Inspection on 11/10/07 for Willowbank Rest Home

This inspection was carried out on 11th October 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Willowbank Rest Home 04/01/07

Willowbank Rest Home 31/01/06

Willowbank Rest Home 09/08/05

Willowbank Rest Home 27/01/05

Willowbank Rest Home 21/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Willowbank Rest Home 42 Lancaster Lane Clayton Le Woods Leyland Lancashire PR25 5SP Lead Inspector Denise Upton Unannounced Inspection 11th October 2007 9:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Willowbank Rest Home DS0000005900.V348110.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. Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Willowbank Rest Home Address 42 Lancaster Lane Clayton Le Woods Leyland Lancashire PR25 5SP 01772 435429 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) hazelhousecare@btconnect.com Willowbank Rest Home Limited Mrs Michelle Florence Darwen Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20), Physical disability (1) of places Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 20 service users in the category of OP (Old age not falling within any other category). One named service user in the category PD (Physical Disability under the age of 65 years of age) may be accommodated with the overall number of registered places. 4th January 2007 Date of last inspection Brief Description of the Service: Willowbank Care Home is situated on the outskirts of Leyland, close to junction 28 of the M6 motorway, in a quiet residential area. Local amenities are close by. Bedroom accommodation is provided on the ground and first floor of the building in eighteen single rooms and one shared bedroom. There are spacious lounge areas available, where a number of activities take place. The home also has a separate dining room although residents may dine in the privacy of their own bedroom accommodation if they so wish. Willowbank Care Home is not registered to provide nursing care. Personal care is provided as required and specialised needs can be catered for. Any nursing needs are referred to the community district nursing team. Information on the home is made available in the Service User’s Guide, a copy of which is given to each new resident when they are admitted. This provides written information about the services and facilities available at the home. Visitors are made welcome at any time of the resident’s choice and can be entertained in the privacy of the residents individual bedroom accommodation or any communal area of the home. Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit took place during the course of a mid-week day and in total spanned a period of approximately eight hours. Twenty-two core standards of the thirty-eight standards identified in the National Minimum Standards-Care Homes For Older People were assessed along with a reassessment of the requirements and recommendations identified in the last inspection report. The inspector spoke with the registered manager, the home’s administrator manager, the homeowners, a senior care assistant, and the cook on duty. Individual discussion also took place with three people living at the home and two relatives who were visiting. Collective discussion also took place for an extended period of time with a number of other residents in a lounge area of the home. A number of records were examined and a partial tour of the building took place that included communal areas of the home, kitchen and laundry and some bedroom accommodation. Information was also gained from the Annual Quality Assurance Assessment completed by the registered manager/homeowners. Three residents, two relatives and one General Practitioner (G.P.) also completed a Commission for Social Care Inspection survey that helped to form an opinion as to whether resident’s needs and requirements were being met. This key inspection focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. Currently the fees at Willowbank Care Home range from £400.00 to £410 00 per week. What the service does well: This is a care home where residents are well looked after. The management team and staff team work well together so that resident’s needs are met in all areas of care. Resident’s spoken with commented on how well they are cared for. Comments made included, “the staff are very kind and helpful” and I feel really comfortable since living here, the staff are very good, I get on well with them all, they are very, very helpful” and “you could not get better care anywhere”. Through discussion with some members of staff it was confirmed they have a good knowledge of the individual care needs and requirements so that Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 6 residents are not disadvantaged in any way. Staff comments included, “the staff get on really well together we work well as a team” The members of staff spoken with were enthusiastic and work well together to provide a good quality of care for people living at the home. Observation of care practices throughout the day confirmed residents are treated with dignity and respect, as well as making sure their right to privacy is respected for example by knocking on bedroom/toilet doors before entering. The G.P. commented that staff, “Always take patients into a private room when we do home visits”. It is very clear that good relationships exist between residents and staff that helps people living at the home feel comfortable and secure. Staff training is given high priority to ensure staff have the skills and understanding to provide a high quality service that meets residents needs and expectations. One resident wrote on a survey form, “It’s not like being at home, but I’m happy here. We were asked to help with the choice of the new mini bus, which has now arrived. We all took part in the activities at the Summer Garden Party in August”. Residents are encouraged to have their say and to help make decisions about the running of the home and were pleased with the accommodation provided and the meals served What has improved since the last inspection? What they could do better: The manager and staff at Willowbank Care Home work hard to make sure that the needs of people living at the home are well met and that residents feel comfortable living at the home. Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 7 However there are a small number of things identified at this inspection that could be improved. The way the administration record of controlled drugs is completed should always be consistent and follow the home’s policy and procedures for the recording of medicines administered. This would help to protect residents and ensure that a complete record is maintained as directed. All staff should be provided with appropriate adult protection training that helps to keep residents safe. It is understood that this training has already been arranged for some staff that will then cascade the training to other members of staff. This training programme should be undertaken as a matter of priority and completed in a timely manner. The homeowners visit the home on a very regular basis and sometimes produce a written report about how the home is run. However there is a requirement that a monthly written report on the conduct of the home must be provided, a copy of which must be given to the registered manager. The homeowners have now been given up to date guidance about this matter and provided with a suggested format for the monthly report. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. The pre admission assessment information to identify what the prospective resident can do well and what help may be required is detailed in order to establish if current needs, wants and wishes could be met at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: New residents are only admitted to the home if their individual needs and requirements could be met. It is routine policy at Willowbank Care Home that all prospective residents are visited prior to admission by the registered manager, in order to undertake an initial assessment of current strengths and needs and to provide further information in respect of the home and facilities and services provided. There is also available a photo album that the manager takes out with her showing internal and external photographs of the home and some of the events that take place. This helps to give the prospective resident some idea of what to expect should they decide to become resident. Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 10 The records of three residents were examined and all had full assessment information recorded. The files seen also had in place a social work assessment with information on file to help assist the registered manager to develop an individual care plan to ensure all health, welfare, social, religious and cultural needs were identified and recorded. A staff member spoken with explained that the assessment information is made known to staff so care staff are aware of the new resident’s initial strengths and needs at the point of admission. This makes sure that the appropriate level support is provided from the beginning. The manager confirmed that the home always undertakes its own pre admission assessment using a good assessment process when residents are admitted privately, so that nobody is disadvantaged in how their individual needs are assessed. Following the pre admission assessment, the prospective resident is informed in writing that their current strengths and needs can be met at the home. This ensures that the resident is confident that the care provided will be tailored to their individual requirements. A recently admitted resident spoken with confirmed that her daughter was involved in the assessment process and was able to give her views of the support and assistance the resident required. This resident was very happy for her daughter to be so involved and confirmed that the registered manager had visited her and her daughter in the resident’s own home prior to admission. Daughter had also visited Willowbank to make sure that the home would be suitable for her mother. This resident felt that her daughter had made a very good choice in choosing Willowbank Care Home and said, “I have felt really comfortable living here everybody is lovely”. On admission newly admitted residents are given a “Welcome Pack” that includes a welcome letter and an individual copy of the home’s Service Users Guide. A member of staff spoken with was clearly aware of the needs, wants and wishes of people who had recently become resident and resident’s spoken with consistently stated that their needs and requirements were being well met “by very good and caring staff”. The home does not provide intermediate care. Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. There is a clear and consistent care planning system in place that gives specific guidance to staff in order for them to satisfactorily meet residents need’s and requirements. The health care needs of people living at the home are well met with evidence of good multi disciplinary working taking place on a regular basis. The medication in this home is well managed promoting good health. However improvements could be made to ensure that certain types of drugs are consistently recorded correctly when administered. Personal support is provided in such a way as to promote and protect resident’s privacy, dignity and independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 12 All residents at Willowbank Care Home have an individual plan of care based on current assessed strengths and needs that is developed from the initial assessment process. The records of the three residents who were case tracked were complete, and had good information relating to the health and welfare of the individual resident. Significant events had been recorded and followed through to ensure that the resident’s needs were being met. The care plans were structured and were being reviewed monthly or whenever a significant event had taken place. The member of the care staff team spoken with explained that all staff are required to read each individual care plan and are involved in the reviews of the resident’s they are the key worker for. In addition, the registered manager also verbally discusses the needs and requirements of each resident on admission and when any changes to the care plan have taken place following a review. Routine risk assessments