CARE HOMES FOR OLDER PEOPLE
Willowbank Nursing Home Pasturegate Burnley Lancs BB11 4DE
Lead Inspector Marie Matthews Announced 19042005 9.30 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 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. Willowbank Nursing Home Version 1.10 Page 3 SERVICE INFORMATION
Name of service Willowbank Nursing Home Address Pasturegate Burnley Lancs BB11 4DE 01282 455426 01282 458009 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Sage Care Homes (Willowbank) Ltd Mrs Lynne Millar Care Home 53 46 46 7 7 Category(ies) of DE(E) registration, with number MD(E) of places MD DE Willowbank Nursing Home Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Within the total of 53, no more than 35 service users requiring nursing care can be accommodated. 2. Staffing for service users requiring nursing care will be in accordance with the Notice dated 22 February 2002. 3. Within the overall total of 53 a maximum of 46 service users who fall into the category of either MD(E) or DE(E) can be accommodated. 4. Within the overall total of 53 a maximum of 7 service users who fall into the category of either MD or DE can be accommodated. Date of last inspection 7/02/05 Brief Description of the Service: 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 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. Willowbank has 29 single and 12 shared bedrooms, a number of comfortable lounge and dining room areas and two conservatories. The home is set in a quiet, pleasant residential area approximately a mile from Burnley town centre. There are shops, a post office, public houses and a convenient bus route near by. Willowbank Nursing Home Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The announced inspection was conducted at Willowbank Nursing and Residential Home on 19th and 20th April 2005. The inspection involved looking at records, talking to management, six staff, eight residents and three visitors, a tour of the premises and generally looking at what was happening in the home. Information was also taken from comment cards filled in by one resident and nine visitors. At the time of the visit the registered manager was still on long-term sickness leave and an acting manager was in charge. This inspection looked at things that should have been done since the last visit, issues raised following two recent complaints and a number of areas that affect residents lives. At the last visit there had been serious concerns raised about a number of issues affecting care that residents received. The home had responded quickly and positively to address these issues. During recent visits it was noted that staff morale had been low; this had improved and as a result residents appeared to be more settled and content. What the service does well: What has improved since the last inspection?
Staff awareness of residents needs including choice, privacy and dignity had improved following a review of how all staff were trained. A key worker system, where a member of staff has ‘special’ responsibilities for a group of service users, had started and staff were able to discuss how this had improved care given to residents. One resident told the inspector he felt he
Willowbank Nursing Home Version 1.10 Page 6 was ‘ well cared for’. A visitor commented that ‘all the staff are lovely and very caring, they can’t do enough for the residents’. A programme of training was in place and although all staff had not completed required training they had been registered to attend and were very positive about this. Staff morale had improved and this had affected staff attendance and improved care for residents. The staff team were enthusiastic, positive and looking forward to further training. Staff told the inspector that ‘staff were starting to work as a team again’ and that they ‘enjoyed coming to work’. Recruitment procedures were good, safe and protected residents. Staffing shortages were still evident but any gaps had been covered using agency staff until new staff were in place. Meals and mealtimes had improved following a recent complaint investigated by the CSCI. Residents stated they were happy with the standard of the food and menu choices available. Staff spoke positively about the management team and were confident that outstanding issues were being addressed to improve the standards of the home for staff, residents and their visitors. The general appearance and cleanliness of the home had improved since the last inspection. A number of concerns had been raised at the last visit about the standard of the environment. Recent redecoration and replacement of furnishings had improved the appearance of some areas of the home. The kitchen had been re-furbished and was well equipped, clean and tidy. Doubleglazing and a nurse call system were being installed on the day of the visit. What they could do better:
The home could improve the standard of information available to residents and their relatives with regard to arrangements for living in the home. Management still need to make sure that staff receive appropriate training and supervision and to know about the special needs of the residents in their care. The home needed to make sure that residents and visitors could have their say about how the home was run. During the inspection a number of serious concerns were raised in relation to management of medicines and the home must develop safe systems to reduce the risk to residents. The provision of activities had not been consistent. Some residents felt there was ‘ not much going on’ whilst others told the inspector about activities they had been involved in. Willowbank Nursing Home Version 1.10 Page 7 Further work needed to be done to improve the environment for residents and the home needed a written development plan to support this. Risk assessments in relation to safe working practices and servicing of boilers/heating systems were needed to ensure a safe, well-maintained environment for residents. