decisions about improvements and developments. A concern had been raised regarding the lack of communication between staff and how this impacted on residents care; comments from staff also indicated that this was a problem and action was needed to improve this aspect. Staff commented we work as a team to provide the best care for the residents and we are caring to residents and each other. One visitor said staff are fantastic and another said they work hard. Residents said staff are very nice and caring and they are lovely. See standard 4 and standard 37 for any requirements and recommendations made Care Homes for Older People Page 23 of 33 Evidence: under the above staffing outcomes. Care Homes for Older People Page 24 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was safe and peoples views and opinions were used to improve the service. People could be at risk as staff had not been provided with the training that would help to keep themselves and others safe. Evidence: The manager of the home has been in post since January 2009 but was not yet registered with the Care Quality Commission; she is a registered nurse and has experience in the management of care homes. The manager is working towards a recognised qualification in management which will provide her with the skills and knowledge needed in her role. The manager is supported by a senior person within the organisation who is able to monitor her practice at regular intervals; she is able to meet and discuss any issues with other registered managers within the organisation and is kept up to date with changes to legislation and the organisations plans for the future. Care Homes for Older People Page 25 of 33 Evidence: Positive comments were made about the management of the home including the management are really good and approachable and changes are made for the right reasons. Residents and their visitors knew the manager by name which showed she was interested in whether they were happy with the service they received. Regular meetings had been held and it was clear residents had been given the opportunity to raise any concerns and to make any suggestions for improvement; this showed that they were involved in the day to day running of the home. Relatives views had been sought through an annual survey; the results had been made available to people and used to improve the service. A large number of relatives had attended a recent meeting to discuss changes that were being considered and how this would affect them and the residents; this showed that people were consulted and their opinions valued. The manager said open evenings were due to be reintroduced to give visitors the opportunity to meet with staff or the manager. The home sent us their annual quality assurance assessment (AQAA) before the inspection visit; this gave us a reasonable picture of what had improved over the past twelve months and where further improvements were needed. There were some gaps in the information and this was discussed with the manager. The home had taken action to respond to the issues raised at the last key inspection; this showed that they were able to work with us to improve the service. Systems to monitor whether staff were following policies and procedures and whether residents needs were met were to be introduced to help to identify any areas for improvement. The standard of the environment, complaints and management of medicines were monitored and action taken if there were any areas of concern. The home had achieved the Investors In People award; this is an quality assurance award accredited by an outside body and demonstrates a commitment to developing staff and improving the management of the home. Policies and procedures were being reviewed and updated to provide staff with safe guidance. There were records to support regular visits from a senior person in the organisation; records supported that the management of the home was monitored. Two residents financial records were looked at in detail; records showed that their Care Homes for Older People Page 26 of 33 Evidence: money was stored and handled safely. Records were stored safely. Any concerns with records were referred to under the relevant standard and included individual care plans, medication, complaints, training and recruitment. Recommendations and requirements relating to staffing and recruitment issues from standard 29 have been made under standard 37 - records. Records did not support that staff had been provided with the training they needed to keep themselves and others safe. The manager was aware of the gaps in training and action was being taken to address them. There were records to support that systems and equipment were serviced regularly; this ensured the home was safe for residents, visitors and staff. Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 8 13 Interventions to reduce any 01/10/2007 identified risks to residents must be recorded in the care plan. Care Homes for Older People Page 28 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The care plans must reflect 02/11/2009 current care needs and the action to be taken by staff to meet those needs. This will ensure residents receive the care they need. 2 8 13 Interventions to reduce any 02/11/2009 identified risks to residents must be recorded in the care plan. This will ensure staff are aware of the action to be taken to keep residents safe. 3 17 13 All staff must be provided 02/11/2009 with up to date safeguarding training. This would help them to recognise and respond appropriately to any abuse or neglect. 4 37 19 A safe and thorough recruitment procedure must 02/11/2009 Care Homes for Older People Page 29 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action be followed and staff must not be employed until satisfactory checks are in place This will ensure residents are protected from unsuitable people 5 38 12 All staff must receive mandatory safety training. This will ensure staff have the skills and knowledge to keep themselves and other safe. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 02/11/2009 1 1 The service user guide should include service user views of the home; this would help people to get an impression of the standard of service available. New staff should have a recorded induction or introduction to the routines and practices of the home; this will ensure they are aware of their responsibilities and safe to practice. There should be a training plan that identifies the skills and competencies of current staff. Residents or their relatives should be involved in the development and review of their care plan; this would ensure they received the care they both needed and wanted. The care plans should include more personal information regarding residents likes, dislikes, preferences and routines; this would help staff to meet all aspects of their needs. 2 4 3 4 4 7 5 7 Care Homes for Older People Page 30 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 6 7 A review of the care plan should be undertaken at least monthly; this would ensure the information is up to date and reflects any changes to care. Residents nutritional needs should be assessed on admission and kept under review; this would help to ensure residents dietary needs were met. The application of prescribed external creams should be signed by the person who was responsible for this task; this would ensure there were no gaps on the MAR and residents received the treatment that they had been prescribed. There should be clear directions on MARs to support staff with their decisions to administer PRN or as needed medicines. Staff should ensure handwritten entries on Medication Administration Records (MAR) were always witnessed (transcribing) and there should be a procedure to support staff with this; this would help to reduce the risk of error. The medication disposal procedure needs reviewing to reflect current practice within the home and that two staff should witness any disposals; this would reduce the risk of mishandling. The records of meals served should be completed in full; this would support that all residents were receiving a healthy and nutritious choice of diet. There should be clear records of any concerns or complaints raised; this will help to identify any ongoing issues and can be used to improve the service. All staff should be provided with up to date training that would help them to recognise and respond to any reports of neglect or abuse. The safeguarding procedures should include the contact information of local agencies who would be involved in any incident; this will ensure staff have the correct information to report incidents promptly. Staff should have training to support them with dealing with verbal and physical aggression; this would help them to respond properly and would keep everyone safe from harm. Page 31 of 33 7 8 8 9 9 9 10 9 11 9 12 15 13 16 14 18 15 18 16 18 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 17 26 Consideration should be given to improving and developing the laundry service; this will ensure residents needs would be met. An application should be made to register the manager with the Care Quality Commission. Systems should be developed to monitor whether staff were following policies and procedures and whether peoples needs were met An audit should be completed on all staff files to ensure all the required checks were in place. Any issues identified from the pre-employment checks should be discussed with the applicant and recorded on their file. All gaps in applicants employment history should be explored. The reference form should reflect the designation of the referee and the company they are from; this would help to identify whether the reference has been given by an appropriate person. References should be verified as part of the recruitment process to help identify whether they are authentic A record of the interview and selection process should be maintained to support that a fair process has been followed 18 19 31 33 20 21 37 37 22 23 37 37 24 25 37 37 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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