were in place that included pressure area’s, falls risk assessment and manual handling. Significant outcomes were incorporated in the individual care plan. A record was also kept of the resident’s weight. There was a sheet that had been signed by the resident or their relative to show that they had been consulted about the content of the plan. Care plans are only signed when the content of the care plan has been explained, understood and agreed with. Residents spoken with without exception were unanimous in their very positive comments regarding the level of care and support received and the kindness of the staff group. One person living at the home commented, “the staff are very good, I get on with them well, they are very, very helpful, will help you anytime”. However one relative stated on a Commission for Social Care Inspection survey form in answer to the question, ‘Do the care staff have the right skills and experience to look after people properly’ wrote, “young carers don’t always appear to have right people skills but the remainder of the carers seem to have the right experience. The same person then went on to say, “Institutional living is always difficult and care varies in this type of home but generally support is good. Another relative made a similar comment on a survey form when he said, “There appears to be some inconsistency in some aspects of the care. Most of the assistants are extremely obliging but a small number it appears do not reach the same standard. However this same person was positive about other things when saying that the home, “provides well appointed and clean accommodation plus an adequate number of staff” and “The manageress is extremely helpful at all times and always consults me on matters that need my attention”. Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 13 A General Practitioner (G.P.) also completed a survey form for health professionals that indicated that usually the staff group have the right skills and experience and commented that, “Staff appear caring and well meaning”. There is a good relationship with health professionals in order to maintain resident’s health and well being. Health care records showed good liaison between the home and healthcare professional including doctors, district nurses, chiropody, and optical services, so that residents are not disadvantaged in any way and their individual health needs are met. In each person’s care file is a list of visits from medical professionals and a ‘doctor’s instruction form’ that details the information given. This ensures that all care staff have up to date guidance on how to address any medical instructions. Residents spoken with all said that they were well looked after at all times including when they were unwell. The administration and recording of medication is in the main very well managed at Willowbank Care Home. All residents who wish to and have capacity to do so are enabled to self-administer their own prescribed medication following the outcome of a satisfactory risk assessment. A secure locking facility is provided in all bedroom accommodation for the safe storage of medication. Medication administered by staff is stored in a locked metal medication trolley and a locked cupboard in an area that is only accessed by staff. As recommended at the last inspection, a smoke detector has now been provided to the medication storage area and a tablet counter is now available. The home’s policy document was available confirming the arrangements for the receipt, recording, storage, handling, administration and disposal of medicines. All staff with responsibility for medication administration have received training in the area of safe medication practices, so that the system is safe for the protection of users of the service. Records are kept of all medicines received, administered and leaving the home or disposed of. Prescriptions were seen before the medicines were dispensed. There was a photograph of the resident for identification purposes. A criteria sheet was used for ‘as required’ medications. This meant that all staff would be giving them in a consistent manner. Controlled Drugs were correctly stored. The balance of controlled drugs kept was checked and agreed with the records. However, although in the main the record of drug’s administered was accurate and in keeping with the home’s medication policy and procedures, there were three recent instances when controlled drugs had been administered, signed by the person administering the medication but not countersigned by a second member of staff. This suggests that the controlled drug had been administered without the instructions for the medication, including dose to be administered being checked and then rechecked by a second member of staff prior to administration to ensure accuracy. It is essential that a second member of staff Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 14 checks prior to administration the dose to be administered and countersigns the administration record after the controlled drug has been administered in order to confirm that the correct medication and dose of medication had been administered. It is recommended that all staff with responsibility for the administration of medication, are reminded of the procedures to be followed for the administration of controlled drugs and any retraining considered necessary should be provided. This would ensure that residents are protected and that staff are following correct procedures. Resident’s dignity and privacy was observed during the visit to ensure residents are treated with respect. This was confirmed by observing staff members knocking on doors before entering rooms, and the way staff talked and responded to residents. Residents spoken with confirmed that they felt that their privacy and dignity was well respected and that “Staff are very good and respectful”. Policies and procedures in respect of privacy and dignity are available to guide staff to make sure that these values are not compromised. All staff receive training in respect of maintaining privacy and dignity during induction training, National Vocational Qualification (NVQ) training and through regular supervision. A member of the care staff team individually spoken with also stated that privacy and dignity was “always respected by all staff working here”. Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. Residents’ social and recreational needs were in the main being met by activities available and contact with relatives/visitors. The daily routines for residents were kept flexible to accommodate individual preferences and choices. Dietary needs of people living at the home are well catered for with a balanced and varied selection of food available that meets resident’s taste, choice and requirements. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents have in place an activity programme that is displayed on a board in the reception area of the home that takes into account the known interests of people living at the home. Comments about the activities provided ‘in-house’ were however mixed. Whilst the majority of residents spoken with collectively in the lounge area of the home felt that appropriate activities were provided ‘in-house’ on a regular basis, some residents disagreed saying that activities Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 16 were not as good as had previously been. One resident on a Commission for Social Care Inspection survey wrote, “I should like to see a few more activities arranged, if possible e.g. more dominoes” All residents were however looking forward to outings in the new mini bus that had recently been purchased to replace an older model. Residents had been involved in selecting the new mini bus and had ‘road tested’ it in the car park of the home before a final decision had been taken to purchase the vehicle. Bingo is a regular feature with staff assisting residents who require support to enjoy the game. Skittles and sing songs are also popular and general discussion and ‘chit chat’ between residents and residents and residents and staff is also enjoyed along with staff also spending time with individual residents. Outings to places of interest in the mini bus are very much enjoyed and staff accompany individual residents on outings to the local shops or for a walk as and when required. Resident were also seen to be enjoying individual interests such as reading and knitting. A singer entertains residents on usually a monthly basis and a fashion show had recently taken place as well as a summer fete to which friends and neighbours of the home were invited. Residents can also attend worship and Holy Communion that is conducted at the home on a regular basis. Given that residents gave a mixed response regarding social activities, consideration could be given to incorporating the subject of social interests/activities as part of the next internal quality audit. This would provide an up to date review of what residents like to do or what they may like to try and assist in the development of future activities programmes. As observed at the time of inspection, it was clearly evident that people who live at the home can entertain visitors of their choice at a time to suit them either in a communal area of the home or individual bedroom accommodation. Two relatives spoken with along with the resident confirmed that they had always been made very welcome and felt that there was a good relationship with the staff group who were described as “very good”. The visitors and resident also confirmed that they were very satisfied with the level of care and support provided. A resident commented on a survey form that, I have many friends from Leyland Methodist Church who are able to visit here often. We have a church service here on several occasions during the month”. Meals and mealtimes at Willowbank Care Home are considered a social event and are given high priority. There is a varied and well-balanced menu provided that is designed around the known likes and dislikes of people living at the home. The menus are regularly reviewed in consultation with residents and it is understood that a nutritional assessment is conducted every six months. All residents spoke very positively about the variety and quality of the meals served. Residents consistently described the meals as “very good”, “excellent”, gorgeous, “lovely meals, cannot find fault”, “ brilliant cooks”. Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 17 During the course of the inspection the midday meal was briefly observed. There was comfortable and friendly atmosphere in the dining room and staff were seen to be encouraging and sensitive when assisting residents. Although the main meal of the day at lunchtime is a set meal, residents are informed of the menu of the day prior to the meal being served and can request an alternative of their choice if preferred. There is a choice of menu at the evening meal, however again residents are given of a meal of choice if they would prefer something different. Discussion with the cook confirmed that she has worked at the home for a considerable period of time, is very experienced and knows the likes and dislikes of each resident very well. Fresh foods are sourced locally and regularly supplied to the home. Specialist diets in respect of medical, cultural or religious needs and requirements can be accommodated and there is a good system in place to record individual requirements. The cook was clearly aware of each person’s preferences and needs and of how to access information regarding specific nutritional diets and requirements. There was a sufficient stock of food on the premises, including fresh fruit and vegetables. Fresh fruit is cut up and made available to residents at least every other day and can be requested at any time. Drinks and snacks are available throughout the day and night staff had access to foodstuffs so that they could make snacks if anybody was hungry during the night time period. Records are kept of fridge, freezer, trolley and cooked temperatures. Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. The home has a satisfactory complaints system with evidence that residents feel that their views are listened to and acted upon. Staff have understanding of the principles of adult protection that helps to protect people living at the home from abuse. However all staff must receive formal adult protection training as planned to ensure they are competent and knowledgeable in protection issues. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Willowbank Care Home has a detailed complaints procedure, which is made available to all residents on admission and contained in the Statement of Purpose and Service User Guide to ensure they feel protected. Residents spoken with were aware of how to make a complaint and felt they would be listened to and acted upon. However no residents spoken with had any complaints. A member of staff spoken with also stated that complaints were very infrequent and usually sorted out very quickly. The atmosphere in the home and relationship observed between residents and staff was conducive to people living at the home being confident at raising any concern immediately so that it could be addressed. Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 19 Since the last inspection there had been one complaint made to the care home that was upheld. The records observed relating to this complaint confirmed that the complaint had been thoroughly investigated by the management team and the outcome recorded. By using a detailed record of what the complaint was, how it was investigated and the outcome helps to inform the internal quality checks to prevent a similar incident occurring again. The home has a procedure in place for dealing with allegations of abuse and a staff-whistle blowing policy. Further protection policies were also in place in respect of challenging behaviour, restraint, and gifts and wills. The manager and staff spoken with had an understanding of the procedures to be followed in the event of any allegations or suspicion of abuse or neglect. However not all staff have undertaken formal, recent or up to date, adult protection training to ensure they have the knowledge and skills to address any concerns raised in an appropriate manner in accordance with local and national guidance. It is understood that arrangements had been made for four senior members of staff including the registered manager to undertake this training within a few days of the site visit. It is then intended to cascade the training to all members of staff. In these instances it is important that internal systems are in place to make sure that all staff have a thorough understanding of the training undertaken including the local protocols and that they are clear on what they should do and should not do if a allegation of suspected abuse is made. Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is good. The standard of the décor in this home is good providing residents with a safe, comfortable and homely place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents at Willowbank Care Home live in comfortable, well-maintained accommodation that is domestic in character and has been designed to meet the individual and collective needs of people living at the home. The layout of home gives resident’s opportunity to move freely round the building and access all areas with ease. Communal accommodation consists of two separate lounges and an attractive dining room. Private accommodation consists of eighteen single bedrooms and one shared bedroom. Resident’s bedroom accommodation is comfortably furnished to suit the needs of the occupant and provided with a locked facility for the safe storage of items of a private nature. Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 21 Since the last inspection, all but one bedroom has now been provided with an appropriate door lock. It is understood that arrangements have been made for the remaining door to be provided with this facility. All radiators in bedroom and communal accommodation are fitted with guards to prevent the risk of accidental injury and a thermostatic device has been fitted centrally to control the temperature of water delivered from hot water outlets in resident accommodation to prevent the risk of accidental scalding. Residents spoken with were all very satisfied with both their private bedroom accommodation and the communal areas of the home. One recently admitted resident was very pleased stating that her bedroom was “very comfortable with my pictures up and my own things around me”. A relative also wrote on a Commission for Social Care Inspection survey form that what the home does well is, “feeds residents a varied, nutritious diet, homemade meals served well, keeps residents rooms clean, residents personal laundry is always clean and towels and bedding”. The home was found to be clean, pleasant and hygienic with a variety of policies and procedures to advise staff in the control of infection. From information contained in the Annual Quality Assurance Assessment (AQAA) completed by the registered manager/homeowners, all staff have received training on the prevention of infection and the management of infection control. Laundry facilities are sited in an area of the home that does not intrude on residents. The industrial washing machine has the capacity to meet disinfection standards and floor and wall finishes are easily cleanable. The laundry had hand washing facilities and plastic gloves to ensure that good hygiene could be maintained. There was liquid soap and paper towels in all areas around the home. Plastic gloves and aprons were available and seen to be used by staff. At the time of the inspection it was observed that the home was clean and free from offensive odours. From discussion with the homeowners and the registered manager, it is understood that there are plans to increase the present accommodation to provide additional bedroom accommodation and additional communal space. All new bedroom accommodation would be provided with an en-suite facility and a number of existing bedrooms would be updated and also provided with an en-suite facility. This proposal has been discussed with residents who have taken an interest in this proposed development. Residents confirmed that “ we have been involved recently in the discussions about the building extensions and changes to the home” and “we have been talking about the plans for the building extensions at Willowbank”. Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 22 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): 27, 28, 29, & 30. Quality in this outcome area is good. There is a good mix of staff offering consistency of care within the home. The arrangements for the induction and more advanced National Vocational Qualification (NVQ) training in care are good with staff demonstrating a clear understanding of their roles. Induction training is compliant with ‘Skills For Care’ induction training standards and provided to newly appointed care staff within the first six weeks of employment. There is a structured process for the recruitment of staff that includes obtaining satisfactory references and clearances in order to protect users of the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Willowbank Care Home staffing levels and skills mix are determined in accordance with the individually assessed needs of people living at the home. All night staff have ‘waking watch’ responsibility and there is sufficient ancillary staff employed to ensure standards in respect of domestic and catering are maintained. A staff rota was available that gave the name, designation and Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 23 hours worked by each member of the staff team. From discussion with the registered manager it was confirmed that staffing levels are kept under review and additional bank staff are available when required. A relative said that sometimes people living at the home can feel rushed but residents spoken with during the course of the inspection did not hold this view. One resident did say however that she felt that there should be extra staff on duty because the carers work hard, but was also very clear that all her needs and requirements were taken care of and that she was very satisfied with the level of care and support received. There is a clear commitment to the training and development of all staff. This is to make sure that a competent staff team are caring for people living at the home. All newly appointed care staff undertake an induction-training programme that is compliant with ‘Skills for Care’ induction training standards, and National Vocational Qualification (NVQ) training is positively encouraged. Currently thirteen of the sixteen members of the care staff team have achieved at minimum an NVQ Level 2 qualification. In addition, a further member of staff is undertaking this course of study and the remaining two members of the care staff team are waiting to commence this training. Of the three members of the bank staff team one person has achieved this award. This exceeds the minimum number of care staff that should have achieved this award and is to be commended. It is anticipated that all members of the permanent care staff team will have obtained an NVQ qualification within the foreseeable future. Good training records are maintained and an annual training plan for each member of staff was available. Along with mandatory health and safety training, individual staff have also undertake other training opportunities that has recently included training in respect of the mental capacity act. Willowbank Care Home has in place a structured recruitment policy and procedure that helps to protect people living at the home. Since the last inspection, new members of staff have been appointed. From observation of one recently appointed staff member’s personnel file, it was evident that the recruitment policy and procedures had been followed. This included an application form, equal opportunities monitoring form, health questionnaire, formal interview, references and a Criminal Records Bureau (CRB) POVA clearance had been obtained prior to the applicant actually taking up post at the home. All residents spoken with were very positive about the staff group. One lady stated that: “the staff are very good, kind and helpful”. Another resident said that “the staff are friendly, I feel safe and well looked after you could not get better than this.” A third resident wrote on a survey form, ”I was desperate for Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 24 some help at the time I came here and the staff have really boosted my confidence in the past two years”. Staff also commented that they felt very well supported and that “ staff get on and work well together, very much so, there is a lot of team work here, this is a very well run home”. Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 25 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): 31, 33, 35, 36 & 38. Quality in this outcome area is good. The manager is qualified, experienced and supported by senior staff in providing clear leadership throughout the home. The home regularly reviews aspects of its performance through a good programme of self-review and consultations, which include seeking the views of residents, staff and relatives. Financial procedures in respect of resident’s monies and safekeeping of valuables is robust to protect the interests of people living at the home. Systems are in place to ensure as far as possible the health and safety of residents, staff and visitors. This judgement has been made using available evidence including a visit to this service. Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 26 EVIDENCE: The registered manager has been in post approximately ten months, is now registered with the Commission for Social Care Inspection, is competent and experienced and has achieved the Registered Managers Award in addition to NVQ qualifications. In addition, the registered manager has undertaken additional recent training that has included, dementia care, protection of vulnerable adults (POVA) and mental capacity act training. The registered manager has the necessary skills and experience required to support the staff and residents and enable the home to meet its stated purpose and objectives. Staff spoken with said they found the management team to be supportive and that they provided a clear sense of leadership. Staff comments included “The manager is very good, always approachable and helpful”. Another comment made was that “The manager manages the home but is also one of the girls, she is very good”. Residents also spoke positively about the manager, describing her as “friendly and helpful”. Although the homeowners visits the home on a very