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Willowbank Nursing Home Version 1.10 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Willowbank Nursing Home Version 1.10 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3 and 4. The home did not provide current or future residents and their representatives with enough information to enable them to make an informed choice about admission to the home. Residents were admitted only when detailed assessments had been completed and when the home was clear their needs could be met. Staff had a clear understanding of residents needs but required specialised training to support them. EVIDENCE: A statement of purpose and service user guide were available. The service user guide still did not contain enough information to ensure that prospective residents and their representatives were able to make a sound choice about admission to the home. Not all residents were provided with the home’s contract/statement of terms and conditions. Willowbank Nursing Home Version 1.10 Page 10 A number of residents files were looked at and showed that detailed needs assessments had been completed and written confirmation was given that the home was able to meet their needs prior to admission. Staff showed the inspector they had a good understanding of residents needs, though they still lacked specialist dementia training. Staff training files confirmed this. Willowbank Nursing Home Version 1.10 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10. The care plans were detailed, showed that residents needs were identified and met and had been reviewed regularly. The medication systems had not improved and placed residents at risk. Staff awareness regarding privacy, choice and dignity had improved with a positive impact on the lives of residents. EVIDENCE: Three care plans were seen. These had improved since the last inspection, were detailed and showed that residents needs were met. Care plans contained appropriate risk assessments. However one resident needed a review of his general risk assessment to ensure staff were aware of the need for supervision. The care plans had been reviewed and updated regularly by the nurses but there was nothing to show that residents or their representatives had been involved in the development and/or review of the plan. However visitors had commented that they were kept informed of important matters affecting their relative. Residents spoken to were unaware of their care plan but felt they were ‘looked after’ and ‘well cared for’.
Willowbank Nursing Home Version 1.10 Page 12 At the present time care staff were not involved in the care planning process and consideration was being given to address this. Medication policies and procedures needed to be reviewed. A number of concerns were raised during the inspection regarding the systems of ordering, recording, administration and disposal of medications. Also a discrepancy was noted during a random check of the controlled drugs register. These were discussed with senior staff at the time of the inspection. Concerns regarding privacy and dignity had been raised in a recent complaint; the management had responded promptly and positively to the complaints. Staff told the inspector that they were now more aware of these matters which had been discussed at meetings. A key worker system had been introduced. This is where a member of staff takes a particular interest in a number of individual of residents. Staff spoke positively about the system and knew about their responsibilities. Staff were friendly and helpful and were seen to treat residents and visitors with respect. One resident commented that he felt he was ‘well cared for’. One visitor commented that ‘all the staff are lovely and very caring, they can’t do enough for the residents’. From information on the nine visitors comment cards it was clear that all were satisfied with the care provided. Willowbank Nursing Home Version 1.10 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15. The home did not provide varied activities to meet residents social and recreational needs. The home has made definite progress to ensure residents are offered a variety and choice of meals that meets their tastes and choices. EVIDENCE: Following a recent complaint regarding the lack of choice for residents it was clear from observation, discussion with residents and staff and review of records that the home had responded positively. ‘Choice’ had been discussed at recent staff meetings. Staff told the inspector they had a better understanding of these issues. The home did not have a member of staff with responsibilities for arranging activities. Staff had arranged some activities such as board games and a recent Easter bonnet parade. One resident told the inspector she had been dancing and singing with staff. Other residents told the inspector there was ‘not much going on’. Due to recent shortages of staff the provision of social activities for residents had not been consistent. Visitors commented they were always welcomed into the home, could visit anytime and were kept informed regarding the care of their relatives. Due to
Willowbank Nursing Home Version 1.10 Page 14 the nature of some service users illness it was not possible for some to make choices but staff were aware of those residents who needed to support to make choices. The home had responded positively to a recent complaint about meals and mealtimes. Residents were offered a variety and choice of meal, meals were served hot and presented well; staff were seen giving assistance to residents. The menu had been reviewed and was displayed. Staff and residents commented positively about the meals offered. One said the food ‘was great’. Staff were aware some residents needed extra food and drinks during the night and stated this would be provided. The kitchen was clean and tidy and had recently been redecorated. No serious concerns had been raised following a visit from Environmental Health. Willowbank Nursing Home Version 1.10 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16. The complaints process in this home is good and residents and their relatives were confident any concerns would be dealt with. EVIDENCE: Records had been maintained of any complaints or concerns raised and any action taken. Two complaints had been investigated by the Commission since the last inspection. The home had taken quick and effective action to respond. Six of the nine visitors who completed the comment cards were aware of the complaints procedure. The procedure was displayed in the home and included in the service user guide. One visitor told the inspector he would discuss any concerns with staff and felt they would be resolved. Residents commented they would ‘talk to the staff’ if they were unhappy. Willowbank Nursing Home Version 1.10 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24 and 26. The standard of décor in the home was gradually improving. Recent redecoration and replacement of furnishings had improved the appearance of the home and has provided comfort and safety for residents. EVIDENCE: A number of concerns were raised at the last visit about the standard of the environment. A fire officer had visited and action had been taken to ensure the home met the requirements in relation to safety. A programme of planned maintenance and renewals was not available, however new furniture had been provided in the conservatory and dining room and on the day of this inspection the nurse call system was being replaced and double-glazing being fitted throughout the home. The gardens were safe and tidy. A number of bedrooms and communal areas were in need of refurbishment and not all rooms contained minimum furnishings. An audit of the home had begun but was incomplete. One resident told the inspector he was ‘very happy’ with his room and another told the inspector about the ‘wonderful view of the gardens’.
Willowbank Nursing Home Version 1.10 Page 17 During a tour of the building one radiator was very hot to touch and it was required that risks were identified and action taken. The home was clean and generally odour free. Staff told the inspector they were ‘changing the beds every day’ and this had helped to reduce any bad odours. Service users were comfortably dressed and staff were seen to assist if clothing needed changing. Willowbank Nursing Home Version 1.10 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30. The procedures for recruitment of staff were robust and protected the people living in the home. Progress had been made to address staffing shortages. Staff morale had improved. Staff were enthusiastic and positive and this had improved quality of life for the residents. The induction and training for staff has improved. Staff were aware of their responsibilities and the needs of the residents. EVIDENCE: Recruitment and retention of suitable staff had been very difficult in recent months. This had caused staff shortages, low staff morale and affected the care and well being of residents. The Commission had received complaints about staff shortages. Residents were aware of staffing shortages and staff changes. Relatives also commented on this. The home was currently using agency staff until new staff were able to start. There was a good skill mix of staff. From observation and discussion with staff it was clear that morale was improving and staff were happy with recent changes. One member of staff told the inspector that the ‘staff were starting to work as a team again’ and that ‘it was a nicer place to work’. Another staff member told the inspector how she enjoyed coming to work. Staff recognised how low morale and staff shortages had affected care given to residents. Unfortunately changes to the staff team had reduced the numbers of staff with appropriate qualifications. The acting manager advised that all care staff had been registered to commence on the NVQ level 2 and one on the level 3; staff were very
Willowbank Nursing Home Version 1.10 Page 19 enthusiastic about this. A number of staff files were checked and it was clear that a thorough recruitment procedure was in place. Following issues raised at the last visit the home had changed the way new staff were trained. Only four staff had completed the TOPSS induction training all other staff were registered to commence this prior to NVQ. Staff had recently attended management of medicines, first aid, infection control and moving and handling training. A need for specialised ‘dementia’ training has been identified earlier in the report. Willowbank Nursing Home Version 1.10 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35, 36, 37 and 38. The acting manager was supported by senior staff to provide clear leadership throughout the home with staff demonstrating an awareness of their roles. The home had been through an extremely unstable period but the management had communicated effectively with staff to gradually improve the care for residents. The systems for consultation with residents and visitors are poor with little evidence that their views are sought or acted upon. EVIDENCE: The registered manager is on long term sickness leave. The home is being managed by Anne Barker – acting manager, Steve Royle – deputy manager and Diane Ireland – administrator. Comments from staff indicated that the management team was competent and experienced and had been effective at introducing improvements. The acting manager was aware of the changes that needed to be made to further help the home to improve its services.