regular basis, but are not in day-to-day management control of the home, there is a requirement that the homeowners must visit the home at least monthly and produce a written report on the conduct of the home. Whilst on some occasions a written report has been produced, this is not necessarily on a monthly basis. This must be addressed. A written report must be completed on at least a monthly basis, a copy of which is to be provided to the registered manager. The homeowners have now been provided with guidance and a suggested format for completing the Regulation 26 monthly reports. Effective quality assurance and quality monitoring systems are in place in respect of residents and staff and the home has achieved the ‘Investors in People’ award and ISO 9001 re-accreditation. Resident surveys are regularly provided and changes have been made as a result of listening to people who use the service. This has included, changing the visiting chiropody services to a provider that residents preferred and various menu changes in terms of variety and choice. Willowbank Care Home has recently introduced a quality assessment, self audit assessment tool ‘Putting Service Users First’. This consists of a range of surveys covering a wide variety of topics. Currently three of these surveys have been introduced covering food, laundry and communication. The outcomes of these have helped to effect change within the home. It is understood that over a period of time, further surveys will be introduced to capture the views and opinions of people living at the home. Surveys will also be available for a wide variety of other people including relatives/friends and other stakeholders who have an interest. Once fully implemented, the quality Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 27 assessment self audit tool will provide a comprehensive account of how residents and other interested people feel that the home is achieving outcomes for residents. Residents meetings are held every six months the last one took place on 02/07/07. At these meetings the registered manager and the homeowners are present. Minutes of the meeting were available. In addition, resident only meetings take place although residents can ask a member of staff to attend if they so wish so long as this is not the registered manager. All staff are encouraged to express their views and opinions by way of senior staff meetings that take place every three months and full staff meetings that generally take place twice a year. In addition, informal dialogue within the home is ongoing between the homeowners, registered manager, residents, relatives and staff. This helps to create an atmosphere where people feel confident to express their views at any time they feel appropriate. Resident’s financial interests are safeguarded by the financial procedures in place. People living at the home wherever possible, are encouraged to remain financially independent or assisted in this task by a family member. Details of advocacy services are available for people to access should they choose to involve an independent advocate. Where the home does retains monies or valuables in respect of a resident, this is appropriately recorded and secure facilities are provided for the safe keeping of monies and valuables held on behalf of the person that was evidenced at inspection. The personal monies record of a random number of residents was checked including the cash balance. These were found to be well maintained and correctly recorded. The registered manager carries out a regular supervision programme for all staff making sure they are adhering to the responsibilities associated with their individual roles, as well as promoting individual development in the area of care practice. A member of staff spoken with confirmed that regular one to one supervision does take place along with an annual appraisal. Informal daily staff supervision also takes place as part of the normal management role. The registered manager ensures the health, safety and welfare of people living at the home through the implementation of the home’s health and safety policies and procedures and staff training initiatives. All staff undertake a variety of mandatory health and safety training including fire awareness, first aid, manual handling, food hygiene and infection control, which will now be updated on a regular basis. Equipment in the home is regularly serviced. All staff have responsibility for reporting any maintenance issues that are then logged. Once the job is completed, the maintenance man ‘signs off’ the task. Maintenance records were also available including the call bell system, alarms and water Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 28 temperatures. Environmental risk assessments are in place that are periodically reviewed. The health and safety systems adopted, all help to ensure that people living at the home are protected and staff have the training and skills to provide a safe environment. Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 3 Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. .1 Standard OP31 Regulation 26(4)© Timescale for action The homeowner(s) must visit the 30/11/07 home on at least a monthly basis and produce a written report as to the conduct of the home. A copy of the monthly Regulation 26 report must be provided to the registered manager. Requirement 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 Refer to Standard OP9 OP12 OP18 OP19 Good Practice Recommendations The administration of all controlled drugs should be checked and countersigned by a second member of staff. Any retraining considered necessary should be provided. It is recommended that consideration be given to exploring with residents the level and type of social weekly activities they would like to be provided ‘in-house’. All staff should receive the planned adult protection training within a short timeframe. The remaining bedroom door without an appropriate lock should be provided with one to ensure privacy for the occupant. Willowbank Rest Home DS0000005900.V348110.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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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