Willowbank Nursing Home Version 1.10 Page 21 Service users surveys were planned to commence and staff meetings had been held to discuss issues that affect residents choices and routines. The home had responded promptly and effectively to address requirements and recommendations made at previous visits although a number of these remained outstanding. Residents financial records had been maintained but the standard of record keeping needed to be clearer though the administrator was reviewing the system. Staff told the inspector they were supported in their work but had not had formal supervision; records confirmed this. The acting manager told the inspector that supervision sessions would begin once the problems with the staff team had been resolved. The registered provider visited the home each week but had failed to provide the home and the Commission with copies of his visits. Examination of records demonstrated that safe working practices were generally up to date with the exception of servicing of boiler/heating systems and safe working practices risk assessments. Willowbank Nursing Home Version 1.10 Page 22 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 x x x x 2 x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 2 3 2 x 2 1 2 2 Willowbank Nursing Home Version 1.10 Page 23 yes Are there any outstanding requirements from the last inspection? 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 1 Regulation 5 Requirement The registered person must provide a service user guide that includes all items listed in standard 1 and regulation 5. Timescale 4/4/05 not met The registered person must ensure that all residents are provided with a statement of terms and conditions/contract that includes all information in Standard 2.2. Timescale 4/4/05 not met the registered person must ensure staff receive appropriate training to enable them to care for residents with a dementia. The registered person must ensure that residents and/or their representatives are involved in the development and regular review of the care plan. Timescale of 4/4/05 not met. The registered person must review medication policies and procedures in line with the Royal Pharmaceutical Society guidelines. The registered person must maintain clear and accurate records of all medicines entering
Version 1.10 Timescale for action by 6/6/05 2. 2 4 by 6/6/05 3. 4 18 by 6/6/05 4. 7 15 by 6/6/05 5. 9 13 by 6/6/05 6. 9 13 by 30/4/05 Willowbank Nursing Home Page 24 7. 19 23 8. 25 13 9. 30 12 10. 33 24 11. 35 12 12. 37 26 and leaving the home. Prescriptions must be seen by the home prior to dispensing. Reasons for omissions of medication must be clearly documented. The practice of potting up medicines must cease. A system to prompt medication reviews must be developed. The registered person must ensure there is a development plan to evidence a programme of replacement and renewals. The registered person must ensure radiators are guarded or have guaranteed low temperature surfaces and assessment of risk to are documented. Timescale 4/4/05 not met. The registered person must ensure that all staff receive induction (within 6 weeks of commencement) and foundation (within 6 months of commencement) training to NTO specification. Timescale 4/4/05 not met. The registered person must ensure there is an annual development plan for the home, based on the systematic cycle of planning, action, review, reflecting aims and outcomes for residents. Timescale 4/4/05 not met. The registered person must maintain clear and accurate records in respect of residents finances. Timescale 4/4/05 not met. The registered provider must supply a copy of the regulation 26 visit to the Commission on a monthly basis. Timescale 4/4/05 not met.
Version 1.10 by 6/6/05 by 30/4/05 by 6/6/05 by 6/6/05 by 6/6/05 by 30/4/05 Willowbank Nursing Home Page 25 13. 14. 38 38 13 13 15. 38 13 The registered person must ensure the boiler and heating systems are serviced annually. The registered person must ensure risk assessments are carried out and recorded for all safe working practice topics. Timescale 4/4/05 not met. The registered person must ensure fire procedures are reviewed. by 6/6/05 by 6/6/05 by 6/6/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard 9 9 9 12 24 Good Practice Recommendations The registered person should ensure transcribing of medicines is witnessed The registered person should ensure a means of identifying residents is in place in relation to administration of medicines The registered person should complete a regular audit of medication stocks. The registered person should ensure residents are given opportunities to participate in varied activities to meet their social and recreational needs. The registered person should ensure that an audit of furniture be completed and if service users had not been provided with the standard furnishings the reason for this should be documented in the care files. The registered person should ensure that residents are provided with a lockable space unless their risk assessment determines otherwise. The registered person should ensure that 50 care staff have the NVQ level 2 in care, or equivalent. The registered person should ensure that formal supervision for care staff is documented and that they receive this at least six times per year. 6. 7. 8. 9. 10. 24 28 36 Willowbank Nursing Home Version 1.10 Page 26 Commission for Social Care Inspection 1st Floor, Unit 4 Petre Road Clayton-le-Moors Accrington BB5 5BR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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